Reply To: Day 4 Induction Discharge for pediatric patients with Acute Lymphoblastic Leukemia (ALL)

  • Janet DeJean

    Member
    August 16, 2021 at 12:22 pm

    At your centre, what is the current practice for newly diagnosed pediatric ALL patients in Induction therapy:
    1) Discharge on Day 4, Day 8, or keep to end of induction (this was our historical standard)?
     The patients may leave on Day 4 if they meet the criteria for discharge (resolved tumor lysis, taking all PO meds without any issues, etc)
    2) Has your centre moved to earlier Day of Induction discharge? If so, what day? What has been the experience with this change (i.e. any quick readmissions for F&N, CVL issues, side effects of chemo requiring readmission, etc.)? 
    Day 4 is the earliest for discharge.  We do have readmission during induction, but not usually prior to Day 8.
    3) Wait until CVLs have been inserted before discharging home? No
    4) Administer first dose of pegaspargase prior to discharge home?
    Yes, they get it and are discharged home after observation period.
    5) Do you ensure Day 8 LP is completed prior to discharge home?
    No.  If the patient is able they are discharged on Day 4
    6) Ensure that new diagnosis teaching has been complete prior to discharge? If so, who does the teaching and when is this done? 
    Yes, all new diagnosis teaching is complete prior to discharge.  The bedside RN is responsible for doing the new diagnosis teaching.  The Central Line RN will help with teaching about line care, but it is reinforced by the bedside RN.  As the Clinical Specialist, I will discuss line care, CLABSI, and hygiene when I do my rounds.

    Please let me know if you need anything else. 

     

    Janet DeJean, MSN-Informatics, RN, CPON

    Clinical Specialist

    Texas Children’s Cancer & Hematology Centers

    Texas Children’s Hospital

    6621 Fannin Street |B.0780.18 | Houston, Tx  77030 

    (: 832-822-4870 | Ê: 832-825-4557

    Voalte: 3-4312 | *jrdejean@texaschildrens.org

     

     

     

     

     


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    ——————————————-
    Original Message:
    Sent: 8/16/2021 9:28:00 AM
    From: Emily Fulford
    Subject: Day 4 Induction Discharge for pediatric patients with Acute Lymphoblastic Leukemia (ALL)

    Hello All,
    We are currently conducting a quality improvement project to review the feasibility of Day 4 Induction Discharge for Newly Diagnosed Pediatric Patients with Acute Lymphoblastic Leukemia (ALL). Our current stardard is to discharge these patients on Day 8 after receiving pegaspargase, LP for IT MTX, and central venous line (CVL) insertion.

    At your centre, what is the current practice for newly diagnosed pediatric ALL patients in Induction therapy:
    1) Discharge on Day 4, Day 8, or keep to end of induction (this was our historical standard)?
    2) Has your centre moved to earlier Day of Induction discharge? If so, what day? What has been the experience with this change (i.e. any quick readmissions for F&N, CVL issues, side effects of chemo requiring readmission, etc.)?
    3) Wait until CVLs have been inserted before discharging home?
    4) Administer first dose of pegaspargase prior to discharge home?
    5) Do you ensure Day 8 LP is completed prior to discharge home?
    6) Ensure that new diagnosis teaching has been complete prior to discharge? If so, who does the teaching and when is this done? 

    ——————————
    Emily Fulford, NP-Pediatrics, MN, CPNP-PC
    SickKids – Leukemia & Lymphoma Program
    ——————————