QIM20-123: Utilization of a Distress Screening Tool in an Inpatient Hematopoietic Stem Cell Transplant Unit

Authors: Ivana Espinosa APRN- BC 1 , Christina Pozo- Kaderman PhD 1 , Maritza Alencar DNP, MBA, APRN-BC, BMTCN 1 , Jessica MacIntyre MSN, APRN, NP-C, AOCNP 1 , Lisa Merheb LCSW 1 , Elise James LCSW, OSW-C 1 , Abby-Gail Solomon MSW 1 , Michelle Rodriguez Diaz PhD 1 , Sophie Torrents BA 1 and Maria Rueda- Lara MD 1
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  • 1 Sylvester Comprehensive Cancer Center, Miami, FL

Background: Hematopoietic stem cell transplants (HSCT) are potentially curative or can extend long-term remission of hematological malignancies. These procedures have a high risk of morbidity and mortality, thus posing a threat to patients’ mental and emotional well-being. Psychological factors, such as distress, have been found to impact treatment outcomes and survival rates for transplant patients (Foster, 2009; Holland, 2011). Accordingly, we developed a quality improvement project to evaluate the current distress screening process at our HSCT inpatient unit. Methods: At Sylvester Cancer Comprehensive Center, current Psychological Distress Screening Guidelines (PDSG) require social workers to administer a distress screening form within 72 hours of a new patient admission. Social workers conduct clinical interviews and review the distress screening tool (DST) with the patients (see appendix A). The patients who exhibit high levels of distress and provide psychosocial consultation. The initial data consisted of gathering the completed DST during the month of January 2019. It demonstrated a lack of consistency in utilizing the DST. An educational session was provided to the inpatient social workers, which reviewed the current PDSG and documentation process. Post-intervention data was collected for a month to assess compliance. Results: Twenty-four patients were admitted to the Inpatient HSCT unit in January 2019. Data analyses revealed a 67% (N=16) completion rate of the distress screening tool. Post-educational intervention data showed 100% (N=18) completion rate, a 33% increase. Post-intervention data also demonstrated that 38% of patients reported high levels of Distress versus 0.8% of patients admitted in January 2019. Conclusions: Implementation of PDSG and standardization of documentation of DST is instrumental in the identification of patients with high levels of distress. Detecting high levels of distress early during hospitalization facilitates prompt intervention by healthcare providers, which can enhance patient outcomes. Recommendations: Future recommendations include transitioning to an electronic format of the DST within the electronic medical record. Monthly audits can monitor compliance and reveal factors that may be affecting clinical performance. Developing a systematic follow-up or re-evaluation of distress during admission can identify barriers that may interfere with treatment plan or outcomes.

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Corresponding Author: Ivana Espinosa, APRN- BC