Infrastructure required to support delivery of supportive care after intensive chemotherapy in the outpatient setting
| Inpatient management | Nursing education on treatment roadmap, expected complicationsCVC education and trainingClear written discharge instructions with contact information for nonurgent and emergent situationsClear communication with outpatient team |
| Outpatient management | SOP for CVC care, antimicrobial prophylaxis, transfusion thresholds, management of neutropenic fever24-h phone access to experienced provider in AML for emergenciesRegular care team available for 3 times per week visits and nonscheduled evaluation of symptomsInfusion center with extended daily and weekend/holiday hours for frequent monitoring and transfusionBlood bank with large transfusion capability and rapid delivery of blood products to clinic settingAbility to rapidly evaluate and initiate treatment of neutropenic fever in clinic (eg, antimicrobial cocktail available for rapid administration before hospital transfer)Multidisciplinary expertise (infectious disease, pulmonary) in management of AML and therapy complicationsAncillary support staff with expertise in AML management: nursing, social worker, pharmacists, physical therapists, nutritionists |
| Inpatient management | Nursing education on treatment roadmap, expected complicationsCVC education and trainingClear written discharge instructions with contact information for nonurgent and emergent situationsClear communication with outpatient team |
| Outpatient management | SOP for CVC care, antimicrobial prophylaxis, transfusion thresholds, management of neutropenic fever24-h phone access to experienced provider in AML for emergenciesRegular care team available for 3 times per week visits and nonscheduled evaluation of symptomsInfusion center with extended daily and weekend/holiday hours for frequent monitoring and transfusionBlood bank with large transfusion capability and rapid delivery of blood products to clinic settingAbility to rapidly evaluate and initiate treatment of neutropenic fever in clinic (eg, antimicrobial cocktail available for rapid administration before hospital transfer)Multidisciplinary expertise (infectious disease, pulmonary) in management of AML and therapy complicationsAncillary support staff with expertise in AML management: nursing, social worker, pharmacists, physical therapists, nutritionists |
CVC, central venous catheter; SOP, standard operating policy.