- Email: [email protected]
Caring with Courage: Implementing a Bone Marrow and Hematopoetic Stem Cell Transplant Caregiver Instructional Class and Support Group
Abstracts / Biol Blood Marrow Transplant 25 (2019) S76 S99
introduced. Interviews with nurses revealed there was a lack of knowledge about CAR-T cell therapy. A nursing education curriculum was developed to address the basics of cellular therapy, its indications, product administration, recognition of toxicities and supportive care. A multi-disciplinary team was established to develop comprehensive clinical guidelines and an educational plan. Methods, Intervention, & Analysis: 3 main goals were established: Develop evidenced based practice guidelines for the program. Train and ensure clinical competency and readiness of the nursing staff. Develop educational material for staff and patients The strategies used to accomplish these goals: All nurses completed product specific REMS training. Pediatric specific clinical practice guidelines were developed and distributed. Checklists were developed for thawing, preparation, delivery, and infusion of a CAR-T cells. Flowsheets and clinician warnings within the electronic medical records (EMR) to optimize documentation. Discharge instruction pamphlet was developed All nurses were trained to utilize the above tools prior to the treatment of the first patient. After treatment of the first two patients, an electronic survey was emailed to all nurses. The survey consisted of 10 questions assessing the nurse’s perception of their competence and preparedness for CAR-T therapy based on the education and training they received. Findings & Interpretation: The surveys revealed that 84% of nurses agreed that they are able to recognize side effects, as well as understand their treatment. 93% of nurses indicated they knew who to contact in the event of a complication or reaction. 71% of nurses felt they could adequately utilize the flowsheets built within the EMR to assess and grade toxicities. Overall, 90% of nurses felt prepared to care for a CAR-T cell patient. The results of this survey demonstrated the effectiveness of our comprehensive nursing education program and the strategies implemented. Discussion & Implications: New treatment modalities are being developed and brought to the bedside at a rapid pace. Clinical programs must be prepared to mobilize quickly by assessing their current resources, developing evidence based clinical practice guidelines, developing documentation tools within the EMR and providing comprehensive nursing education programs.
111 BMT Patient Education: Consistency and Understandability in a Complex Population; Creating a Standardized Patient Education Process for Blood and Marrow Transplant, a Single Institution Experience in an Academic Medical Center Kara Armato BSN, RN, OCN1, Breanna Weisbrod MS, APRN, AGCNS-BC2. 1 Blood and Marrow Transplant and Cellular Therapeutics, Unviersity of Kansas Health System, Westwood, KS; 2 The University of Kansas Cancer Center, The University of Kansas Health System, Kansas City, KS Topic Significance & Study Purpose/Background/Rationale: Blood and marrow transplant (BMT) patient care is complex, and patient education is paramount to improving outcomes [1]. Standardized patient education has shown to decrease
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length of stay and lower readmission rates [2]. Previous to this quality improvement project, patients reported inconsistent verbal and written education, and staff reported difficulty finding education documents. Content was outdated, multiple document versions existed in various locations, and materials were not evaluated for readability. The purpose of this project was to objectively curate the current catalog of patient education and increase use by nursing staff. Methods, Intervention, & Analysis: A nursing-led committee was developed to review all current education. Those from open source websites or other non-peer reviewed sources were removed. Non-proprietary education was reviewed and new institution-specific material was developed using a standard template. The committee scored new education for actionability and understandability using a validated tool (PEMAT), modifying materials to maximize the score [3]. Scores for both measures can range from 0-100%, with 100% being ideal.3 All approved education was uploaded to an internal website, accessible by all staff. Findings & Interpretation: An analysis of pre-intervention education showed 68 content contradictions. After the intervention, 37 pieces of new, standard education were