- Email: [email protected]
The Development of Patient Education Treatment Plans
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Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
auto & allo) collections (n = 116) containing both precollection peripheral and post-collection product Absolute CD34+ counts. Standard Pearson Correlation Coefficient Analysis was applied to these data points quarterly to evaluate if an 80% EPL was met. Numbers and reasons for failed collections and points of time of staff hire and training/retraining interventions was identified. Results: The CD34+ collection correlation continued a three quarter downtrend [72%, 77%, 48%] and collection failure was .25%. Staff training/retraining interventions were made every two months for 6 months and then monthly for 4 months. Apheresis trained 5 staff competent in HCT collection. Two have advanced trouble shooting training. Most recent analysis of the CD34+ collection correlation is 79% with zero failed collections. Conclusion: FACT standard C4.4 addresses personnel requirements for the Apheresis Collection Facility. TUHC Quality SOPs and Quality Management Plan mirror the standard. Emphasizing TUHC FACT Accreditation needs, we were able to engage the cooperation of the contracted vendor towards process improvement. Continuous monitoring of HCT collection data, staff hire and training patterns were essential towards significant improvements in Quality Metrics, patient safety and product quality.
NURSING ADMINISTRATION
505 Respiratory Challenges in Inpatient BMT: “No Such Thing As ‘Flu Season” Sara Barr 1, Paige Reason 2. 1 Blood and Marrow Transplant, Princess Margaret Cancer Centre, Toronto, ON, Canada; 2 Infection Control, Princess Margaret Cancer Centre, Toronto, ON, Canada Topic Significance & Study Purpose/Background/Rationale: Respiratory infections (e.g. influenza, RSV, parainfluenza) are major challenges year-round in the BMT population. Outbreaks pose major challenges for immunocompromised patients and the staff caring for them. Due to repeated respiratory outbreaks in BMT Units at XXX several positive changes were made in the approach to respiratory challenges. Methods, Intervention, & Analysis: An analysis was done between infection control and management and it was identified that: 1) there was a lag between patient symptom identification, isolation and specimen testing, 2) only physicians were able to order nasopharyngeal swabs and 3) often health care staff would associate seemingly benign respiratory symptoms to a non-infectious or treatment related cause. We developed a number of strategies to address these challenges including a medical directive authorizing Registered Nurses to perform the testing provided certain criteria were met. Indications included a new onset of at least one respiratory symptom with or without a fever. Findings & Interpretation: Benefits of this directive include a shorter time frame between isolation and isolation discontinuation for NP negative patients, symptomatic patients are isolated and swabbed upon symptom detection, potential unit issues are identified more efficiently and there is more clarity for clinicians as to when to isolate and swab. Discussion & Implications: Conclusion: 1) Symptomatic patients are to remain isolated until they are no longer symptomatic, 2) there is a sense of empowerment amongst RNs to take prompt action when symptoms are detected, 3) timely symptom identification, isolation and testing of
specimens, 4) excellent communication between inpatient units and IPAC staff, 5) many good catches and 6) zero outbreaks in BMT in over one year. This presentation will detail our experience with respiratory outbreaks in malignant hematology at XXX and propose that comparable units may wish to follow a similar approach to this issue.
506 The Development of Patient Education Treatment Plans Suzanne Costello. Bone Marrow Transplant, New York Presbyterian Columbia University Medical Center, New York, NY Topic Significance & Study Purpose/Background/Rationale: With the development of a FACT accredited BMT Program in a large urban academic medical center, it was necessary to build a comprehensive patient education program. This program includes BMT treatment plans which serve to educate patients and serve as an education contract between the patient and clinician. Methods, Intervention, & Analysis: As per our institutional policies, the consent form used for BMT is the same form used for surgical invasive procedures. This form is modified to reflect conditioning regimens and stem cell infusions. Lacking are the details of the regimens, side effects of BMT or anything specific to transplant however the signed form satisfies the legalities of the consenting process. A patient education committee was created consisting of a multidisciplinary team including inpatient and outpatient clinicians, social work, and BMT nursing administration to develop supplemental patient education materials. BMT education manuals were written for Autologous and Allogeneic transplants. Treatment plans for each conditioning regimen were also developed which included a comprehensive review of each drug and side effects associated with them. Also included were an overview of pre-transplant testing, and the potential toxicities of transplant specific to each regimen. At the end of each plan, the patients and clinician sign off in the “education agreement” section which is the attestation that the patient agrees that adequate verbal and written information has been provided and that they have read and reviewed the content. It also includes the statement that questions have been answered to the patient’s satisfaction. Findings & Interpretation: Treatment plans are documents that have been approved by our BMT leadership committee and are maintained in our document control system. They cannot be edited and are reviewed and approved every two years. As per patient education SOP, patients receive a treatment plan and sign the education agreement prior to signing the consent form for transplant. Discussion & Implications: Treatment plans are a necessary supplement to our current consent forms. . These also serve as a patient education documentation tool as they are signed by the clinician and patient. Our goal is to present these documents to appropriate hospital committees so that these alone can serve as our consent forms.
