Ensuring Quality and Standardizing Care for BMT Patients in an Expanding Program

Topic Significance & Study Purpose/Background/Rationale

Because of higher readmission rate and increase in the number of transplants, BMT inpatient volume at Stanford Hospital has increased significantly. As a result, the patient are overflown to non BMT units daily. Since care of BMT patients is unique and staff on other units lacks specialty training, BMT team members are concerned that overflown patients are not receiving the same level of quality specialized care as the BMT unit provides. Furthermore, patients are dissatisfied with not being on a dedicated unit and not having easy access to nursing staff with specialty training.

Methods, Intervention, & Analysis

The goal of the project is to ensure that we maintain the same standard of quality care for all BMT patients. Since it wasn't feasible to find an additional dedicated space, the focus was on nursing staff training, providing additional support to nursing staff on other units, and monitor patient safety. Interventions included: (1) develop off-unit nurse float role and staff it 7 days a week on day shift; (2) offer formal BMT classes and informal 1:1 or small group in-services on other units that had BMT patients; (4) in addition to staff training, float nurse attends bedside team rounds and facilitates communication with providers, as well as provides role based and task based nursing support on other units; (5) management monitors and follows up on safety reports.

Findings & Interpretation

Addressing needs of BMT patients roomed on other units is an ongoing challenge. There is limited quantitative data to measure effectiveness of our interventions to date. However, off-unit nurses who attended classes and in-services verbalized increased comfort when caring for BMT patients. Furthermore, anecdotally, off-unit float nurse's support on other units is appreciated by nursing staff, medical providers, and patients. We are planning to maintain off-unit float nurse role on day shift, and are considering expanding it to 24/7 support. To measure effectiveness, we will develop survey for nurses on other units and will continue monitoring safety reports.

Discussion & Implications

Growing pains is probably a common theme in BMT programs with increased inpatient volume. We believe our approach is generalizable and, hopefully, other programs can learn and benefit from our experience.