Congress Abstracts 2003

66

THE ADMINISTRATIVE CHALLENGE IN THE DEVELOPMENT OF A POINT-OF-SERVICE CLINIC FOR POST BLOOD AND MARROW TRANSPLANTATION PATIENTS. Susan Stary, RN, BSN, OCN®, Serry Sorensen, RN, BSN, OCN^®, Debra Adornetto, RN, BSN, MS, Joyce Neumann, RN, MS, AOCN^®, and Cindy Ippoliti, PharmD, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Today’s healthcare climate and advancements in blood and marrow transplantation have challenged the outpatient administrative staff to develop innovative strategies in caring for higher acuity patients. Autologus transplantation patients are frequently discharged from the hospital immediately following chemotherapy for mobilization, or soon after engraftment. The challenge was to integrate this patient population into the outpatient clinic, which has traditionally been set up to assess patients pre- and post-transplant. These “early discharges” challenge the entire outpatient staff to provide quality care while balancing the benefits, risks, and needs of all patients. The rationale for the development of the “Fast Track Clinic” is to perform laboratory testing and patient evaluation by an experienced bone marrow transplant nurse, APN, and clinical pharmacist in a familiar environment. Identified treatment needs such as fluid and electrolyte replacement or antibiotics are also performed in the clinical area. Long-term fluid infusion and blood product transfusion are transitioned to clinical areas capable of providing infusions greater than one hour.

The administrative staff faced various challenges in developing this new clinical area, which included space feasibility, level of staff education/skills, equipment/supply issues, financial issues, room utilization, and staff buy-in. Space feasibility was evaluated by a room utilization study indicating low usage in the morning hours.

The staff educator provided intense training on pump usage, CVC care, and IV drug administration, as these new patients demanded a different set of skills. Strategies were planned in collaborative multidisciplinary meetings with the administrative and clinical staff. The meetings provided a sense of ownership and allowed the staff to come up with “out of the box” solutions regarding the flow of the clinic. One advantage of the fast track clinic is that patients are followed by the same personnel from initial consultation throughout the transplant journey. Another impact of the implementation of the fast track clinic is the enhancement of the RN’s technical, critical thinking, and problem solving skills. Patient satisfaction surveys and comment cards are obtained on a monthly basis and reviewed for possible improvements. The results demonstrate a high level of satisfaction regarding care of the patient.