approved.. The average PEMAT score of new education is 92% for both measures. On average patient education is accessed by staff 30 times daily. Discussion & Implications: The development of a committee structure and validated assessment tool answered concerns from staff and patients about patient education. A shared website allows for centralized control of education.. The committee structure and review process can be used in other practices to organize and improve complex education delivered to cancer patients. REFERENCES [1]MZ.CohenD.JenkinsE.C.HolstonE.D.CarlsonUnderstanding health literacy in patients receiving hematopoietic stem cell transplantationIn Oncol Nurs Forum4052013508515 [2]BThomsonG.GorospeL.CookeP.GiesieS.JohnsonTransitions of Care: A Hematopoietic Stem Cell Transplantation Nursing Education Project Across the TrajectoryClinical journal of oncology nursing1942015 [3]PEMAT for Printable Materials (PEMAT-P) Content last reviewed October 2013. Agency for Healthcare Research and Quality, Rockville, MD. http:// www.ahrq.gov/professionals/prevention-chronic-care/improve/selfmgmt/pemat/pemat-p.html
112 Caring with Courage: Implementing a Bone Marrow and Hematopoetic Stem Cell Transplant Caregiver Instructional Class and Support Group Danica Jhoelle Dorlette MPH, BSN, RN, OCN1, Tatiana Costa MSN, RN-BC2, Sarah Waxse LCSW, ACSW-R3, Tori Eigner LMSW4. 1 Bone Marrow and Stem Cell Transplant, New York Presbyterian Weill Cornell Medical Center, New York City, NY; 2 Department of Care Coordination, New York Presbyterian Weill Cornell Medical Center, New York City, NY; 3 Department of Social Work, Weill Cornell Medical Center, New York City, NY; 4 Department of Social Work, New York Presbyterian Weill Cornell Medical Center, New York City, NY Learning Objective: A multi-disciplinary and multi-ecological comprehensive health program to facilitate role transition for hematopoietic stem cell transplant caregivers. Topic Significance & Study Purpose/Background/Rationale: Patients undergoing hematopoietic stem cell transplantation (HSCT) have an illness trajectory that is long and uncertain with varying demands of care (Gemmill, 2011). The responsibility for safely caring for these patients after discharge is placed on identified informal caregivers. However, the potential burden on these caregivers is considerable. Literature states that they experience a lack of preparation and confidence needed to be
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Abstracts / Biol Blood Marrow Transplant 25 (2019) S76 S99
successful in their role (Kurtz et al., 2005; Beatie and Lebel, 2011; Gemmill et al., 2011; Bevans and Sternberg, 2012; Metoyer, 2013). Additionally, poorer physical and mental quality of life was found within this sub-group (Fred Hutchinson Cancer Research Center, 2017). Sampling of informal caregivers on a 16bed Hematopoetic Stem Cell Transplant unit within an 862-bed academic medical center in New York, New York mirror these themes of under-preparedness and unmet support. Such implications pose a risk of delayed discharge, re-admission, and poor quality of life. The essential role that caregivers play in survivorship must be acknowledged. Methods, Intervention, & Analysis: The Care Coordination, Social Work, and Nursing departments developed a task force to address this important issue. A comprehensive health program was constructed through the Intervention Mapping (IM) process and included the review of scientific literature, health behavioral theory, interviews with key informants, and dissemination of a mixed-methods Caregiver Readiness Survey over a 2-month period using a convenience sample of 28 (n=28) informal allogenic and autologous caregivers. Collected data was used to create an educational curriculum. Findings & Interpretation: Studies underscore the need for clear, consistent, and tailored education for caregivers before the caregiving skills are needed (McDonald et.al, 1996; Foxall and Gaston- Johansson, 1996; Simoneu et al., 2017). Caregiver
Readiness Surveys showed greatest uncertainty regarding central line catheter care (92%) and handling instances of nausea and vomiting (85%). Discussion & Implications: A monthly 2-hour intervention was constructed with 1-hour devoted to skills-based education and a 1-hour support group, following. This class will be led by multi-disciplinary staff members and cover topics across the physical, psychosocial, and spiritual domains of care for comprehensive support. Projected evaluative measures include attendance monitoring, evaluation sheets, and pre- and posttesting to gauge information retention.
