Demonstrating Efficacy of CHG Bathing Treatment for Inpatient Adult Hematopoietic Stem Cell Transplant Recipients Improves Daily Compliance Among Staff

Abstract

Topic Significance & Study Purpose/Background/Rationale: Delayed discharge negatively impacts patients, staff, hospitals and their interrelationships. Within an NCI-designated Cancer Center in the Southwest United States, an inpatient stem cell transplant (SCT) unit observed discharge delays that can impede patient throughput and access to care. To streamline the process, an interprofessional team collaborated to identify discharge barriers, implement process flow changes and develop standardized teaching tools to improve time of discharge among hospitalized SCT patients. Methods, Intervention, & Analysis: An interprofessional nurse-led team consisting of SCT nurse leaders, advanced practice registered nurses (APRN) representing the medical team, and clinical pharmacists collaboratively identified several opportunities for workflow improvement, including: (a) streamlining nursing and APRN discharge education to reduce duplicity (b) integrating discharge teaching by APRNs and clinical pharmacists during the rounding period rather than after rounds, which was often in the afternoon; (c) improving communication between nurses and medical teams, insuring timely administration of electrolytes, blood product replacements and/or antibiotics. The initiatives included 1. Creating standardized discharge teaching materials for autologous and mobilization patients by consolidating APRN and nursing discharge teachings. This enabled APRNs to delegate their discharge teachings to nurses and provided free time for APRNs to assist clinical pharmacists in medication reconciliation and teaching. Clinical Nurse Leaders (CNLs) collaborated with APRNs to educate nursing staff about these changes. 2. APRNs serve as liaison to communicate anticipated discharges with CNLs on a daily basis, and conduct teaching prior to discharge. 3. APRNs collaborate with CNLs and nursing informatics to develop "day of discharge orders". This would prompt nurses to draw labs at midnight instead of 4 am and initiate necessary replacements sooner. Findings & Interpretation: After 3 months of the initiative, the units have seen average discharge time improve from 3:00 PM to 2:00 PM. Discharge teaching tools are incorporated into the electronic health record (EHR), readily available to nurses, and printable along with other discharge materials. "Day of discharge orders" are currently available in the EHR. Discussion & Implications: Proactive planning and care coordination can improve time of discharge. Enhancing our practices and leveraging resources such as the EHR can support more efficient discharge processes that lead to improved throughput and efficiency.