Driving Outcomes: Registered Nurses Performing Bone Marrow Biopsies Utilizing a Battery Operated Rotary Device

Purpose:
Our organization collaborated with the state board of nursing to expand the scope of the registered nurse to include bone marrow biopsies (BMBX). Nurses in our facility are trained to perform biopsies utilizing a battery powered drill resulting decreased procedure time and larger biopsy samples.

Relevance/Significance:
BMBX procedures are traditionally performed by physicians, NPs, or PAs using a manual method which can be physically demanding due to the twisting motion of the wrist during the procedure. It is uncommon for nurses to perform biopsies independently, and even more rare for nurses to perform them using non-traditional techniques, such as the battery-powered bone marrow device. We share our experience in expanding the RN scope and leveraging technology to enhance delivery of patient care.

Strategy and Implementation:
Our facility performs an average of 10 BMBX procedures a day for patients with hematologic malignancies. In 2005, we collaborated with the state board of nursing to expand the Scope of Practice for a Registered Nurse (RN) to perform BMBX's as long as requirements related to competency, validation, training, and supervision were met. The traditional method using the Jamshidi needle, involved the manual rotary insertion into the marrow cavity of the posterior aspect of the iliac bone to obtain both an aspirate and a biopsy. Many of the nurses in the team complained of operator problems such as carpal tunnel syndrome and wrist pain after doing cases. In 2007, a team of nurses trained to perform BMBX procedures using a battery powered drill to insert the marrow needle into the iliac bone of adult hematology patients. All nurses completed a questionnaire aimed at assessing the patient experience during and after the procedure and overall nurse satisfaction with the powered driver.

Evaluation:
In 94 patients evaluated, pre-procedure pain was 0 (0-10 scale) in 72 (76.5%) while 21 (22.3%) reported pain up to 5 just before the procedure (avg=2). The post-procedure pain score in the same patients was 0 in 78 (83%) and up to 4 in six (6%) (avg=1). Nearly all (95%) nurses felt improved ergonomics using the battery-powered driver compared to the manual method.

Implications for Practice:
Trained nurses can safely and effectively perform BMBX procedures using manual method as well as using novel techniques such as the battery-powered driver system. Organizations can collaborate successfully with state boards of nursing to expand the RN scope of nursing practice to include BMBX's.