113 The Blood and Marrow Transplant Time out: Application of Universal Protocol As a Model to Improve Patient SelectionSuitability to Improve Allogeneic 1-Year Survivals Patricia Van Strien MSN, RN, OCN, CHTC, BMTCN1, Bernice Coleman Ph.D, ACNP-BC, FAHA, FAAN2, Ronald Paquette MD1, Lorraine Alonzo Hernandez MBA1, Mahendra Yatawara MBA3, Margarita Guerrero BSN, RN, CHTC, OCN, BMTCN1, Leticia Uy BSN, RN, OCN, BMTCN1, Yvette Federizo BSN, RN, PHN, OCN1, Sara Cooper MSN, ACNP-BC1, Seda Gharapetian RN, MSN/FNP-BC, BMTCN, OCN1, Michael C. Lill MD1. 1 Blood and Marrow Transplant, Cedars-Sinai Medical Center, Los Angeles, CA; 2 Director, Nursing Research Department, Cedars-Sinai Medical Center, Los Angeles, CA 90048, CA; 3 Research Informatics and Scientific Computing Core, Cedar Sinai Medical Center, Los Angeles, CA Topic Significance & Study Purpose/Background/Rationale: Patients being considered for allogeneic Blood and Marrow Transplant (Allo-BMT) undergo rigorous evaluations of which can influence Allo-BMT plan and outcomes. The goal of this project was to improve the patient selection process prior to admission for Allo-BMT. The process was modeled after the Universal Protocol (UP) used prior to surgery. UP is a National Patient Safety Goal, supported by Joint Commission, Institute of Medicine, and World Health Organization. Our center aimed to standardize the approach to determine patient suitability and treatment plan with the goal of improving 1-year survival. A UP approach was employed prior to BMT to secure consensus on patient suitability and treatment plan. Methods, Intervention, & Analysis: A 1-page comprehensive BMT-Time Out (BMT-TO) checklist was created with critical domains selected to provide programmatic workflow (Figure 1). All Allo-BMT recipients underwent systematic BMT-TO reviews through progressive handoffs beginning July 2016. Checklists were audited monthly for completeness and adherence to standard operating procedures. Blood Marrow Transplant Information Patient System (“bmTIPSTM ”) generated Allogeneic Transplant Intake Dashboard (ATID) reports, providing real-time numerical data on intake distribution patterns (Figure 2). The 2017 Allo-BMT 1-year survival data reported by Center for Blood and Marrow Transplant Research(CIBMTR) were used to set confidence levels and forecast CY18,19 projected 1-year survivals. Findings & Interpretation: ATID for calendar years (CY)13,14, and 15, showed acceptance rates at presentation of 92%(n=98), 94%(n=105), and 77%(n=89), respectively. ATID for CY16, 17, 18 after implementation of BMT-TO showed lower acceptance rates: 83%(n=89), 86%(n=92), 85%(n=72), respectively. CIBMTR results showed improvement in our center’s Allo-BMT 1-year survival rates with use of BMT-TO checklist (Figure 3): CY14 (64%/reported); CY15=64%(n=45/reported); CY16=78%(n=28/ reported); CY17=89%(n=37/predicted). Discussion & Implications: Implementation of systematic review of patient selection-suitability data and BMT treatment
introduced. Interviews with nurses revealed there was a lack of knowledge about CAR-T cell therapy. A nursing education curriculum was developed to address the basics of cellular therapy, its indications, product administration, recognition of toxicities and supportive care. A multi-disciplinary team was established to develop comprehensive clinical guidelines and an educational plan. Methods, Intervention, & Analysis: 3 main goals were established: Develop evidenced based practice guidelines for the program. Train and ensure clinical competency and readiness of the nursing staff. Develop educational material for staff and patients The strategies used to accomplish these goals: All nurses completed product specific REMS training. Pediatric specific clinical practice guidelines were developed and distributed. Checklists were developed for thawing, preparation, delivery, and infusion of a CAR-T cells. Flowsheets and clinician warnings within the electronic medical records (EMR) to optimize documentation. Discharge instruction pamphlet was developed All nurses were trained to utilize the above tools prior to the treatment of the first patient. After treatment of the first two patients, an electronic survey was emailed to all nurses. The survey consisted of 10 questions assessing the nurse’s perception of their competence and preparedness for CAR-T therapy based on the education and training they received. Findings & Interpretation: The surveys revealed that 84% of nurses agreed that they are able to recognize side effects, as well as understand their treatment. 93% of nurses indicated they knew who to contact in the event of a complication or reaction. 71% of nurses felt they could adequately utilize the flowsheets built within the EMR to assess and grade toxicities. Overall, 90% of nurses felt prepared to care for a CAR-T cell patient. The results of this survey demonstrated the effectiveness of our comprehensive nursing education program and the strategies implemented. Discussion & Implications: New treatment modalities are being developed and brought to the bedside at a rapid pace. Clinical programs must be prepared to mobilize quickly by assessing their current resources, developing evidence based clinical practice guidelines, developing documentation tools within the EMR and providing comprehensive nursing education programs.
