Pre-Transplant Caregiver Education for out-Patient Multiple Myeloma Hematopoeitic Transplant Admission in New Day Hospital: Caregiver Role and Contract in Outpatient Transplant Patient Care

Topic Significance & Study Purpose/Background/Rationale 

Hematopoietic transplantation is complex procedure. Excellent education and discussion with patients and family is imperative because of increasingly complicating clinical and psychosocial management of their care. In the early steps of pre-transplant preparation, before admission, it is important to initiate discussion with the patient and family about discharge teaching. This was important when moving autologous transplant in outpatient day hospital.

To discuss process of patient/caregiver evaluation and caregiver support during patient day hospital visits: 1) the implementation of Pre transplant Caregiver education; 2) identify specific content areas for pre-transplant teaching; 3) additional methods of teaching involving both patient and caregiver.

Methods, Intervention, & Analysis 

A group was formed to develop Day Hospital HCT Discharge Teaching to: 1) improve patient/family caregiver education about outpatient HCT multiple myeloma in the day hospital; 2) create content and develop methods for patient & caregiver education in preparation for admission in Day Hospital and 3) developed and administered satisfaction survey of new OPD transplant process.

Findings & Interpretation 

A task force of staff nurses, nurse practitioner, nurse educators, nursing leaders, case managers, and clinical social worker were assembled to develop caregiver education which included caregiver to attend a group class facilitated by a nurse coordinator; caregiver contract; and complete symptom management forms.  In addition,  nurse coordinators and day hospital staff review specific content for HCT patient care common medications and side effects, expected transplant related symptoms, discharge issues which includes VAD care, infection precautions, dietary restrictions, home preparation, clinic routine, long term survivorship topics with the caregiver. With the pre-transplant education, patient and caregiver satisfaction was high at day of transplant (caregiver 90.3%, patient 91.8%) and at day of discharge (patient only 90%); with these efforts, it achieved a decrease in the HCT number of length of stay days from 21 days to 14 days. Ninety two percent of patients (n=12) received their stem cells in outpatient setting.

Discussion & Implications 

There was improved cooperation between physician/mid-level/nursing teams resulting in timely and efficient care and cooperation between outpatient and inpatient; patient obtained prescribed medication 100% and patient expressed quality of life is better maintained.  The institutional commitment to the program has promoted seamless care.