Adult Blood and Marrow Transplant Program Inpatient Unit — Unit 7 West

The Adult Blood and Bone Marrow Transplant (BMT) Facility is located on the seventh floor of the Cancer Center / South Tower of UF Health Shands Hospital.  The program consists of an inpatient unit, outpatient clinic, apheresis collection unit, and stem cell laboratory.

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 provides care for both the pre and post BMT phase and other hematology / oncology patients. The budgeted bed occupancy is 80% and the budgeted average daily census is 19.8.

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, cellular therapy, and pre- and post- cellular therapy complications.  Types of transplants include: autologous, syngeneic, allogeneic, haplo-identical, or matched-unrelated donor transplants in the form of cord blood, peripheral blood stem cells or bone marrow. We also administer Car T cellular therapy. 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 15.98 days.

Nursing Care

Nursing care is directed toward the 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 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 advanced practice 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.  Weekly patient coordination meetings attended by medical staff, nurses, pharmacists, protocol/research nurses, and transplant coordinators foster collaboration.  There are multidisciplinary daily rounds on the inpatient unit and a weekly interdisciplinary administrative meeting.

The nursing management structure consists of one Nurse Manager and one inpatient Clinical Leader.  Registered nurses and 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.

Staffing Plan

Unit staffing is based upon budgeted nursing hours per patient day (HPPD) which is formulated using national benchmarks and historical unit acuity data.  Daily staffing is adjusted based on unit census and  feedback from charge nurses to account for special circumstances that increase patient acuity, such as the need for a sitters, increased number of 1:1 patients, etc.

Nursing care on the Bone Marrow Transplant Unit is based on the total patient care nursing delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance.  The patient care assistant (PCA) is assigned under the direct supervision of a registered nurse. Support tech (unit clerical/mobility support) coverage is provided 24 hours/day. Skill mix is 86% RN and 14% PCA. The predominant staffing ratio of nurses to patients is 1:3-4 on days/evenings/nights. The charge nurse (CN) frequently takes a modified assignment of 1-2 patients. On all shifts, the CN is available to all staff for consultation and assistance in providing patient care. Patient care assignments are made each shift by the CN as described in the Hospital Plan for Nursing Care. Patient bed assignments are made by the CN and are based upon patient acuity, safety concerns, patient/family requests, monitoring capabilities, and skills required. Patients requiring 1:1 observation as a result of personal safety concerns are assigned a therapeutic attendant who is supplied through the central staffing office or from reassigning unit staff.  Every attempt is made to put 1:1 observation patients close to the nursing station.

The staffing plan is based on a budgeted 11.06 HPPD and acuity of 1.58. Additional staffing needs are met on Bone Marrow Transplant Unit as described in the Hospital Plan for Nursing Care. The Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care and the nursing policy, determines the need for extra shifts/overtime.

In the event of an emergency such as severe weather conditions or other disaster, the minimum amount of staff required to safely operate up to 75% capacity on the inpatient unit would be 5 Registered Nurses, 1 PCA and 1 support tech.

Requests for scheduled time off (STO / PTO) are reviewed on a case-by-case basis and will take into consideration the staffing needs of the unit. Requests are granted only if minimum staffing numbers are maintained with coverage that does not incur overtime.

Staff attendance at meetings, education offerings, and other activities are coordinated so that patient care coverage is continuous.

Reviewed / Revised 2/12/2021