111 BMT Patient Education: Consistency and Understandability in a Complex Population; Creating a Standardized Patient Education Process for Blood and Marrow Transplant, a Single Institution Experience in an Academic Medical Center Kara Armato BSN, RN, OCN1, Breanna Weisbrod MS, APRN, AGCNS-BC2. 1 Blood and Marrow Transplant and Cellular Therapeutics, Unviersity of Kansas Health System, Westwood, KS; 2 The University of Kansas Cancer Center, The University of Kansas Health System, Kansas City, KS Topic Significance & Study Purpose/Background/Rationale: Blood and marrow transplant (BMT) patient care is complex, and patient education is paramount to improving outcomes [1]. Standardized patient education has shown to decrease
S83
length of stay and lower readmission rates [2]. Previous to this quality improvement project, patients reported inconsistent verbal and written education, and staff reported difficulty finding education documents. Content was outdated, multiple document versions existed in various locations, and materials were not evaluated for readability. The purpose of this project was to objectively curate the current catalog of patient education and increase use by nursing staff. Methods, Intervention, & Analysis: A nursing-led committee was developed to review all current education. Those from open source websites or other non-peer reviewed sources were removed. Non-proprietary education was reviewed and new institution-specific material was developed using a standard template. The committee scored new education for actionability and understandability using a validated tool (PEMAT), modifying materials to maximize the score [3]. Scores for both measures can range from 0-100%, with 100% being ideal.3 All approved education was uploaded to an internal website, accessible by all staff. Findings & Interpretation: An analysis of pre-intervention education showed 68 content contradictions. After the intervention, 37 pieces of new, standard education were approved.. The average PEMAT score of new education is 92% for both measures. On average patient education is accessed by staff 30 times daily. Discussion & Implications: The development of a committee structure and validated assessment tool answered concerns from staff and patients about patient education. A shared website allows for centralized control of education.. The committee structure and review process can be used in other practices to organize and improve complex education delivered to cancer patients. REFERENCES [1]MZ.CohenD.JenkinsE.C.HolstonE.D.CarlsonUnderstanding health literacy in patients receiving hematopoietic stem cell transplantationIn Oncol Nurs Forum4052013508515 [2]BThomsonG.GorospeL.CookeP.GiesieS.JohnsonTransitions of Care: A Hematopoietic Stem Cell Transplantation Nursing Education Project Across the TrajectoryClinical journal of oncology nursing1942015 [3]PEMAT for Printable Materials (PEMAT-P) Content last reviewed October 2013. Agency for Healthcare Research and Quality, Rockville, MD. http:// www.ahrq.gov/professionals/prevention-chronic-care/improve/selfmgmt/pemat/pemat-p.html
112 Caring with Courage: Implementing a Bone Marrow and Hematopoetic Stem Cell Transplant Caregiver Instructional Class and Support Group Danica Jhoelle Dorlette MPH, BSN, RN, OCN1, Tatiana Costa MSN, RN-BC2, Sarah Waxse LCSW, ACSW-R3, Tori Eigner LMSW4. 1 Bone Marrow and Stem Cell Transplant, New York Presbyterian Weill Cornell Medical Center, New York City, NY; 2 Department of Care Coordination, New York Presbyterian Weill Cornell Medical Center, New York City, NY; 3 Department of Social Work, Weill Cornell Medical Center, New York City, NY; 4 Department of Social Work, New York Presbyterian Weill Cornell Medical Center, New York City, NY Learning Objective: A multi-disciplinary and multi-ecological comprehensive health program to facilitate role transition for hematopoietic stem cell transplant caregivers. Topic Significance & Study Purpose/Background/Rationale: Patients undergoing hematopoietic stem cell transplantation (HSCT) have an illness trajectory that is long and uncertain with varying demands of care (Gemmill, 2011). The responsibility for safely caring for these patients after discharge is placed on identified informal caregivers. However, the potential burden on these caregivers is considerable. Literature states that they experience a lack of preparation and confidence needed to be
S84
Abstracts / Biol Blood Marrow Transplant 25 (2019) S76 S99
successful in their role (Kurtz et al., 2005; Beatie and Lebel, 2011; Gemmill et al., 2011; Bevans and Sternberg, 2012; Metoyer, 2013). Additionally, poorer physical and mental quality of life was found within this sub-group (Fred Hutchinson Cancer Research Center, 2017). Sampling of informal caregivers on a 16bed Hematopoetic Stem Cell Transplant unit within an 862-bed academic medical center in New York, New York mirror these themes of under-preparedness and unmet support. Such implications pose a risk of delayed discharge, re-admission, and poor quality of life. The essential role that caregivers play in survivorship must be acknowledged. Methods, Intervention, & Analysis: The Care Coordination, Social Work, and Nursing departments developed a task force to address this important issue. A comprehensive health program was constructed through the Intervention Mapping (IM) process and included the review of scientific literature, health behavioral theory, interviews with key informants, and dissemination of a mixed-methods Caregiver Readiness Survey over a 2-month period using a convenience sample of 28 (n=28) informal allogenic and autologous caregivers. Collected data was used to create an educational curriculum. Findings & Interpretation: Studies underscore the need for clear, consistent, and tailored education for caregivers before the caregiving skills are needed (McDonald et.al, 1996; Foxall and Gaston- Johansson, 1996; Simoneu et al., 2017). Caregiver
Readiness Surveys showed greatest uncertainty regarding central line catheter care (92%) and handling instances of nausea and vomiting (85%). Discussion & Implications: A monthly 2-hour intervention was constructed with 1-hour devoted to skills-based education and a 1-hour support group, following. This class will be led by multi-disciplinary staff members and cover topics across the physical, psychosocial, and spiritual domains of care for comprehensive support. Projected evaluative measures include attendance monitoring, evaluation sheets, and pre- and posttesting to gauge information retention.
