Planning for Success: A Multidisciplinary Approach to Complex Discharges in Pediatric Blood and Marrow Transplant

Abstract

Topic Significance & Study Purpose/Background/Rationale The discharge process for the pediatric bone marrow transplant patients is very complex. It is overwhelming for both the patient and their caregiver as they struggle to learn about infections, precautions, medication administration, dietary restrictions, social isolation, and when and whom to call in the event of a fever or other medical emergency. Although patients look forward to leaving the hospital after a tenuous inpatient stay, the care remains very multifaceted and informational needs are high at the time of discharge. We have developed a pathway that eases the stressors of discharge for families and helps the team provide individualized support specific to their needs. As a team we can anticipate those needs and ensure a successful transition to home. Methods, Intervention, & Analysis Preparation starts early with education provided prior to admission and is reinforced repetitively during their inpatient stay. The multidisciplinary team who collaborate with discharge planning include providers, pharmacists, social workers, case managers, nurses, and nutritionists. The role of each team member is explained and they are present at a discharge meeting that is scheduled with the family upon the patient showing first signs of engraftment and clinical stability. Those members are then expected to follow-up as needed with each patient prior to discharge. A discharge roadmap and checklist is used and may be modified based on additional needs of individual patients. Key elements of the discharge pathway reviewed at the discharge meeting include: clinical eligibility for discharge completed by the provider, medication review completed by BMT Pharmacist and Case Manager, transition to home completed by Acute Care Nurse Coordinator, and ensuring appropriate resources are utilized while identifying potential barriers completed by the BMT Social Worker. Findings & Interpretation This pathway has streamlined the discharge process by decreasing medication errors and improving medication compliance, establishing effective communication among the team and to patients and their caregivers, setting clear expectations for patients in the outpatient setting. Discussion & Implications This pathway can help other Pediatric Blood and Marrow Transplant Centers in reorganizing the discharge process to improve quality of care and outcomes.