Letting Kids Be Kids: A Quality Improvement Project to Deliver Supportive Care at Home After High-Dose Methotrexate in Pediatric Patients With Acute Lymphoblastic Leukemia [Formula: see text].
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引用次数: 7
Abstract
The Children's Oncology Group recommends children with high-risk acute lymphoblastic leukemia (ALL) receive high-dose methotrexate (HD MTX) throughout treatment. Historically, patients have been hospitalized for at least 54 hours for HD MTX. Literature supports the safety and efficacy of the transition of supportive care interventions of intravenous (IV) fluids and leucovorin to ambulatory care. The goal of this quality improvement (QI) project was to implement a system to support the safe delivery of supportive care in the home after inpatient HD MTX in children with high-risk ALL. An interdisciplinary team implemented system changes including an ambulatory supportive care protocol, standard computerized order sets, family education, and education of staff in the inpatient, outpatient, and home care setting. Measurements included laboratory results of renal function and medication clearance, length of hospitalization, and family-reported quality of life. During project implementation, 10 patients completed a total of 38 cycles. The system safely and effectively supported transition to the outpatient setting for all patients. Average length of stay was decreased by 37.8 hours per HD MTX cycle. Families reported that quality of life improved in most domains with family time and sleep having largest improvement, while level of stress remained the same. Ambulatory monitoring post-HD MTX requires a multidisciplinary approach to meet individualized patient needs. Future QI efforts should consider outpatient administration of HD MTX in addition to supportive care as a means to improved quality of life.
儿童肿瘤组织建议高危急性淋巴细胞白血病（ALL）患儿在整个治疗过程中接受大剂量甲氨蝶呤（HD MTX）治疗。一直以来，患者住院接受 HD MTX 治疗的时间至少为 54 小时。文献支持将静脉输液和亮菌甲素等支持性护理干预措施过渡到非卧床护理的安全性和有效性。本质量改进（QI）项目的目标是实施一套系统，支持在高危 ALL 患儿住院接受 HD MTX 治疗后在家中安全提供支持性护理。一个跨学科团队实施了系统改革，包括非住院支持性护理方案、标准计算机化医嘱集、家庭教育以及对住院、门诊和家庭护理环境中的工作人员进行教育。衡量标准包括肾功能和药物清除率的化验结果、住院时间以及家属报告的生活质量。在项目实施期间，10 名患者共完成了 38 个周期的治疗。该系统安全有效地支持了所有患者向门诊环境的过渡。每个 HD MTX 周期的平均住院时间缩短了 37.8 小时。据患者家属报告，他们在大多数方面的生活质量都得到了改善，其中家庭时间和睡眠改善最大，而压力水平则保持不变。HD MTX 治疗后的非住院监测需要多学科方法来满足患者的个性化需求。未来的质量改进工作除了支持性护理外，还应考虑在门诊使用 HD MTX，以此提高生活质量。
期刊介绍：
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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