(24) Will a Small Change Make a Big Difference?

Title: In pediatric stem cell transplant patients, does promoting enteral feeds compared to
TPN alone reduce length of stay post-transplant?

Abstract : Evidence suggests promoting enteral feeds in BMT patients versus using parenteral feeds alone may improve patient outcome. Historically our institution did not have standardized guidelines for promoting enteral feeds in BMT patients, and the use of enteral feeds in the BMT recovery period was sporadic. Implementing a standardized multidisciplinary plan of care supported by the practitioners, bedside nurses, registered dietitians, and Child Life Therapists ensures every patient potentially benefits from the process.
Initially the conception of a process change was presented to the multidisciplinary team to identify potential barriers. A set of guidelines and an algorithm were adapted from an established process at an outside facility based on the team’s feedback, analysis of available research data, and current practice. A proposed plan of care was presented to the BMT physicians and multidisciplinary team for approval. Education was provided to bedside nursing prior to implementation, with guidelines available for review at the nurse's station and electronically. Nursing education was reinforced with regular check-ins with bedside nursing.
Data from the previous 4 years prior to implementation was collected for comparison. 45 transplants, consisting of 27 allogeneic transplants and 18 autologous met the criteria for our comparison. Prior to implementation 44% of BMT patients in the previous 4 years had enteral access in the post-transplant recovery period, 37% had enteral access no later than Day +1. The average length of stay post-transplant for patients with enteral access no later than Day +1 was 51.29 days, and the length of stay for patients who did not have enteral access on or before Day +1 was 49.96 days. Since implementation in Q3 of 2024, 80% of patients have had enteral access no later than Day +1 post-transplant with and average length of stay of 37.5 days post-transplant.