Published on March 10, 2014
Calvary Mater Newcastle Hospital in The Home 10 Years On Colleen Collogan – Registered Nurse HiTH Wendy Johnson – NUM Haematology Unit
Introduction Calvary Mater Newcastle is a regional tertiary referral centre geographically located in Newcastle NSW in the suburb of Waratah within the HNE Local Health District. Specialty Services provided at this centre include: General Medicine including subspecialties in respiratory medicine, stroke, geriatric medicine with acute aged care services Cancer Services including medical, radiation oncology and haematology Cardiac, Emergency, Toxicology and Pharmacology, Alcohol and Drug, Melanoma Unit, Liaison Psychiatry Surgery Medical Centre – ambulatory care for all specialties Outreach Services - Palliative Care, Hospital in The Home Support Services Co-located services (managed by HNE) include Mental Health & Breast Screen
Catchment Area Service is provided within a one hour driving distance from the hospital
Previous Project & Findings A Research Paper was prepared by CMN Haematologists' and Haematology Nurses to investigate the idea of HITH intervention for management of Post autologous Haematologous Stem Cell Transplant (Post AutoHSCT ) for patients with multiple myeloma and lymphoma. This research was published in the Australian Journal of Advanced Nursing in 2006 by Johnson et al. Data Collection Period: March 2001 to June 2003 = 28 months 33 patients underwent AutoHSCT for lymphoma or multiple myeloma at the Hunter Haematology Unit. 13 were treated under the HiTH program (as they complied with the criteria) Ratio 10 males to 3 females (10:3) Average age was 48 The chemotherapy types were also taken into consideration. 9 receiving LACE (Fludarabine, Cytarabine, Dexamethasone) and 4 receiving Melphalan only treatments. 11 of the patients were readmitted to the Calvary Mater with an infection within 7 days of discharge from haematology ward.
Current Project & Findings Metric 2003 Results 2012 Results March 2001June 2003=28mths September 2010 December 2012=28mths 33 54 13 (9 LACE/4 Melphalan) 17 (7 LACE/10 Melphalan) Gender Ratio 10M:3F 14M:3F Mean Age 48 years 59 years 11 (84.6%) 13 (64.7%) 98 119 Data Collection Period Number of Patients who underwent AutoHSCT for lymphoma or multiple myeloma Number of Patients Suitable for HiTH Readmissions Total Number of Haematology patients seen by HiTH
Readmission Rates Since 2001, there has been a 19.9% reduction in re-admission to hospital from the HiTH service within 7 days, for those receiving autologous haematologous stem cell transplantation (AutoHSCT) following LACE or Melphalan treatment. 19.9% n=13 n=17 (Note: The lower proportion of readmissions could just be sampling variability, but it is promising nevertheless).D
Patient Survey Results A survey was mailed out to 60 Haematology patients, asking about their experiences with the HiTH service and sharing care management with the Haematology Day Ward. Respondents were asked what the main benefits of the service for them. Responses included: Able to relax at home and spend time with family and sleep in my own bed. My freedom and being home, plus the comfort of having knowing that nurses were coming to me. Support of family & friends, this helped my recovery. Care and attention given to me outside the hosp helped me prepare for returning home away from the cancer team. ‘Stay in my own home, benefits physically and physiologically. More pleasant to be home with my family during this mentally anxious period and the shock of prognosis as well as the trauma of treatment.’
Haematology Patient Survey Results Start typing n=22 Response Rate: 37%
Case Study: Background Acute myeloid leukaemia (AML) is a type of cancer that affects the blood and bone marrow. AML is characterised by an overproduction of immature white blood cells, called myeloblasts or leukaemic blasts. These cells crowd the bone marrow, preventing it from making normal blood cells.
Case Study: Diagnosis and Initial Treatment September 2009 • • • • • Joe a 53yo male. He presented to his GP with abnormal bruising. Haematologist at the Calvary Mater Newcastle diagnosis AML Joe consented to M12 clinical trial for AML. He had a full dose of chemotherapy induction (Big ICE (Idarubicin + high dose Cytosine arabinoside + Etoposide). • Joe was taken off the M12 trial. Hospital stay 26 days Day Ward + HiTH = 41days HiTH visits =19 Bone marrow biopsy done November 2009 showed Joe was not relapsing. Remission
September 2010 Relapse of AML Blood count dropped and confirmed with a BMB showing 10% abnormal cells. Treated with FLAG (Fludaralaine, Cytarobine, Dexamethasone, Granisetran) chemotherapy to re-induce him into a remission state. Hospital stay = 7days Day Ward and HiTH service = 25 days HiTH visits =11 Joe continued to have blood products, injections, autoimmune drugs and prophylactic antibiotics as an outpatient. November 2010 Day Ward 8 days of FLAG chemotherapy and blood product transfusions. Hospital stay = 0 Day Ward & HiTH = 8 days HiTH visit 1 only
Patient contacts with health services: Inpatient at CMN = 28days total Day Procedures = 6 Emergency Department = 5hrs Out patient shared care Ward 5D = 76 visit. HiTH = 31visits Pathology interventions in excess of 424 Medical Imaging in excess of 26
Case Study: Bone Marrow Transplant January 2012 After visiting a specialist at the Westmead Hospital he is scheduled in for a bone marrow transplant with an unrelated mismatched donor. Late in January Joe receives a bone marrow transplant at the Westmead hospital.
March 2011 The blood count is improving. Bone marrow biopsy demonstrates disease in remission. No longer on immune suppression drugs. Joe returns to work and says “that he now enjoys a gifted life with his beloved wife”. January 2012 to present Persistently elevated Iron level up to 1642. (Normal = 60-170). Osteopenia (identified on bone mineral density). No evidence of graph vs. host. Remains oral antibiotics and calcium replacements. Continue regular venesections.
Acknowledgements: • Wendy Johnson – NUM Haematology Unit • The HiTH Team – Margaret, Stacey, Anne. • Lynne O’Brian – Assistant Director Clinical Services • Mandy Bassos – Administrative Assistant • My children! THANKYOU
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