Bone Marrow Transplant Program

Description of Unit

The Adult Blood and Bone Marrow Transplant (BMT) Facilities are located on the seventh floor of the UF Health Shands Cancer Hospital and consist of an inpatient unit, outpatient clinic and apheresis collection unit. The stem cell laboratory is co-located on the seventh floor UF Health Shands Cancer Hospital and the fourth floor UF Health Shands Hospital with long term storage off-site. The inpatient unit (7 West) has twenty-four private rooms with bedside cardiac and pulse oximetry monitoring capability. All rooms are HEPA filtered and can be positive air flow rooms. Two negative air pressure rooms are available. An adjacent outpatient clinic providing care for both the pre and post BMT phase and other hematology / oncology patients is on 7 East. The outpatient clinic consists of 10 examination rooms, 3 procedure rooms, 12 chairs in an infusion center, 4 apheresis stations for both stem cell collection and photopheresis, and a stem cell lab. Current hours of operation for the clinic are Monday through Friday from 8:00 a.m. – 4:30 p.m. with additional weekend hours based on patients’ needs. Average bed occupancy on the inpatient unit is 90%. The outpatient unit maintains an average of 750 visits per month and approximately 27 apheresis procedures per month.

Description of Patient Populations

Admissions come as pre-scheduled appointments from: the Bone Marrow Transplant outpatient clinic, the Emergency Department, in-hospital transfers, and hospital-to-hospital referrals. Patients are admitted to the unit for chemotherapy, stem cell transplants, and pre- and post- transplant complications. Types of transplants include: autologous, syngeneic, allogeneic, halpoidentical, or matched-unrelated donor transplants in the form of cord blood, peripheral blood stem cells (PBSC), or bone marrow. Patients are treated for a variety of hematological, oncological, immunological, malignant, and metabolic disorders. The population includes patients 18 and older. The average length of stay is 14 days.

Nursing Care

Nursing care is directed toward provision of the full range of transplant care including prevention and treatment of complications by focusing on assessment, nursing diagnosis outcome identification, planning, treatment, and evaluation of patients requiring inpatient care. Nursing care activities include: comprehensive care of all body systems, assessment and treatment of comfort (pain, nausea/vomiting, temperature imbalance), treatment of fluid and electrolyte abnormalities, administration and management of intensive medication therapies (antibiotics, antivirals, antifungals, growth factors, chemotherapy, immunoglobulins ,immunosuppressants, biological response modifiers, and blood products), and early intervention and treatment of common complications/side effects of transplant including mucositis, bowel changes, myelosuppression, graft-versus-host disease, hemorrhagic cystitis, veno-occlusive disease, tumor lysis syndrome, and sepsis. Nurses also provide ongoing education for the patient and their family/caretakers.

Health Care Team

The Bone Marrow Transplant Medical Director (Dr. J.R. Wingard) is appointed by the Chief of Hematology/Oncology Division. The Medical Director is board certified in medical oncology. Bone Marrow Transplant medical team consists of attending physicians, fellows, physician assistants, and nurse practitioners. Patients are cared for by a multidisciplinary team consisting of the medical team (physicians and midlevel providers), registered nurses, patient care assistants, support techs, transplant coordinators, pharmacists, respiratory therapists, physical therapists, occupational therapists, social workers, registered dieticians, chaplains, patient and family service representatives, case managers, and the Arts in Medicine program. Collaboration is fostered by weekly patient coordination meetings attended by medical staff, nurses, pharmacists, protocol/research nurses, and transplant coordinators. There are multidisciplinary daily rounds on the inpatient unit and a weekly interdisciplinary administrative meeting. Outpatients are cared for by an outpatient attending physician and 3 – 4 mid-level practitioners along with a team comprised of registered nurses, apheresis technicians and ancillary staff.

The nursing management structure consists of one Nurse Manager, one inpatient Clinical Leader and one outpatient Clinical Leader. Registered nurses, patient care assistants provide bedside nursing care. Support techs provide clerical support for the direct patient caregivers and patient mobility support. The registered nurse is responsible for guiding care of the patient based upon their individualized plan of care.

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