Inpatient Pediatric Hematology-Oncology, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, SC, USA.
Clinical Practice Nurse Expert II, Cancer and Blood Disorders Unit, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, SC, USA.
J Pediatr Hematol Oncol Nurs. 2023 Nov-Dec;40(6):432-439. doi: 10.1177/27527530221147886. Epub 2023 Jul 4.
The time period after a pediatric hematopoietic stem cell transplant (P-HSCT) is tenuous as the patient is severely immunocompromised and awaiting immune reconstitution. Managing activities of daily living and medication administration after discharge from the hospital requires 24-hour care placing a heavy burden on caregivers and patients. Patients who do not adhere to the posttransplant regimen are at a higher risk for hospital readmission within the first 30 days of initial discharge with serious potential for life-threatening complications. The objective of this project was to improve 30-day readmission rates and caregiver readiness for discharge through the implementation of an evidence-based discharge protocol for P-HSCT patients and caregivers. This quality improvement project included development and implementation of comprehensive Pediatric Blood & Marrow Transplant Guidelines and discharge protocol for patients who received an inpatient autologous or allogeneic HSCT and were scheduled for discharge from a 16-bed inpatient pediatric hematology-oncology unit of a children's hospital in the southeastern United States. Readmission rates were captured through the hospital-monitored system. The comprehensive discharge protocol was implemented for six patients, and 30-day readmission rates decreased from 27.29% to 3.57% following the intervention. Results suggest the combination of an evidence-based discharge protocol with a focus on caregiver readiness for discharge and a 24-hour Rooming-In period can influence caregiver confidence and reduce 30-day readmission rates after initial discharge from a P-HSCT.
在儿科造血干细胞移植（P-HSCT）后，患者的免疫功能严重受损，正在等待免疫重建，这段时间非常脆弱。管理日常生活和出院后的药物管理需要 24 小时的护理，这给护理人员和患者带来了沉重的负担。不遵守移植后治疗方案的患者在最初出院后的 30 天内再次住院的风险更高，严重时可能会出现危及生命的并发症。本项目的目的是通过实施针对 P-HSCT 患者及其护理人员的循证出院方案，提高 30 天内的再入院率和护理人员的出院准备情况。该质量改进项目包括制定和实施针对接受住院自体或异体 HSCT 并计划从美国东南部一家儿童医院的 16 张住院儿科血液肿瘤学病房出院的患者的综合儿科血液学与骨髓移植指南和出院方案。通过医院监测系统捕捉再入院率。在实施了全面的出院方案后，六名患者中有 30 天的再入院率从 27.29%降至 3.57%。结果表明，将循证出院方案与关注护理人员出院准备情况以及 24 小时同室期相结合，可影响护理人员的信心并降低 P-HSCT 后最初出院后的 30 天内的再入院率。
