Mobilization Algorithms Streamline the Role of UNC Hospitals' BMT Nurse Coordinators

Topic Significance & Study Purpose/Background/Rationale 

The BMT Outpatient Clinic at UNC Hospitals is an extremely busy place.  Five adult Nurse Coordinators orchestrate care for multiple patients at various stages of the pre-transplant process.  The Coordinators rotate being on call every fifth week , a role that includes overseeing mobilizations and collections for patients heading for autologous transplant.  In the past much time was spent notifying the medical team, pharmacy and fellow Coordinators when there was doubt about whether to end the collection, extend it another day, administer plerixafor etc.  The on call Coordinator might have 4 patients in apheresis in a single day that had to be followed, creating a huge time commitment.

Methods, Intervention, & Analysis 

 Thanks to a collaborative effort by the Coordinators, BMT attending physicians, APPs, PharmDs, and the apheresis staff we now have two algorithms to guide us.  These algorithms were a year in the making as decisions were made about the minimum pre-apheresis CD34 count that is acceptable and the minimum total cell dose necessary to proceed to transplant.  To ensure that we capture all collection processes we have an algorithm for growth factor (GCSF) based mobilizations and one for chemo mobilization.

Findings & Interpretation

Rather than having to make multiple phone calls to multiple members of our BMT team in order to formulate a plan all information goes through the on call BMT Nurse Coordinator.  If assistance is needed with judgment calls the PharmD is pulled in first. 

Discussion & Implications 

This has greatly decreased calls to our attending physicians.  The on call Coordinator communicates to the BMT team any decisions that are made outside the algorithm. 

This presentation will detail:  the steps that we went through as we developed our algorithms, reasons that it works well for us, and lessons we learned along the way.