Impact of Delaying Stem Cell Transplant Related to Dental Work Clearance 1

Abstract

Purpose The primary purpose of this project was to decrease the percentage of Blood and Marrow Transplant (BMT) delays and/or cancelations due to a lack of dental clearance. A secondary purpose was to identify dental resources and education for patients and nurses. Topic Significance & Study Purpose/Background/Rationale A dental clearance is required for all patients prior to BMT. Poor dentation such as dental caries, periodontitis, and other issues may lead to complications such as: delayed healing of mucositis, need for parenteral nutrition and pain medications, increased length of stay, and increased risk for infection, sepsis, and death. Delays in obtaining dental clearance can place patients at a higher risk for relapse creating the need for additional therapy prior to BMT or cancellation of the BMT. Methods, Intervention, & Analysis After identifying the percentage of BMT patients delayed or canceled related to dental clearance, a review of literature was undertaken in the following areas: dental evaluation prior to BMT, oral status of BMT patients, and effects of delayed BMT. Additionally, current available dental resources, education materials, and nursing knowledge and satisfaction of dental resources were assessed. Based on findings, the following interventions were implemented. BMT nurses worked with social workers to identify dental resources in the community that can provide dental work and clearance for BMT patients that do not have dental insurance or coverage. Patient education materials were developed to include the importance of dental clearance. An education program was developed for both BMT and hematology nursing staff which highlighted the importance of dental clearance as well as the tools and resources available so that patients can be educated early in the BMT process. Findings & Interpretation The percent of patients delayed decreased from 4.6% at baseline to 1.8% and the percent of patients canceled decreased from 2.8% to 0% during the project and has remained below baseline. Nursing staff report less difficulty in obtaining dental clearance from the patients and are far more knowledgeable and satisfied with current dental tools and resources. Discussion & Implications This project supports working with multidisciplinary teams, including the community, to obtain resources for patients to obtain dental clearance. This project was successful in decreasing delays and cancelations in BMT patients related to dental clearance. Regular review of resources is ongoing.