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According to published guidelines from FACT, apheresis must be performed by “adequately trained” collection personnel. This recommendation gives collection facilities wide latitude to determine the appropriate skill set for optimal apheresis collections. Comparing apheresis-trained oncology nurses with apheresis technicians, our program determined which group was best suited for the early recognition and treatment of procedure-related adverse reactions based on patient outcomes.
Upon the initiation of our community-based blood and marrow transplant (BMT) program in 2007, the collection of hematopoietic progenitor cells was contracted to a local blood center. There were 35 collections performed on 12 patients using the contracted apheresis technicians on site. Seventy-five percent (75%) of patients experienced apheresis complications requiring immediate medical attention.
Interventions
To improve the quality outcomes within our BMT program, a comprehensive nursing education plan was developed and implemented in November 2008. A core group of oncology nurses completed a competency-based apheresis program. Protocols were developed for the nurse to manage pre-emptive medical interventions when required. Subsequent to this intervention, we used these nursing personnel exclusively for collections.
Outcome
As of 2011, there have been 96 collections on 40 patients since switching to apheresis-trained nursing personnel. With this change only 7.5% of the patients experienced adverse reactions, a ten-fold decrease. Although not quantified, program staff felt there was additional improvement to the quality of patient care; as there was a decrease in delays to addressing adverse reactions. The shift from technicians to apheresis trained oncology nurses was a timely nursing intervention which improved patient outcomes by an order of magnitude.