Patients who receive bone marrow transplantations (BMT) require vigilance for complications such as graft versus host disease (GVHD), opportunistic infections, and febrile neutropenia. During a presentation for the inaugural ONS Bridge™ virtual conference, Barbara E. Wenger, DNP, APRN, AOCNS®, CRNI, of UCHealth Metro, and Stephanie Armstrong, DNP, AGNP, NP-C, of Froedtert Hospital Clinical Cancer Center, described interventions to improve care quality in the BMT population.
patients are seen preadmission, potentially for multiple week admissions, and then followed up postdischarge.
“For some transplants, allogeneic in particular, they may be sent home with as many as 5–10 different medications with various schedules and tapering doses,” Wenger explained. “Medication adherence and patient education regarding their medication can help to prevent emergency department visits, clinic visits, or even hospitalizations due to potential non-adherence complications.”
Wenger’s practice implemented an intervention to decrease incidence of GVHD and opportunistic infections through improved medication adherence practices. In the care transition process, nurses reviewed common medications, a self-report adherence survey, and pill box filling with patients.
Wenger said that time was one of the biggest barriers to successful implementation. “Medication education in the inpatient and outpatient areas takes extra time. Knowing it is the right thing to do was the impetus that helped us overcome many of these barriers,” she said.
Overall, rates of GVHD and infections decreased during the intervention, and nurses reported improved patient communication and comfort. “Teamwork and stakeholder buy-in are crucial for these projects,” Wenger said. “If the group has a common aim, they have a better chance to work collaboratively to meet goals, deal with barriers, and improve outcomes.”
“Engaging the patients and watching them take part in this process was inspiring to the team,” Wenger said.
Nurse-Driven Interventions for Suspected Febrile Neutropenia