Decreasing Readmission Rates in Autologous Stem Cell Transplant Patient for Symptom Management

Decreasing Readmission Rates in Autologous Stem Cell Transplant Patient for Symptom Management

As of July 7^th 2011, in an effort to decrease readmission rates, the Bone Marrow Transplant (BMT) program instituted a requirement for all autologous stem cell transplant patients to be seen at the Taussig Cancer Center within 2-4 days following discharge for symptom assessment and labs.  Prior to this change, patients had labs done locally and were contacted by their nurse coordinator within 48 hours of discharge.  Patients were seen for symptom assessment by their local oncologist within one week.

Data review for 6/2010 – 6/2011 found there were a total of 142 patients discharged and 11 readmissions within the first 30 days of discharge; 4, or 36% of those were for symptom control, which included pain management, shortness of breath (SOB), and nausea, vomiting, and diarrhea (N/V/D).

Prior to discharge, patients and their caregivers are educated about post-transplant care.  Medications for symptom management, usually prescribed ‘as needed’ are often misunderstood.  In an effort to provide clarity we instituted:

• A ‘Med Action’ form, created by the PharmD, with the generic and brand names of each medication, dosage, frequency, and rationale
• The PharmD reviews the ‘Med Action’ form the morning of discharge
• Patients discharged on blood pressure (BP) medications are instructed on the use of a BP monitor, and logging their readings twice a day

At the follow-up visits, the BMT nurse assesses patient’s symptom control and understanding of their discharge instructions, including medications. It was found that:

i 53% were dehydrated, (evidenced by orthostatic vital signs), requiring IV fluids

i 37% required a medication change

i 39% needed additional appointments for symptom management

Between 7/2011 and 7/2012, out of 129 patients, 11 were readmitted, 2 for symptom control.

Conclusions:

• Outpatient visits for symptom assessment/intervention were effective in preventing readmissions for symptom management
• The 2 patients readmitted for symptom management had Primary Amyloidosis. They were found to have EGD biopsy proven Amyloidosis of the gut diagnosed post transplant.  This may have contributed to the long term intensive pharmacological/medical management needed for nausea and vomiting.
• Readmission rates overall increased by 0.8%, however only 9% were for symptom management.   The remaining 91%, readmitted per BMT program protocol, were for infections and fevers.