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PATIENT CARE UNIT:

Scope of Service:

The staff from the adult Stem Cell Transplant (SCT) clinic provides care and assistance to all new patients enrolled in the stem cell program, especially in the process of pre and post transplant workup/ follow-up.  The team is also responsible for patients discharged from the ward after the transplant and followed closely at the regular SCT clinics. This includes all patients from autologous and allogeneic transplant programs.  The main responsibility of the team is to ensure, with the physician team, a tight follow-up of patients post allogeneic stem cell transplants, donor leukocyte infusions (DLI). This follow-up includes the coordination of post-transplant workup, scheduling of regular clinics and “drop-in” nurse clinic.

The adult patient population includes Saudi and non Saudi nationals who suffer from the

following types of diseases and require a stem cell transplant:

·         Acute leukemia

·         Chronic leukemia

·         Myelodysplastic syndrome

·         Severe aplastic anemia

·         Lymphomas

·         Multiple myeloma.

Frequent Procedures/ Services /Functions

The adult SCT activities can be divided into two broad categories:

1.       Those that do not require the assistance of the SCT physicians in charge, which include:

• HLA typing
• Patient and donor pre-transplant workup.
• Patient and family education (teaching pre and post SCT)
• Admission scheduling for donor/recipient pair
• Psychosocial support
• Case manager orienting duties and evaluation

·         Scheduling for central venous access (Hickman triple lumen catheter, Permacath or stiff      Quinton for peripheral blood stem cell collection)

• Central line care management
• Blood sampling

·         Permanent communication with patient and family trough out the transplantation time frame

• Post SCT follow/up according to protocol guidelines.
• Vital signs / physical assessment/weight
• Skin care and suture removal
• Nutritional support
• Scheduling and management of SCT clinics
• Operating room scheduling for bone marrow harvests
• Peripheral blood stem cell harvest scheduling with the apheresis team.

2.       Those requiring the assistance of the SCT of physicians in charge:

• Bone marrow aspirations and biopsies
• Lumbar punctures
• Administration of intrathecal chemotherapy (Metothrexate, Cytosine arabinoside).
• Patient and donor assessment and evaluation 
• Care of drop in patients
• F/u post Non Myelo-Ablative Transplant (requires daily SCT clinic screening)
• F/u post Donor lymphocytes infusion (requires regular appointment in the SCT clinic)

·         Appointment and scheduling with treatment area for administration of  outpatient IV     medication, such as ganciclovir, other antibiotics, I.V. fluids for hydration, Blood products

• Prescription of immunization
• Arrangement of medications refills

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 oncology/ hematology/ SCT program through Medical Eligibility/Royal Order.

STAFFING PLAN:

a. Staff members:

·         One Adult SCT Coordinator

·         Five Staff Nurse I

·         One Ward Clerk

·         One Translator

b. Clinic activities

The Adult SCT program has the following clinics per week:

1.       Saturday PM: three post SCT clinics(run by Hematology/ SCT physicians)

2.       Sunday PM: two post SCT clinics (run by Hematology/SCT physicians)

3.       Tuesday PM: three post SCT clinics (run by hematology/BMT physicians)

4.       Daily SCT nurse clinic

The above SCT clinics are focused mainly on post SCT patients.

The average number of patients seen per month is approximately 300.

The following activities take place during these clinics:

• Pre stem cell transplants assessment, evaluation, education, etc
• Clinical assessment and laboratory follow-up.
• Renewal of medications, refills.
• Monitoring of graft-versus-host disease
• Infection Status
• Adequate nutrition,
• Compliance with medication
• Post-SCT general guidelines.

Drop in post SCT patients are seen and evaluated by the SCT team.

The average number of patients seen in SCT Nurse Clinic visits is approximately 600 per month. 

Methods of Adjusting To Staffing Variances:

The adult SCT clinic staff has the responsibility to make sure that enough qualified staff is present in the clinic daily trough out working hours. The adult SCT clinic team works closely with those of the oncology and pediatric SCT clinics 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 base competency yearly.

Continuing education is offered through Nursing Education & Research.

Unit base staff inservices are provided based on identified education needs.

Educational needs are identified through treatment protocols, performance improvement, individual input and survey.

Local/international symposiums, conferences, workshops are posted 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, FAX, e-mail, written memos, and minutes from meetings. 

The adult SCT coordinator has a pager number in case of immediate intervention or needs. 

Describe collaborative interactions with other department:

·         SCT/Hematology Collaborative Practice meeting.

·         Weekly SCT meeting for presentation of SCT patients:

1. New patient for eligibility discussion.
2. Potential candidates for BMT.

·         Weekly meeting with the director of SCT program

·         Monthly meeting with principal investigator and co-principal investigators discussing progress of approved randomized trials.

·         Weekly meeting with the apheresis team

·         Weekly SCT meeting for Oncology patients

·         Weekly Oncology meetings and sign-outs.

·         Daily visits to F3, and B2.

DISCHARGE CRITERIA:

Patients stay on the STC program for life and follow-up can be on a daily to yearly basis.  If patient has a relapse requiring immediate intervention or decision the patient will be seen and evaluated for appropriate management.

Ongoing adult SCT projects include:

·         Transplants in out patient setting

·         Bone marrow Harvest in out patient setting

·         Development of post BMT program and follow/up.

·         To improve patient and family teaching.

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