Guidelines with Intent to Achieve Minimal Level of Sedation for Bone Marrow Aspirate and Biopsy

Abstract

Length of inpatient stay • Stem Cell Dose expressed as CD34+ cells per kg, (target dose vs actual dose given) • Survival at day 100 A key was created to identify the center's expected baseline for days to neutrophil and platelet engraftment and was identified for each transplant type (e.g. autologous vs allogeneic and allogeneic related vs unrelated) and included on the scorecard. Patients whose engraftment times were outside of these target days were highlighted. Stem cell dose expressed as CD34+ cells per kg is an important factor in determining rate of and time to engraftment, so we correlated to CD34+ cell dose. Appendices were later added to the scorecard including: unrealized endpoints and quarterly mortality review. Results: The BME score card is a structured, readable snapshot of the transplant experience highlighting trends and providing critical information for clinical staff, regulators, administrators, and payors. Using an already available Microsoft Access platform allowed for data structuring, complex queries, automation of common events and database management with multiple users. Changes in practice made after reviewing trends on the engraftment score card included refining patient selection criteria, use of the HCT co-morbidity score, and patient discharge guidelines. The score card has greatly enhanced our ability to readily visualize the outcomes of our patients through pro-active review and enabled systematic evaluation and improvement of the quality of care.