Apheresis in the ABMT Outpatient Setting

Purpose: To describe strategies for successful implementation and positive outcomes of a comprehensive outpatient Adult Blood and Marrow Transplant (ABMT) Apheresis Program

Bone Marrow Transplant (BMT) nurses are trained experts in the care of patients along the continuum including pre-transplant, peri-transplant and post-transplant periods.  Leukapheresis for the collection of peripheral blood progenitor cells (PBPC), donor lymphocytes, granulocytes, and Extracorporeal Photopheresis (ECP) can be successfully incorporated into the scope of practice of the BMT outpatient nurse. With the opening of the Duke Adult Blood and Marrow Transplant (ABMT) Clinic in 1992, all nurses were trained in apheresis and were required to perform leukapheresis for the collection of PBPC. This consisted of a staff of 5 registered nurses.  The initial model allowed for flexibility in staffing to accommodate a changing patient census and acuity in the clinic and apheresis.

 Our apheresis program has experienced a 50 % growth in the past 10 years.  With this growth we have added two new apheresis devices which added another level of complexity to the scope of practice.  As our program and staff grew, and as regulations regarding safe practice have evolved, we found it increasingly challenging to maintain apheresis competency for our larger staff, and still provide high quality care in the outpatient setting. Therefore, in 2010, we implemented an optional Core Apheresis Team model, to which nurses may voluntarily commit to being a member.

To maintain apheresis competency of a core group of nurses, a regular rotation assignment was implemented and an apheresis coordinator was designated.  Advantages of this model include: 1) improved competency validation 2) decrease in procedural errors 75% and associated costs in the first month  3)consistency in  apheresis practice  4)increased nursing satisfaction by allowing nurses to opt whether they become a member of the core team.  Apheresis has long been an outpatient procedure.  As we move more care into the outpatient setting, our coordination of apheresis practice provides a model to follow for implementation of other services we provide to our ABMT patients.