HOME CARE EARLY DISCHARGE.

Transcription

1 HOME CARE EARLY DISCHARGE. Eugenia Trigoso (PNG) Lucia Lopez (DM) Jose Mª Fernanadez (MDr.) 1 The European Group for Blood and Marrow Transplantation

2 Home care. Early discharge Introduction Major HSCT complications Discharge criteria Home care. Our experience Nurses role. 2

3 HSCT Paediatric Bone Marrow Transplantation has evolved over the past decade and is now an accepted and successful intensive therapy for a wide range of disorders in children. 3

4 Historical markers : the beginning of the Modern Era of human marrow transplantation. - Improved antibiotics : widening application of allogeneic marrow grafting for human patients. - Increasing knowledge of HLA. 4

5 Historical markers present: haematopoietic cell transplantation as standard therapy. - Cyclophosphamide and busulfan. - Peripheral blood or cord blood. - Donors registries. 4

6 Major HSCT complications, first month Conditioning Infusion day Mucositis Bacteraemia Veno-occlusive diseasse Herpes Simplex Virus, Herpes 6 Disseminated fungal infections Acute GVHD Vomiting, diarrhea, fever, pain Days

7 Major HSCT complications, first year Herpes Simplex Virus, Herpes 6 Disseminated fungal infections Aspergillus Veno-occlusive disease (VOD) Acute GVHD Chronic GVHD Vomiting, diarrhea, fever, pain Days

8 Discharge from Unit Engrafted (the ANC exceeded 0.5 x10 9 /l) Afebrile No significant infections or treatment related complications Without signs of bleeding (platelet count more than 10x10 9 /l) Able to take PO meds No pain or well controlled 7

9 Paediatric Oncologic Unit. is a reference centre for Comunidad Valenciana. We carry out an average of 25 transplants per year (autologus and allogenic including cord blood transplant). The most common underlying disease are ALL, AML and high risk Neuroblastoma. 8

10 Autologous: Types of transplants peripheral blood stem cell autologous bone marrow transplant Allogeneics: related unrelated cord blood transplant 9

11 Types of transplants Autologus Males (%) Females(%) (63.01%) 27 (36.99%) Allogeneic (71.11%) 13 (28.89%) 10

12 Overall activity last 6 years Autologus Allogeneics Total

13 January 2005-December 2010 Children: 110 Males : 70 Females: 40 Nº of transplants : males twice, 1 of them 3 2 females twice. 14

14 Patients age ranged Patients' age at the time of BMT are ranged between: 6 months (0.60) and 20 years (20.01) median 7.01 years 15

15 Underlying diagnosis of the transplanted patients Osteosarcoma 1 Tumor de celulas Germinales 1 Hodgkin's lymphoma 3 Ependimoblastoma 1 Leiomiosarcoma 1 Linfoma 2 Acute lymphoblastic leukaemia 39 Acute myeloid leukaemia 29 Acute myeloid leukaemia + Fanconi A. 2 Ewing s Sarcoma 9 Neuroblastoma 18 Meduloblastoma 4 Myelodysplasia sindrome 1 Central nervous system tumours 1 Tumor rabdoide 2 Rabdomiosarcoma 1 16

16 the team one paediatric oncologist two paediatric nurses in morning shifts one clinical assistant support team 3 more paediatricians 2 more nurses 17

17 The team!!!

18 ADINO ADINO Atención Domiciliaria Teléfono: Integral a Niños Oncológicos Abonado:37048 Mensaje: Nombre del niño y Teléfono de contacto Si no te llamamos en 10 ó 15 min. Repite tu mensaje Hospital Infantil La Fe Valencia 11

19 Como ya han sido informados durante Durante el tiempo en que su hijo esté La hospitalización de su hijo, la Unidad ingresado en ADINO, pueden contactar de Oncología Pediátrica del Hospital con la enfermera de guardia a través La Fe, dispone de un equipo para la del servicio busca personas hospitalización de los pacientes en Telf: sus domicilios. Nº de abonado: Deben dejar como mensaje el nombre del niño y un nº de tlf. ADINO está formado por un médico, dos enfermeras y una auxiliar de clínica. Una de las enfermeras y el La enfermera se pondrá en contacto con médico responsable estarán ustedes tan pronto reciba el mensaje. localizables 24h al día, 7 días a la Si no les llamamos en 10 ó 15 min, repitan semana. su mensaje. Una vez su hijo ha sido dado de alta en ADINO, para resolver cualquier duda, deben llamar al teléfono de la Consulta Externa ( ) horario días laborables de 8h. a 15h. 12

20 the scheduled The scheduled working time is: 24 hours a day 365 days a year, there are always a physician and a nurse on call. 18

21 the geographic area: Comunidad valenciana km² and inhabitants

22 Duration of the assistance Median duration of the assistance per child was 9.62 days Ranged between 2-84 days. Total of 1135 days. 20

23 Telephone calls Median of tlph. calls/patient : 9.12 Ranged between: 2 and 97. Total of

24 blood tests Main procedures 1 i.v. therapy (antibiotics) total parenteral nutrition (TPN) transfusions central venous catheter (CVC) care and teaching symptom control pain control 22

25 Main procedures 2 provide all necessary medications and give every instruction they need coordinate care with the rest of health care team. (RX; labs. Day hospital) psychological support and. Going back home advices: 23

26 24 going back home advice

27 Preparing House Major cleaning some days prior to discharge Avoid home renovations prior to child's discharge 25

28 Cleaning house 1 Dust and vacuum Disinfect hard surfaces Clean bathroom that child uses daily and clean bathtub after each use Change filters often 26

29 Cleaning house 2 Disinfect kitchen well after each use, clean out fridge often Take out trash daily Avoid burning fireplace and stoves Patient's bedroom 27

30 Continue BMT daily routines Mouth care Mask Medications Low bacteria diet Avoid crowds Wash hands Light exercise 28

31 Skin care Shower daily Avoid bubble bath Moisture skin often Reduce sun exposure Sunscreen, sunglasses, hat, cover arms and legs 29

32 Avoid Swimming Hot tubs Sand boxes Construction sites Contact sports no birds, reptiles, chickens, ducks. 30

33 Conclusion Home care for transplanted patients programme give confidence to families makes easier transit to normal life permits to shorten the stay in the hospital The most common cause of discharge was the achievement of the goals. 31

34 Conclusion : nurses role-1 to support home care, allowing children to return home early following BMT to facilitate early discharge for the child and family to provide assessment and monitoring of the child after discharge 32

35 Conclusion : nurses role 2 to ensure appropriate education and information is given and reinforced to enable parents to feel confident and competent when caring for their child to make effective links within the day care hospital, primary care team, health care team and between hospital and community 33

36 Conclusion : nurses role 3 Major problems still need to be solved : >relapse after transplant >graft rejection >more effective and less toxic conditioning regimen >improve control of GvHD 34

37 Conclusion : nurses role 4 Nurses are vital in orchestrating the complicated care these therapies mandate, as well as providing emotional support to patients and their families. 34

38 Conclusion : nurses role 5 Nursing research is being conducted in many areas of marrow transplantation. Quality-of-life and survivor issues have been identified as priorities by many nurses working in this field. Nurses will continue to play a pivotal role in caring for patients as marrow transplantation continues to evolve as a major form of cancer treatment. 34

39 Thank you Merci Gracie Kiitos Tack Gracias 35

40 Thank you Merci Gracie Kiito Tack Gracias