home care early discharge.

HOME CARE
EARLY DISCHARGE.
Eugenia Trigoso (PNG)
Lucia Lopez (DM)
Jose Mª Fernanadez (MDr.)
1
The European Group for Blood and Marrow Transplantation
Home care. Early discharge
► Introduction
► Major HSCT complications
► Discharge criteria
► Home care. Our experience
► Nurses role.
2
HSCT
Paediatric Bone Marrow Transplantation has evolved
over the past decade and is now an accepted and
successful intensive therapy for a wide range of
disorders in children.
3
Historical markers 1
► 1968–1975:
the beginning of the Modern Era of human
marrow transplantation.
- Improved antibiotics.
► 1976–1986:
widening application of allogeneic marrow
grafting for human patients.
- Increasing knowledge of HLA.
4
Historical markers 2
► 1986-
present: haematopoietic cell transplantation as
standard therapy.
- Cyclophosphamide and busulfan.
- Peripheral blood or cord blood.
- Donors registries.
4
Major HSCT complications, first month
Conditioning
Infusion day
Mucositis
Bacteraemia
Veno-occlusive diseasse
Herpes Simplex Virus, Herpes 6
Disseminated fungal infections
Acute GVHD
Vomiting, diarrhea, fever, pain
Days-7
5
0
7
14
21
30.
Major HSCT complications, first year
Herpes Simplex Virus, Herpes 6
Disseminated fungal infections
Aspergillus
Veno-occlusive disease (VOD)
Chronic GVHD
Acute GVHD
Vomiting, diarrhea, fever, pain
Days 60
6
90
120
150
180.
.
Discharge from Unit
► Engrafted (the ANC exceeded 0.5 x109/l)
► Afebrile
► No significant infections or treatment related
complications
► Without signs of bleeding (platelet count more
than 10x109/l)
► Able to take PO meds
► No pain or well controlled
7
Paediatric Oncologic Unit…
…. is a reference centre for Comunidad Valenciana
. We carry out an average of 25 transplants per year
(autologus and allogenic including cord blood
transplant).
The most common underlying disease are ALL, AML
and high risk Neuroblastoma.
8
Types of transplants
► Autologous:
peripheral blood stem cell
autologous bone marrow transplant
► Allogeneics:
related
unrelated
cord blood transplant
9
Types of transplants
Autologus
Males (%)
Females(%)
73
46 (63.01%)
27 (36.99%)
32 (71.11%)
13
Allogeneic
45
10
(28.89%)
Overall activity last 6 years
13
Autologus
Allogeneics
Total
2005
7
3
10
2006
11
7
18
2007
18
9
27
2008
12
8
20
2009
12
11
23
2010
13
7
20
January 2005- December 2010
► Children:
110
► Males :
70
► Females:
40
► Nº of transplants : 118
► 7 males twice, 1 of them 3
► 2 females twice.
14
Patients’ age ranged
► Patients' age at the time of BMT
between:
► 6 months (0.60) and
► 20 years (20.01)
► median 7.01 years
15
are ranged
Underlying diagnosis of the transplanted patients
Osteosarcoma
Tumor de celulas Germinales
1
Hodgkin's lymphoma
3
Ependimoblastoma
1
Leiomiosarcoma
1
Linfoma
2
Acute lymphoblastic leukaemia
39
Acute myeloid leukaemia
29
Acute myeloid leukaemia + Fanconi A.
2
Ewing´s Sarcoma
9
Neuroblastoma
18
Meduloblastoma
4
Myelodysplasia sindrome
1
Central nervous system tumours
1
Tumor rabdoide
2
Rabdomiosarcoma
16
1
1
…the team
► one
paediatric oncologist
► two paediatric nurses in morning shifts
► one clinical assistant
support team
► 3 more paediatricians
► 2 more nurses
17
The team!!!
ADINO
ADINO
Atención Domiciliaria
Integral
a Niños Oncológicos
Teléfono:
940331313
Abonado:37048
Mensaje:
Nombre del niño y
Teléfono de contacto
Si no te llamamos en 10 ó 15 min.
Repite tu mensaje
Hospital Infantil La Fe
Valencia
11
Como ya han sido informados durante
La hospitalización de su hijo, la Unidad
de Oncología Pediátrica del Hospital
La Fe, dispone de un equipo para la
“hospitalización” de los pacientes en
sus domicilios.
