Infrastructure required to support delivery of supportive care after intensive chemotherapy in the outpatient setting
| Inpatient management | • Nursing education on treatment, roadmap, expected complications • CVC education and training • Clear written discharge instructions with information for nonurgent and emergent situations • Clear communication with outpatient team |
| Outpatient management | • SOP for CVC care, antimicrobial prophylaxis, transfusion thresholds, management of neutropenic fever • 24-hour phone access to experienced provider in AML for emergencies • Regular care team available for 3 times per week visits and nonscheduled evaluations of symptoms • Infusion center with extended daily and weekend/holiday hours for frequent monitoring and transfusion • Blood bank with large transfusion capability and rapid delivery of blood products to clinic setting • Ability 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 complications • Ancillary support staff with expertise in AML management; nursing, social worker, pharmacists, physical therapists, nutritionists |
| Inpatient management | • Nursing education on treatment, roadmap, expected complications • CVC education and training • Clear written discharge instructions with information for nonurgent and emergent situations • Clear communication with outpatient team |
| Outpatient management | • SOP for CVC care, antimicrobial prophylaxis, transfusion thresholds, management of neutropenic fever • 24-hour phone access to experienced provider in AML for emergencies • Regular care team available for 3 times per week visits and nonscheduled evaluations of symptoms • Infusion center with extended daily and weekend/holiday hours for frequent monitoring and transfusion • Blood bank with large transfusion capability and rapid delivery of blood products to clinic setting • Ability 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 complications • Ancillary support staff with expertise in AML management; nursing, social worker, pharmacists, physical therapists, nutritionists |
AML, acute myeloid leukemia; CVC, central venous catheter; SOP, standard operating policy.
Ref. Halpern and Walter.8