Making inpatient cancer care better for patients and caregivers
Kurt Holtzer never had a problem racing up multiple flights of stairs to respond to code calls for his job at Penn State Hershey Medical Center. But when he couldn’t climb a single flight without doubling over to catch his breath in May 2012, he knew something was wrong.
After an initial diagnosis of asthma, and a battery of tests that lasted several weeks, he was diagnosed with myelogenous leukemia and myelofibrosis, as well as a genetic mutation putting him in a high-risk category for survival. Without treatment, doctors gave him three months to live.
“I had recently lost my mother to lung cancer,” he says. “Having seen how my mother dealt with the chemo regimen, I didn’t want to go through that.” Because of his wife, Julie, and two children, he decided to do it: “I wasn’t ready to let go of her and the kids.”
So, on Memorial Day of last year, the life he had known ceased to exist. He fought fear, worry, and trepidation during nine rounds of chemotherapy, nine bone marrow biopsies and a stem cell transplant.
Holtzer’s cancer went into remission this spring, and he is back at work as a supervisor for the medical center’s biomedical team.
Each Friday, he takes his lunch break at 11 a.m. so he can take part in a weekly music and physical therapy program in the new inpatient adult cancer unit on the seventh floor. He shares his story, talks with others, and assures them he does understand what they are going through.
“It’s nice to have an advocate who has been through what you are going through – someone to cry with, yell at, share with and laugh with,” he says. “If the whole purpose of this diagnosis was to change me as a person and allow me to be there for others going through this, I would do it again all over again.”
During grand opening ceremonies for the new inpatient adult cancer unit in September, Holtzer was the first to ring a bell mounted on the wall of the seventh-floor rotunda that symbolizes a milestone in the journey that cancer patients travel: “Ring this bell. Three times well. It’s toll to clearly say. My treatment’s done. This course is run. And I am on my way!”
The now-widespread tradition of ringing out gives patients a way to celebrate the end of chemotherapy or radiation – or whatever milestone they have been working to reach.
Michelle Kopp, nurse manager for the new inpatient unit says it’s important that adult cancer patients can be together in a dedicated unit for the first time in the hospital’s recent history.
Until the new unit opened this fall — after pediatrics moved to the freestanding Penn State Hershey Children’s Hospital and the floor was renovated — inpatient cancer patients were scattered between among units on two different floors.
Kopp says it’s common, although far from ideal, for oncology and hematology patients to be scattered among medical surgical patients in many hospitals.
“Oncology patients need oncology nurses who have special training to give chemo and bio therapy,” she says. Oncology nurses also get trained in fundamentals of blood and marrow treatments and things like side effect management, quality of life and the psycho-social aspects of survivorship.
“Here, patients can interact with others who are going through similar things,” Kopp says. “And being together as one staff is really important for morale.”
The new unit includes three wings of patient rooms with new beds and large televisions, including 20 with specially filtered air that creates a protective environment for bone marrow transplant patients. Its location high above the hustle and bustle of regular hospital traffic also helps immunosuppressed patients stay infection-free.
Two larger rooms with pull-out sofas, a kitchenette, table and chairs can accommodate patients with larger families. A family lounge at the end of the north wing offers space for group gatherings and a place for family members to read, watch movies, play games or relax on a couch with a cup of coffee while staying close to their loved ones in treatment.
A patient education room in the rotunda provides books, pamphlets, magazines and Internet resources for patients to learn about their condition, as well as ways to manage life with their diagnosis once they go home.
“Because our patients might stay anywhere from a week to a month or more, we try to make it like a home away from home,” Kopp says.
One of the most popular features is slushy machine. “One of the most common side effects of chemotherapy and radiation is that their mouths get sore, so that is a big thing,” she says.
Caregivers are also enjoying having a dedicated unit. “It increases interactions and casual conversations that don’t happen when you are in different areas of the hospital,” says W. Christopher Ehmann, a hematologist/oncologist at the Cancer Institute. “That leads to better patient care because even with our modern tools of communication, conversations are still the best way to communicate.”
Nurse stations in the middle of each hallway allow nurses to do their work where they care for patients and provide easy access to drinks and ice water, supplies and medication. They can also send samples to the lab or get chemo for patients right from the rotunda, without taking an elevator and leaving the unit.
An electronic display in the rotunda makes it easy to track which providers are assigned to each patient, and two rooms for physician charting help keep the hallways clear.
The conference room is a convenient place for caregivers to meet to collaborate, and a family consult room provides privacy for important conversations. “Sometimes, I think it is even harder for the caregivers,” Holtzer says. “We all need each other.”
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