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PATIENT CARE UNIT:

Scope of Service:

The pediatric Stem Cell Transplant (STC) clinic provides pre and post stem cell transplant care for pediatric patients who need Stem Cell Transplants. The patients’ population includes Saudi and Non-Saudi nationals of children less than 14 years of age who suffer from the following types of disease:

·         Acute and Chronic Leukemia

·         MDS

·         Immunodeficiency Disorders

·         Lymphomas

·         Aplastic Anaemia

·         Fanconi’s Anaemia

·         Thalassemia

·         Osteopetrosis

·         Hemophagocytosis

·         Metabolic Disorders

·         Congenital Sidroplastic Anaemia

·         Congenital Thrombocytopenia

·         Neuroblastoma

Frequent Procedures / Services / Functions:

·         HLA typing for patient and family

·         Pre SCT work up for patient and donor

·         Patient and family education pre, during, and post SCT transplant

·         Arrangement of admission for both patient and donor

·         Psychosocial support

·         Arrangement of central line insertion and removal

·         Central line care and management

·         Bone marrow biopsies and aspirations

·         Lumbar punctures

·         Patient assessment and evaluation

·         Patient triage via phone

·         Communication with family and patient through out the SCT procedure

·         Blood extraction via central line

·         Skin care and suture removal

·         Nutritional support ( weight, diet follow up, and growth chart )

·         Care of “drop in” patients

·         Post SCT annual follow up

·         Arrangement of post transplant clinic visits

·         Arrangement of IVIG infusion every 2 weeks

·         Follow up of STR results ( status of marrow engraftment post SCT )

·         Un-related donor search ( cord blood and MUD )

·         Arrangement of shipment and receiving of cord blood units

·         Communication with international transplant centers

·         Vaccinations

·         Medication refill

·         Mobilization of PBSC donors

·         Arrangement of bone marrow harvest through DPC

Hours of Operation

Saturday – Tuesday:     08:00 (am) – 18:00 (pm)

                  Wednesday: 08:00 (am) – 17:00 (pm)

CRITERIA FOR ADMISSION TO SERVICE:

Patients must be approved for tertiary care after referral to Pediatric Oncology/Hematology/ SCT program through Medical Eligibility/Royal Order.

STAFFING PLAN:

Number of staff:

• One Pediatric SCT coordinator
• Two Staff Nurse I
• One Staff Nurse II
• One Ward Clerk
• One Health Educator ( Belongs to Health Education Program )

Pediatric SCT program has the following clinics per week:

• Saturday PM: One post SCT clinic ( Run by Oncology/Hematology Physician )
• Monday PM: One post SCT clinic ( Run by Oncology/Hematology Physician )
• Tuesday PM: Two Post  SCT clinics ( Run by Oncology/Hematology Physician and Immunology/Allergy Physician )

The clinics take care of pre and post SCT patients as well as pediatric donors pre and post donation assessment. The average number of patients seen in the follow up clinics per month is approximately 200.

Number of patients seen at the Pediatric SCT Nurse clinic per month is between 200 – 300 patients.

 Major Nursing and Clinical Functions:

Assessment:

·         Vital signs

·         Symptoms of post SCT complications

·         Educational needs

·         Psychosocial needs

·         Nutritional needs

·         Major complaints

·         Medication refills

·         Review lab results and rely results to physicians for decision making

·         Height, weight, and head circumference

·         Growth assessment

·         Allergies

Planning and Performing:

Intervention:

Based on nursing assessment and physicians orders intervention includes:

Lab tests, swabs taking, referral to treatment areas for IV therapy, fluid and electrolyte balance and replacement, airway / respiratory management, symptoms management, monitoring patient’s safety, infection control, skin and wound care, oral care, blood and blood products transfusion, emergency resuscitation procedures, assisting medical staff with procedures, coordination of various disciplines / department and other health institutions, psychosocial care, arrangement for admission and referral to other departments (EMS, DPC, and other out-patient clinics).

Education:

Teaching and education of patient, family and care giver is of a great importance in Pediatric SCT clinic. Education includes: diagnosis, treatment plan, pre SCT preparations, and procedures, post SCT follow up plans, precautions, medications, vaccination, post SCT complications, psychosocial aspects, and nutrition.

Teaching is done by the staff at the clinic as well as a certified health educator. Teaching is given pre, post, and during SCT.

Evaluation:

Through daily / weekly visits to clinic, evaluation of patients takes place on an ongoing basis. Evaluation includes response to interventions, and treatments. Patient care providers include: registered nurses, physicians, PCA’s, ward clerks, physical therapist, social workers, home health care nurses, radiology technologist, IV therapists, phlebotomist, dieticians, and infection control team.

Methods of adjusting to Staffing Variances:

Pediatric SCT clinic staff cooperates to ensure presence of enough daily qualified staff in the clinic through out the working hours. In addition they work collaboratively with Oncology clinic and Adult SCT clinic for appropriate staffing.

QUALIFICATION OF STAFF:

Qualifications/ Licenses/ Certifications Required:

·         Registered nursing license from the country of origin

·         Registration with the Saudi Council for Health Specialists

·         BCLS

·         KFSH & RC Chemotherapy certification program

·         KFSH & RC IV Therapy certification

·         Pediatric physical assessment

·         Pharmacology

CONTINUING EDUCATION/ IN-SERVICES PROVIDED TO MAINTAIN STAFF COMPETENCY:

All registered nurses are required to complete identified unit based competency every year. Continuous education is offered through Nursing Education & Research. Unit base staff in-services are provided based on identified educational needs. Educational needs are identified through implementation of new treatment protocols, performance improvement projects, individual input, and surveys. Additional local / national and international symposiums, teleconferences, and work shops information are posted on regular basis for staff information.

Required Competencies

·         Initial competencies:                Competency based summary

·         Annual competencies:             Fire and safety

                                                On-line Infection Control

                                                                On-line Performance Improvement

                                                Unit specific competency based skills

·         BCLS every two years

METHODS OF COMMUNICATION WITH OTHER DEPARTMENTS:

Internal and External Methods of Communication:

Communication is accomplished via direct verbal communication, telephone calls, FAX, e-mail, written memos, and minutes from meetings. The Pediatric SCT coordinator has a pager for immediate intervention or triage needs.

Collaborative Relationships with Other Departments:

·         SCT/ Hematology Collaborative Practice meetings

·         Weekly SCT coordination meeting to discuss potential patients for transplant

·         Weekly Cord Blood Transplant coordination meeting to discuss potential patients for transplant.

·         Oncology clinic staff meeting every two weeks

·         Daily / Bi-weekly visits to B3-2, B-1 and CCC

·         Patient Care Administration meeting.

DISCHARGE CRITERIA:

Patients are discharged when they are off therapy and all immunizations are completed. They are then referred to the Immunology Clinic/ KFCCC & R/ KFSH Jeddah/ Adult STC Program or any other referring hospital. The Donor is discharged from the program after 3-4 weeks following the harvest and physical assessment by the consultant.

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