ADINO está formado por un médico,
dos enfermeras y una auxiliar de
clínica. Una de las enfermeras y el
médico responsable estarán
localizables 24h al día, 7 días a la
semana.
Durante el tiempo en que su hijo esté
ingresado en ADINO, pueden contactar
con la enfermera de guardia a través
del servicio busca personas
Telf: 940331313
Nº de abonado: 37048
Deben dejar como mensaje el nombre del niño y un
nº de tlf.
La enfermera se pondrá en contacto con
ustedes tan pronto reciba el mensaje.
Si no les llamamos en 10 ó 15 min, repitan
su mensaje.
Una vez su hijo ha sido dado de alta en
ADINO, para resolver cualquier duda,
deben llamar al teléfono de la Consulta
Externa (963862789) horario días
laborables de 8h. a 15h.
12
…the scheduled
The scheduled working time is:
24 hours a day
365 days a year,
there are always a physician and
a nurse on call.
18
…the geographic area:
Comunidad valenciana
19
23.255 km² and 5.094.675 inhabitants
Duration of the assistance
► Median duration of the assistance per child was 9.62
days
► Ranged between 2- 84 days.
► Total of 1135 days.
20
Telephone calls
► Median of tlph.
calls/patient : 9.12
► Ranged between: 2 and 97.
► Total of 1076.0
21
Main procedures 1
► blood tests
i.v. therapy (antibiotics)
► total parenteral nutrition (TPN)
► transfusions
► central venous catheter (CVC) care and teaching
► symptom control
► pain control
►
22
Main procedures 2
► provide all necessary medications and give
every instruction they need
► coordinate care with the rest of health
care team. (RX; labs. Day hospital)
► psychological support and….
► Going back home advices:
23
…going back home advice
24
Preparing House
►Major cleaning some
days prior to
discharge
►Avoid home
renovations prior to
child's discharge
25
Cleaning house 1
► Dust and vacuum
► Disinfect hard surfaces
► Clean bathroom that
child uses daily and
clean bathtub after
each use
► Change filters often
26
Cleaning house 2
► Disinfect kitchen well
after each use, clean
out fridge often
► Take out trash daily
► Avoid burning fireplace
and stoves
► Patient's bedroom
27
Continue BMT daily routines
►Mouth care
►Mask
►Medications
►Low bacteria diet
►Avoid crowds
►Wash hands
►Light exercise
28
Skin care
►Shower daily
►Avoid bubble bath
►Moisture skin often
►Reduce sun exposure
►Sunscreen, sunglasses, hat, cover arms
and legs
29
Avoid
►Swimming
►Hot tubs
►Sand boxes
►Construction sites
►Contact sports
►…no birds, reptiles,
chickens, ducks….
30
Conclusion
Home care for transplanted patients programme
► give confidence to families
► makes easier transit to normal life
► permits to shorten the stay in the hospital
► The most common cause of discharge
achievement of the goals.
31
was the
Conclusion : nurses role-1
► to support
home care, allowing children to return
home early following BMT
► to facilitate early discharge for the child and family
► to provide assessment and monitoring of the child after
discharge
32
Conclusion : nurses role 2
► to ensure appropriate education and information is
given and reinforced to enable parents to feel
confident and competent when caring for their child
► to make effective links within the
day care hospital,
primary care team, health care team and between
hospital and community
33
Conclusion : nurses role 3
► Major problems still need to be solved :
>relapse after transplant
>graft rejection
>more effective and less toxic conditioning
regimen
>improve control of GvHD
34
Conclusion : nurses role 4
► Nurses are vital in orchestrating the
complicated care these therapies mandate, as
well as providing emotional support to patients
and their families.
34
Conclusion : nurses role 5
► Nursing
research is being conducted in many areas of
marrow transplantation. Quality-of-life and survivor
issues have been identified as priorities by many nurses
working in this field. Nurses will continue to play a
pivotal role in caring for patients as marrow
transplantation continues to evolve as a major form of
cancer treatment.
34
Thank you
Merci
Gracie
Kiitos
Tack
Gracias
35
Thank you
Merci
Gracie
Kiito
Tack
Gracias