Cedars-Sinai’s Samuel Oschin Comprehensive Cancer Institute

TON - September 2012 VOL 5, NO 8 — October 9, 2012

Blood and Marrow Transplant Program

The Blood and Marrow Transplant Program was established at Cedars-Sinai’s Samuel Oschin Comprehensive Cancer Institute in 1991 to provide stem cell transplants to patients with breast cancer. The program fell into a lull when transplant was proven ineffective for breast cancer, but about 10 years later it had a resurgence under the directorship of Michael Lill, MD, who joined the center in 1997. In 2002, the first allogeneic transplants were performed there. Now the program has grown to include 6 medical doctors and 6 nurse coordinators. An expected 140 transplants will be performed in 2012. The largest group of transplant patients is those with multiple myeloma, followed by those with lymphoma and leukemia.

The program is widely respected for its commitment to excellence in patient care. A complex array of services is available through the program, including diagnosis, screening, pretransplant preparation, postdischarge care, and counseling for recovery and nutrition. Cedars-Sinai was ranked once again as one of America’s Best Hospitals for cancer care in 2012-2013 in US News & World Report.

The Oncology Nurse-APN/PA spoke with Anne Rosenblatt, RN, MSN, lead clinical program coordinator and quality assurance coordinator of the Blood and Marrow Transplant Program about her center and her role.

What is the approach to managing patients at Cedars-Sinai’s Blood and Marrow Transplant Program?

Anne Rosenblatt (AR): Our ap­proach is patient focused and family focused. We have developed materials for patients about to undergo transplant, and our goal in developing these is to empower both the patient and the caregiver as they go through the journey from pretransplant, to transplant to home care. The materials, developed by another nurse coordinator here, Laura Snoussi, RN, BSN, OCN, were written so as to tease out key points for safety and compliance throughout the treatment plan.

The first 2 books are Autologous Blood and Marrow Transplant 1 and 2. Book 1 deals with pretransplant, and Book 2 deals with management from admission to discharge. Laura has finished writing the next 2 books on allogeneic transplant, and that series is in production.

I picked Laura to write these materials for patients and families because I knew she was a good writer and could provide a reader-friendly format, drilling down to the most important messages about the transplant experience at our center. The books are colorful and will appeal to readers from all walks of life.

What is your role at the Blood and Marrow Transplant Program?

AR: I came here 3 years ago to be lead nurse coordinator of the program. Before my time, there was no supervisor. I was hired to be the quality assurance person. This means having the entire team report any problems to me, and then we look at how care can be improved. For example, we might look at whether the patient is getting the appropriate blood tests as frequently as she/he is supposed to. If the tests are not being given as recommended, then we try to address the problem and try to fix it.

How does this translate to better patient outcomes?

AR: We use national benchmarks for transplant centers to determine whether our center meets these benchmarks, but we don’t just try to meet the benchmarks, we try to do even better. For example, if the national benchmark for hand washing is 80%, we want to do it 95% of the time. Of course, some of our outcomes do not need to be improved. We belong to the University Health Consortium, and we compare ourselves with transplant centers that have the same patient volume.

What inspired you to enter the field of oncology nursing?

AR: I have been a nurse for 42 years. I was put into a staff position in oncology and witnessed how the field is changing and how many people are being cured of cancer. It is exciting to be part of a burgeoning field, and our center is implementing innovations. For example, we are 1 of only 2 transplant centers in the world that provide a bloodless transfusion program for Jehovah’s Witnesses. Dr Michael Lill, head of the Blood and Marrow Transplant Program here, has devised a way to treat Jehovah’s Witnesses with advanced leukemia that encompasses their religious beliefs.

What is another innovative feature of your program?

AR: We are not affiliated with a university, but we have academics on our staff who were trained at the best universities in the country. We collaborate with academics and community physicians on patient management. This feature is part of what makes our program so good.

What are you excited about in the transplant field right now?

AR: For one thing, our quality assurance program. For another, our staff members are passionate about their work. Eighty percent of our coordinators have been here for less than 6 years, and they have new ideas. We are now performing more allogeneic transplants, and these are the most complex and most interesting types of transplants. We can now use umbilical cord blood for transplants, and we are working on haplotypes. These developments allow more types of patients with different cancers to undergo transplant.

What work would you be doing if you were not an oncology nurse?

AR: That is a crazy question. I wouldn’t consider doing anything else. The field is exciting. We are growing quickly and getting better at doing transplants and becoming more well known. A unique feature of working here is having a great team and great teamwork. There is a meshing of roles, and we all share ideas. When I came here, one of our newer nurses taught me about aspects of coordination, and I taught her about management.

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