Improvements in Blood and Marrow Transplant (BMT) Handoffs to Community Practices

Abstract

Topic Significance & Study Purpose/Background/Rationale Our Long Term Follow Up (LTFU) program supports 6,000 BMT survivors via telemedicine and an on-site clinic. LTFU telemedicine nurses field approximately 50 consults a week. This department hosted a Nursing Summit in October 2017 with community oncology nurses (n=18) to explore challenges when caring for complex post-BMT patients. Challenges identified included the community nurses not receiving the discharge (DC) packet and so were not aware of the imminent return of the patient to their practice. The community nurse role varied across practices, but most were responsible for arranging labs, testing, and the appropriate appointment type. We identified changes the BMT Clinic could make with the DC of patients to improve coordination with community practices. Changes included standardization of DC information, earlier notification of discharge, and nurse to nurse handoffs. Methods, Intervention, & Analysis LTFU nurses presented the Summit discussion to the BMT nurses in February 2018. At their local practice council, BMT nurses explored their differences in workflows when discharging patients to community practices. Generally, patients delivered the DC packet to the home oncologist. The DC packet included a discharge summary, medication list, post-transplant monitoring calendar, recent labs, and a CD of recent radiology images. Clinical records were also faxed by Health Information Management, though this information was often not received by the community nurse. Telephone contact between BMT nurse and the community practice was often unsuccessful for giving verbal report as the appropriate community staff member was unavailable to take the call. Our practice council discussion led the BMT nurses to sending a standardized DC packet directly to the community care nurse, implemented July 2018. Findings & Interpretation Community nurses will be surveyed to determine effectiveness of this change to the handoff process. An online survey will assess if community nurses have increased awareness of patients returning to their care and evaluate if the updated DC packet improves patient care in community practices. Discussion & Implications This project provides a platform to enhance working relationships between the BMT Clinic and community nursing partners. As we continue to build the collaborative clinical partnership we hope to ultimately improve timely and comprehensive support of BMT survivors as they return home.