Collaborative, interprofessional care for hematopoietic stem cell transplantation (HSCT) recipients improves time to electrolyte repletion; reduces cardiac adverse events, oral mucositis severity, and bloodstream infections; and improves use of patient-controlled anesthesia, researchers reported in study findings presented at the 48th Annual ONS Congress® in April 2023.
Researchers, including ONS members Shivani Gopalsami, RN, MSN, ANP-BC, AOCNP®, and Tia Wheatley, DNP, RN, AOCNS®, BMTCN®, identified a need for interprofessional collaboration between advanced practice nursing and pharmacy to improve clinical practice. The nurse practitioner, pharmacist, and clinical nurse specialist participated in daily patient rounds and met regularly to discuss the unit’s workflows and practice issues, which they found allowed them to assess patient needs in real time through unique perspectives.
The group identified several opportunities for inpatient practice improvement:
- Oral care and cryotherapy with melphalan
- Reduction of fluids for conditioning regimens
- Hyperhydration and diuresis with high-dose cyclophosphamide
- Antiemetic guidelines
- Infusion reaction medication guidelines
By updating their HSCT admission order sets to incorporate best practice recommendations and ensure consistent patient care delivery, they reduced the average time of magnesium and potassium repletion from 6 hours to 1.5 hours and saw fewer adverse cardiac events in their early findings. Incorporating an oral care regimen reduced oral mucositis severity, patient-controlled analgesia utilization, and mucosal barrier injury associated bloodstream infections. Decreasing fluids for HSCT conditioning regimens reduced fluid overload, based on their preliminary analysis of weight gain and diuresis frequency. The researchers are currently evaluating hemorrhagic cystitis incidence rates after initiating a hyperhydration protocol.
“Increased collaboration allows multidisciplinary team members to develop stronger understanding of each other’s role and responsibilities,” the researchers said. “And, by engaging each role to its full potential, knowledge can be integrated into innovative yet evidence-based care that improves patient outcomes.”