507 Transitional Care Management Guiding Process Improvement Paul Anthony Freeman 1, Erica Bayless 2, Kelly Terrell 3. 1 BMT, Barnes-Jewish Hospital, St. Louis, MO; 2 Barnes-Jewish Hospital, Saint Louis, MO; 3 Division of Leukemia and Stem Cell Transplantation, Barnes Jewish Hospital, Saint Louis, MO
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
auto & allo) collections (n = 116) containing both precollection peripheral and post-collection product Absolute CD34+ counts. Standard Pearson Correlation Coefficient Analysis was applied to these data points quarterly to evaluate if an 80% EPL was met. Numbers and reasons for failed collections and points of time of staff hire and training/retraining interventions was identified. Results: The CD34+ collection correlation continued a three quarter downtrend [72%, 77%, 48%] and collection failure was .25%. Staff training/retraining interventions were made every two months for 6 months and then monthly for 4 months. Apheresis trained 5 staff competent in HCT collection. Two have advanced trouble shooting training. Most recent analysis of the CD34+ collection correlation is 79% with zero failed collections. Conclusion: FACT standard C4.4 addresses personnel requirements for the Apheresis Collection Facility. TUHC Quality SOPs and Quality Management Plan mirror the standard. Emphasizing TUHC FACT Accreditation needs, we were able to engage the cooperation of the contracted vendor towards process improvement. Continuous monitoring of HCT collection data, staff hire and training patterns were essential towards significant improvements in Quality Metrics, patient safety and product quality.
NURSING ADMINISTRATION
505 Respiratory Challenges in Inpatient BMT: “No Such Thing As ‘Flu Season” Sara Barr 1, Paige Reason 2. 1 Blood and Marrow Transplant, Princess Margaret Cancer Centre, Toronto, ON, Canada; 2 Infection Control, Princess Margaret Cancer Centre, Toronto, ON, Canada Topic Significance & Study Purpose/Background/Rationale: Respiratory infections (e.g. influenza, RSV, parainfluenza) are major challenges year-round in the BMT population. Outbreaks pose major challenges for immunocompromised patients and the staff caring for them. Due to repeated respiratory outbreaks in BMT Units at XXX several positive changes were made in the approach to respiratory challenges. Methods, Intervention, & Analysis: An analysis was done between infection control and management and it was identified that: 1) there was a lag between patient symptom identification, isolation and specimen testing, 2) only physicians were able to order nasopharyngeal swabs and 3) often health care staff would associate seemingly benign respiratory symptoms to a non-infectious or treatment related cause. We developed a number of strategies to address these challenges including a medical directive authorizing Registered Nurses to perform the testing provided certain criteria were met. Indications included a new onset of at least one respiratory symptom with or without a fever. Findings & Interpretation: Benefits of this directive include a shorter time frame between isolation and isolation discontinuation for NP negative patients, symptomatic patients are isolated and swabbed upon symptom detection, potential unit issues are identified more efficiently and there is more clarity for clinicians as to when to isolate and swab. Discussion & Implications: Conclusion: 1) Symptomatic patients are to remain isolated until they are no longer symptomatic, 2) there is a sense of empowerment amongst RNs to take prompt action when symptoms are detected, 3) timely symptom identification, isolation and testing of
specimens, 4) excellent communication between inpatient units and IPAC staff, 5) many good catches and 6) zero outbreaks in BMT in over one year. This presentation will detail our experience with respiratory outbreaks in malignant hematology at XXX and propose that comparable units may wish to follow a similar approach to this issue.
506 The Development of Patient Education Treatment Plans Suzanne Costello. Bone Marrow Transplant, New York Presbyterian Columbia University Medical Center, New York, NY Topic Significance & Study Purpose/Background/Rationale: With the development of a FACT accredited BMT Program in a large urban academic medical center, it was necessary to build a comprehensive patient education program. This program includes BMT treatment plans which serve to educate patients and serve as an education contract between the patient and clinician. Methods, Intervention, & Analysis: As per our institutional policies, the consent form used for BMT is the same form used for surgical invasive procedures. This form is modified to reflect conditioning regimens and stem cell infusions. Lacking are the details of the regimens, side effects of BMT or anything specific to transplant however the signed form satisfies the legalities of the consenting process. A patient education committee was created consisting of a multidisciplinary team including inpatient and outpatient clinicians, social work, and BMT nursing administration to develop supplemental patient education materials. BMT education manuals were written for Autologous and Allogeneic transplants. Treatment plans for each conditioning regimen were also developed which included a comprehensive review of each drug and side effects associated with them. Also included were an overview of pre-transplant testing, and the potential toxicities of transplant specific to each regimen. At the end of each plan, the patients and clinician sign off in the “education agreement” section which is the attestation that the patient agrees that adequate verbal and written information has been provided and that they have read and reviewed the content. It also includes the statement that questions have been answered to the patient’s satisfaction. Findings & Interpretation: Treatment plans are documents that have been approved by our BMT leadership committee and are maintained in our document control system. They cannot be edited and are reviewed and approved every two years. As per patient education SOP, patients receive a treatment plan and sign the education agreement prior to signing the consent form for transplant. Discussion & Implications: Treatment plans are a necessary supplement to our current consent forms. . These also serve as a patient education documentation tool as they are signed by the clinician and patient. Our goal is to present these documents to appropriate hospital committees so that these alone can serve as our consent forms.
507 Transitional Care Management Guiding Process Improvement Paul Anthony Freeman 1, Erica Bayless 2, Kelly Terrell 3. 1 BMT, Barnes-Jewish Hospital, St. Louis, MO; 2 Barnes-Jewish Hospital, Saint Louis, MO; 3 Division of Leukemia and Stem Cell Transplantation, Barnes Jewish Hospital, Saint Louis, MO