Comprehensive Patient Care

Care of leukemia/bone marrow transplant patients is provided by a multidisciplinary team that includes physicians, nursing staff, pharmacists, social workers, as well as food and nutrition services, psychiatric consultation, pastoral care and occupational/ physiotherapy.

The Program also has three bone marrow transplant co-ordinators and the support of a large network of clerical, administrative and laboratory technical staff.

Health Care Team on Both Units

During the hospital stay there will be a number of people involved in each patient's care. The specialised health care team consists of Bone Marrow Transplant Physicians, Registered Nurses, Pharmacy Specialists, a Chaplain, a Dietician, an Occupational Therapist, a Psychiatrist, a Physiotherapist, and a Social Worker:

BMT Physicians:

Each morning the BMT Physicians review and examine each inpatient, and make any necessary changes to their treatment plan. Patients will meet several BMT Physicians throughout your transplant experience. All BMT Attending Staff and Fellows work in block rotations that change every month. This means that most patients will experience a physician change at some point during their stay. However, the medical care will be consistent regardless of changes in physicians.

Registered Nurses:

Nursing care is delivered via a primary care model. This means that a primary nurse and two or three associates work closely with an individual patient throughout their hospitalisation. In addition to performing specialized care, they help both the patient and family learn about the treatment, and ways to cope with side effects, hospitalisation, and recovery.

When patients are discharged, they will meet the Registered Nurses who work in the Leukemia/Bone Marrow Transplant Day Care on B4 of the Heather Pavilion at Vancouver General Hospital. These nurses perform specialized treatments, monitor patient progress and help patients learn about medications and adjustments during the recovery phase.

BMT Co-ordinators:

There are three Co-ordinators with the Bone Marrow Transplant Program. The Co-ordinators look after many of the details that need to be worked out before the transplant. They are involved in arranging tests, co-ordinating donor searches, and helping patients and donors with travel and accommodation plans. Some patients may have already 'met' one of the Co-ordinators over the telephone.

When a patient arrives in Vancouver and has settled into their accommodation, he/she can call the Co-ordinator's office at 604-875-4831 or 604-875-4939 if there are any questions or simply to provide a current contact phone number.

Dietician:

The Dietician will visit each patient shortly after admission. Nutrition is an important part of overall transplant care. The Dietician will make sure that patients receive good nutrition through regular meals, or through intravenous nutrition if the patient is unable to eat. Throughout hospitalization, the Dietician will see patients on a regular basis to follow progress and make any necessary changes to their diet that will help them through the transplant.

Occupational Therapist:

The Occupational Therapist (OT) focuses on enabling patients to do the things that are important to them. The OT in the Bone Marrow Transplant Program may work with patients to address concerns they have about:

How they will do everyday tasks such as taking care of themselves (washing and dressing)
Participating in meaningful leisure activities
Staying at work while receiving treatment (or returning to work after treatment)

OT services in the Leukemia/Bone Marrow Transplant Program are available to inpatients and outpatients and include educating patients about making the most of their energy, coping with stress and finding ways to relax. The OT can also recommend appropriate custom splints (to decrease pain and improve function), adaptive equipment (e.g. raised toilet seat, bath seat, wheelchair), and can arrange referral to community-based OT services.

Patients can arrange to meet the OT by asking their doctor, nurse, or other team members.

Pastoral Care Chaplain:

A nondenominational, interfaith Chaplain from the Pastoral Care Department is part of the Bone Marrow Treatment team. There is always a Chaplain on call during the night and on weekends for emergencies or sudden needs. These Chaplains are available to assist with the spiritual and religious needs of patients, families, and friends, particularly in times of crisis. Pastoral support, in-depth counselling, and sacramental resources are part of the care provided.

If a patient has not met the team Chaplain within a few days of admission, requests for pastoral care may be made through nursing staff, day or night, or by calling the department directly at 604-875-4151. Patients and their families can get access to specific denominational or faith needs through the team Chaplain. The Chaplain can also provide information about churches, temples and synagogues in Vancouver.

Physiotherapist:

The Physiotherapist is primarily concerned with assisting to maintain the physical condition of patients undergoing treatment. The therapist assesses each individual soon after admission and designs an exercise and activity program based on previous activity level and individual needs.

A patient's progress and program are regularly monitored by the Physiotherapist and adaptations and adjustments are provided if necessary. Treatment may also be provided for any conditions or injuries that would normally need physiotherapy intervention, such as respiratory or musculoskeletal problems.

Psychiatrist:

The Bone Marrow Transplant team also includes a Psychiatrist, a medical doctor who specialises in difficulties with mood, thinking, and coping. Such difficulties can be due to physical factors, psychological factors, spiritual factors, or a combination of these.

Bone marrow transplant patients can experience emotional ups and downs due to the illness itself, medication side effects, and a range of psychological or spiritual issues related to being sick and in hospital for prolonged periods with a life-threatening illness. Upon request, the Psychiatrist will see patients to help identify causes of emotional difficulties and to assist in treatment.

Social Worker:

Social Workers are trained specialists in the area of illness-related problems. They know that serious illness and treatment can bring additional stress into many areas of life, often creating numerous practical problems, along with feelings of frustration, anxiety and grief. Social workers respond to the needs of patients and their families by offering services such as:

Emotional support at the time of diagnosis or medical/psychological crisis.
Support in times of decision-making, discharge planning and with transition to the outpatient setting.
Support groups for patients and family caregivers to discuss feelings, coping tips, concerns and successes.
Information for children and families coping with illness
Relaxation and guided imagery.
Information about and referral to community resources
Financial information.
Accommodation for patients and families from out of town
Patient and family ward tours.

Pharmacy Specialists:

Drug therapy in Leukemia/Bone Marrow Transplant patients can be complicated. Patients are usually on multiple drugs at any one time and side effects are not uncommon. Some drugs (e.g. antibiotics, cyclosporine) need to have blood level monitoring to ensure that each patient is receiving the appropriate dosage.

Pharmacy Specialists are assigned to work on the Leukemia/Bone Marrow Transplant Unit and assist the physicians in selecting drugs and their doses. These individuals are also available to discuss with patients the drugs, their side effects, and their times of administration. This is particularly useful prior to commencing a new chemotherapy treatment or just before leaving hospital after chemotherapy or a transplant.

Oral Medicine:

All patients on the Leukemia/Bone Marrow Transplant Unit are seen by the Oral Medicine team, which includes a dentist and an oral hygienist. Subsequent visits depend upon whether a patient has developed soreness or inflammation in their mouth. The mouth normally contains bacteria and infection is a common problem in the mouth and around the gums (gingiva) when infection-fighting cells are reduced by chemotherapy or radiation, which can also directly damage the mouth lining. Leukemia/Bone Marrow Transplant patients utilise mouth rinses routinely to combat this problem.