Rivera, Z.R.

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Co-morbidities aging population on the rise 

bocytopenia that is refractory despite twice-daily platelet tranfu-
sions and a high risk for bleeding. The purpose of this abstract is
to describe the indications, risks, beneﬁts, and nursing challenges
associated with continuous platelet drips.
287
THE DUKE PEDIATRIC STEM CELL TRANSPLANT SAFETY PROGRAM: AN
INITIATIVE TO REDUCE RISK AND IMPROVE PATIENT OUTCOMES
Frey, M.A.1,2, Talbert, G.1,2 1. The Duke University Children’s Hos-
pital, Durham, NC; 2. The Duke Pediatric Stem Cell Program,
Durham, NC
The development of innovative and progressive treatment op-
tions can greatly increase the risks to patients. Complex treatment
plans become more difﬁcult to administer in light of a regional and
national nursing shortage. Many transplant programs struggle with
recruiting and retaining top talent. Nowhere are safety concerns
more apparent than in the treatment of pediatric bone marrow and
stem cell transplant patients. The Duke Pediatric Transplant Pro-
gram typically treats high risk patients. The 16 bed inpatient unit
runs an occupancy rate of over 90%. The nurses on this unit
provide many high risk (and sometimes low volume) procedures
that require specialized training and a heightened awareness of
safety precautions. The unit administers more than 18,000 medi-
cations and 500 blood products per month. Nurses on Duke’s
Pediatric Stem Cell Transplant unit administer high dose chemo-
therapy, blood products, antibiotics, anti-GVHD medications,
parenteral nutrition and other supportive drugs. Additionally, the
program provides intensive care measures that require a specialized
care delivery model. The purpose of this poster will be to outline
the inherent risks associated with pediatric stem cell transplanta-
tion. In 2003 The Duke Children’s Hospital began a Patient Safety
Initiative. The goals of the program are to identify high risk
procedures and therapies and to develop and implement a plan to
minimize or eliminate the risk to the patient. The major goal of
this poster will be to describe the safety measures implemented for
this high risk population. Included in the discussion are safety
checks, staff training and competencies, and equipment safety. All
safety initiatives are monitored on a monthly basis and reviewed by
leadership at all levels within the organization. This information is
also presented to staff at the unit level for feedback and recom-
mendations for change if needed.
288
CO-MORBIDITIES AGING POPULATION ON THE RISE
Rivera, Z.R. University of Texas MD Anderson Cancer Center, Hous-
ton, TX
Bone Marrow Transplantation (BMT) is a specialty area in On-
cology that is challenging in many aspects for nurses. In addition to
post transplant issues is the nursing management of BMT patients
with co-morbidities. Nursing implications are tremendous in car-
ing for patients who are older, acutely ill, or have functional
limitations.
According to Healthy People 2010 the initiatives set are to
increase quality of life and decrease health disparities. Predictably,
the aging population will result in increased incidence of chronic
diseases including cardiac issues and cancer. Offering BMT to
older patients is increasing because of the advent of less toxic
regimens, we are not just dealing with one chronic condition. By
2010 estimations state there will be 40 million Americans age 65 or
older. The average rates of cardiovascular events rise from 7 per
1,000 men ages 35-44 to 68 per 1,000 men ages 85-94 with
narrowing gaps with advancing age and comparable rates occur 10
years later in life for women (NHLBI Framingham Heart Study).
An increased incidence of end-stage renal disease has been noted in
the elderly aged 70-74. As is evident by some of these statistics,
Americans are sicker compounded with more ailments resulting in
hospitalizations and prolonged medical treatments.
Age related chronic diseases have potential to impact the treat-
ment course for BMT recipients. Research shows that common
co-morbidities are cardiovascular, respiratory, renal, or endocrine
related. Shahjahan et al. has documented retrospective data at our
center studying effects of co-morbidity in AML/MDS patients.
Critical management of these patients with their age related
conditions is essential in preserving quality of life. It is important
to know contributing factors in patients’ history and to maintain
current knowledge related to the management of these co-morbid
conditions. Responsibility lies among all members of the team,
especially the nurse giving direct patient care.
Transplant Nursing
102


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Co-morbidities aging population on the rise

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