Impact of Specialty Nursing Model On Pediatric Bone Marrow Transplant Patient Outcomes

Impact of Specialty Nursing Model on Pediatric Bone Marrow Transplant Patient Outcomes

Background: Bone Marrow Transplant (BMT) is an aggressive therapeutic option for many non-malignant diseases. Specialized nursing care is crucial to prevent and manage expected and unexpected toxicities and has been recommended by many experts in the field. Little evidence is available to support this model of care. This retrospective study aims to investigate the impact of a specialized nursing model on adverse events, ICU transfers, length of stay and other incidents within this highly complicated and critically ill population.

Objectives:  Retrospective study to investigate the impact of a specialized nursing model on ICU transfers, length of stay and reportable incidents in the pediatric transplant population.

Methods: All records of transplant patients from January 2008 to October 2012 were retrospectively reviewed for length of stay, PICU transfers and reported incidents. The specialty BMT nurses went through an initial orientation period of 16 weeks with an experienced preceptor. Didactic was given in modules focused on all phases of the transplant process. The nurses were required to complete an exam at the end of the orientation period. Nurses also attended an annual BMT retreat aimed at continuing education and practice review.

Results:  Median length of stay decreased with implementation of specialty nursing.  Median LOS from 2008-2009 was 35-40 days respectively. Median LOS from 2010-2012 was 28-30 days.  ICU transfers significantly decreased and are depicted in Figure 1.  Reportable incident rates remained between 58-60%.

Discussion:  Based on findings from our study, the specialty nursing model impacts overall LOS and PICU transfers. Reportable incidents remained the same, however could be attributed to an institutional initiative related to safety and hypervigilant documentation by specialized nurses.  Further research is needed to describe the specialty nursing model and overall impact on care for this unique population.