Understanding the Many Facets of a Blood and Marrow Transplant (BMT) Team Registered Nurse Role in an Ambulatory Clinic

Topic Significance & Study Purpose/Background/Rationale: Our Clinic is part of a NCI-designated cancer center performing nearly 500 blood and marrow transplants (BMT) a year. Our standard is to care for BMT patients in the outpatient department; hospitalization occurs with patients, pre-transplant who have multiple co-morbidities, and post-transplant for symptom management. As a result, patient acuity in the outpatient clinic is generally high. We operate 7 days a week with a "Team" concept of Advanced Practice Provider and Team nurse caring for 15-20 patients, and Attending physician with oversight of 2-3 teams. Nurses see patients in twice weekly team visits and multiple independent visits for clinical assessment and teaching. The role of the nurse is currently defined by the scheduled clinic visits, but the responsibilities of care coordination are labor intensive, occur throughout the day and are undefined. Nurses attribute much of their non-patient facing time to responding to phone calls and pages from patients, caregivers, home infusion agencies, research coordinators, lab and pharmacy. Nurses answer daytime phone calls immediately or retrieved from voice mail. Patients with urgent concerns call directly to Reception and are transferred live to the Triage Nurse for immediate response. Data analysis of after-hours BMT Triage calls revealed that most were medication related, but no data existed for daytime calls. Responding to patient needs is crucial to best practice, and a project was undertaken to assess calls to Team nurses. Methods, Intervention, & Analysis: Daytime phone data collection was implemented with Team Nurses. Calls were tracked manually for 7 consecutive days for multiple variables, including length, time, and topic of call. We hypothesized that most calls from patients or home agencies could be recorded and responded to at a later time. The data will be reviewed for deficits in answering live and barriers to prompt response. Issues will be separated into nursing and non-nursing topics for further evaluation. Findings & Interpretation: Data analytics provided the call numbers, length, and time of day for the same 7 days. Calls came at the busiest clinic times and preliminary results indicate most calls can wait for a response. However, there are significant medication questions and symptom management issues that are time-sensitive and need an immediate response. Discussion & Implications: Our preliminary data necessitated an immediate intervention. We revised the Team nurse recorded message to include an automated option that allows callers with urgent needs to connect directly to the Triage Nurse. Further review of the data will allow us to discover if there are non-nursing activities that can be transferred to other personnel to allow the BMT nurse greater capacity to manage care of complicated BMT patients. Continuing to refine nursing responsibilities will allow BMT nurses to function at the top of their license and support best outcomes for all BMT patients.