113 The Blood and Marrow Transplant Time out: Application of Universal Protocol As a Model to Improve Patient SelectionSuitability to Improve Allogeneic 1-Year Survivals Patricia Van Strien MSN, RN, OCN, CHTC, BMTCN1, Bernice Coleman Ph.D, ACNP-BC, FAHA, FAAN2, Ronald Paquette MD1, Lorraine Alonzo Hernandez MBA1, Mahendra Yatawara MBA3, Margarita Guerrero BSN, RN, CHTC, OCN, BMTCN1, Leticia Uy BSN, RN, OCN, BMTCN1, Yvette Federizo BSN, RN, PHN, OCN1, Sara Cooper MSN, ACNP-BC1, Seda Gharapetian RN, MSN/FNP-BC, BMTCN, OCN1, Michael C. Lill MD1. 1 Blood and Marrow Transplant, Cedars-Sinai Medical Center, Los Angeles, CA; 2 Director, Nursing Research Department, Cedars-Sinai Medical Center, Los Angeles, CA 90048, CA; 3 Research Informatics and Scientific Computing Core, Cedar Sinai Medical Center, Los Angeles, CA Topic Significance & Study Purpose/Background/Rationale: Patients being considered for allogeneic Blood and Marrow Transplant (Allo-BMT) undergo rigorous evaluations of which can influence Allo-BMT plan and outcomes. The goal of this project was to improve the patient selection process prior to admission for Allo-BMT. The process was modeled after the Universal Protocol (UP) used prior to surgery. UP is a National Patient Safety Goal, supported by Joint Commission, Institute of Medicine, and World Health Organization. Our center aimed to standardize the approach to determine patient suitability and treatment plan with the goal of improving 1-year survival. A UP approach was employed prior to BMT to secure consensus on patient suitability and treatment plan. Methods, Intervention, & Analysis: A 1-page comprehensive BMT-Time Out (BMT-TO) checklist was created with critical domains selected to provide programmatic workflow (Figure 1). All Allo-BMT recipients underwent systematic BMT-TO reviews through progressive handoffs beginning July 2016. Checklists were audited monthly for completeness and adherence to standard operating procedures. Blood Marrow Transplant Information Patient System (“bmTIPSTM ”) generated Allogeneic Transplant Intake Dashboard (ATID) reports, providing real-time numerical data on intake distribution patterns (Figure 2). The 2017 Allo-BMT 1-year survival data reported by Center for Blood and Marrow Transplant Research(CIBMTR) were used to set confidence levels and forecast CY18,19 projected 1-year survivals. Findings & Interpretation: ATID for calendar years (CY)13,14, and 15, showed acceptance rates at presentation of 92%(n=98), 94%(n=105), and 77%(n=89), respectively. ATID for CY16, 17, 18 after implementation of BMT-TO showed lower acceptance rates: 83%(n=89), 86%(n=92), 85%(n=72), respectively. CIBMTR results showed improvement in our center’s Allo-BMT 1-year survival rates with use of BMT-TO checklist (Figure 3): CY14 (64%/reported); CY15=64%(n=45/reported); CY16=78%(n=28/ reported); CY17=89%(n=37/predicted). Discussion & Implications: Implementation of systematic review of patient selection-suitability data and BMT treatment