Korie Bigbee, DNP, MSN, RN, ANP-C

Abstract:

Background: There have been remarkable achievements and advancements in bone marrow transplant (BMT), also known as hematopoietic stem cell transplant (HSCT), for the treatment of hematologic cancers. Stem cell advancements have improved overall HSCT survival rates and have contributed to HSCT’s ability to be a potentially curative treatment. With patients surviving longer after HSCT, attention to transplant-related late complications is needed. These complications significantly influence the quality of life (QoL) and morbidity and mortality. Objectives: This study assesses quality metrics of HSCT survivorship care and the need for a standardized operating procedure to guide long-term follow-up care in the hematopoietic stem cell transplant survivor, according to National Marrow Donor Program (NMDP) guidelines. Methods: A retrospective chart review utilizing a convenience sample was conducted to assess patterns of survivorship care delivered to patients at the one-year post-transplant timepoint. The chart review focused on care metrics related to three organ systems (cardiac, pulmonary, and endocrine), which were chosen based on their level of impact and potential organ toxicity. Documentation of care provided was compared to the NMDP recommendations for the three organ systems to illustrate the consistency of care delivered and to identify opportunities to improve guideline-concordant care. Twenty-four metrics were collected and analyzed, some were pertinent to all three systems, but five were cardiac specific, four were pulmonary specific, and seven were endocrine specific. Results: Of the 100 charts reviewed, two-thirds (70.1%) did not receive a DEXA scan, 76.3% did not have pulmonary functions tests performed, and 61.9% of the charts reviewed did not have an echocardiogram (ECHO) or an electrocardiogram (EKG). Conclusions: The results indicate a need to augment current practice in HSCT survivorship care. A standard operating procedure (SOP) may help to ensure that follow-up care is systematically delivered and reflects the NMDP recommendations. Future work will use these findings to inform the development and implementation of an HSCT SOP. 

Click here to see the full manuscript.