Discharge Essentials: A Program for Preparing Adult Blood and Marrow Transplant Patients for Self -Care after Transplant

Topic Significance & Study Purpose/Background/Rationale 

To create a systematic method for providing discharge education to autologous and allogeneic stem cell transplant patients.  Discharge education for hematopoietic stem cell transplant (HSCT) patients must include both the patient and caregiver.  This institution had no systematic method of providing discharge teaching to all patients.  Discharge Essentials incorporates the first three levels of Bloom’s Taxonomy (revised) to allow for basic and mid-range learning by our patients and families.  Remembering, understanding and applying content is accomplished using a variety of methods.  Patients and caregivers learn the expectations of discharge and have plenty of time and support to learn content, have discussions and ask questions. 

Methods, Intervention, & Analysis 

We developed comprehensive discharge videos for Autologous and Allogeneic transplant patients.  Multidisciplinary feedback from all areas of the Blood and Marrow transplant program-was included in content evaluation.  The unit-based Patient Family Centered Care group developed the Keys to Discharge sheet.  All nurses were oriented to the Discharge Essentials program and how to prescribe videos on The Get Well Network.  Three Discharge Essentials RNs were identified and took turns engaging in the program every Wednesday by meeting with patients and facilitating the discussion group.

Findings & Interpretation 

60 patients were admitted for transplant in the 3 month period from January 15 through April 16, 2014.  95% (57 out of 60) of patients viewed the video.  In one case the video was translated to paper secondary to language barrier.  22 Allogeneic patients and 34 Autologous patients viewed video.  Attendance at the BMT support group increased substantially from 13 people in 2013 (Sept-Dec) to 66 people in 2014 (Jan-Apr) after the Discharge Essentials discussion segment was added. That equated to 507% growth in attendance with addition of the Discharge Essentials segment.  The Press Gainey 12 month rolling average in March 2014 reported the Overall Discharge Index up 4.2 after initiation of Discharge Essentials (7.2% above hospital average) and the Instructions for care at home Index up 1.1% (7% above the hospital average).

Discussion & Implications 

Patients must be prepared for self-care at home.  This program offers a method to capture every patient and family and to provide standard, yet individualized discharge education post transplantation.