Care of Heme/Onc patients on General Pediatric floor

[littlepeoplern]

I work on a small general inpatient Pediatric Unit which is growing. We care for patients with general to IMCU acuity levels as long as they do not require tele monitoring (higher level patients are generally respiratory, seizure, suicide precautions, etc) We are now starting to accept Heme/Onc patients (so far only ALL patients with fever) and working on developing order sets, how to educate staff, etc. Does anyone else care for these patients on a general floor, and if so, what advice can you give us as we develop our care standards for these patients. We have a wonderful multidisciplinary team and want to make sure we give good, appropriate care as well as good education to our staff. Love any advice you can provide! Thank you so much!

[Buckeye.nurse]

I would start with focusing on neutropenic precautions. There are some great guidelines on ONS, as well as the Leukemia and Lymphoma Society. The latter has great educational materials for patients/families as well.

Basics are no fresh fruits or vegetables, no live flowers, no sick visitors/masking, and a mask on the patient at all times when they leave the room.

Fever in neutropenic patients (any temp > 100.4) is a medical emergency. We pan culture, and give stat broad spectrum antibiotics within 1 hour.

ONS should have guidelines for the care of thrombocytopenic patients as well. We educate our patients on mouth care, monitor for signs of bleeding, don't give heparin to anyone with a platelet count

It's worth saying that anyone who has received chemo within 48 hours should be on chemo precautions. Take a look at the websites I mentioned, and best of luck as you develop your care standards!

[littlepeoplern]

Thanks, this is really helpful and validation of where we're focusing :)