Shai-
Thanks for your prompt and excellent reply!
I just printed the reference article and will be handing it out to my PT/OT
colleagues for review. I also appreciate the challenges that you saw, “reading
between the lines” in relationship to our RN colleagues.
Thanks again,
Allison
[cid:image001.png@01D67170.65FC55C0]
Allison Brookins, PT
Clinical Educator
Acute Care SCCE
St. Luke’s Health System
• 208-381-1100, ext 7953001
208-381-2090
(best call reception)
• brookina@xxxxxxxx<mailto:brookina@xxxxxxxx>
From: aptaoncology-bounce@xxxxxxxxxxxxx <aptaoncology-bounce@xxxxxxxxxxxxx> On
Behalf Of Shai Sewell
Sent: Wednesday, August 12, 2020 7:44 PM
To: aptaoncology@xxxxxxxxxxxxx
Subject: [aptaoncology] Re: Oncology Lab Values Reference
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Thanks so much for your question. I think it’s a very important one, and one we
don’t necessarily have concrete answers to, although we do have some pretty
good evidence.
I think there are some things going on here that are tough to address, like the
possibility that the nursing staff doesn’t want to ambulate with patients and
therefore trying to get PT to do it when it may be contraindicated, or when we
have more skilled services we can provide. But I don’t want to assume that is
what’s happening so having said that let's dive in.
There are acute care guidelines for a reason. While the BMT population is very
different than the “normal” acute setting, those values are pretty good
starting points. Having worked at two inpatient BMT units in two different
hospitals, there have been some constants such as what blood values we hold at.
We are not an “ASAP” service for the most part. Therefore I always ask myself,
what is the risk vs reward for waiting 3, 4, maybe 5 hours for a patient to get
a platelet transfusion and then to work with them? Risk, I’d say none. Reward,
possibly a lower chance of bleeding if performing more skilled, higher level
therapy services.
I’ve followed these guidelines myself and in my short-ish career, have had no
adverse events (yet): Hold anything more than an ADL if <10,000 for platelets
(most facilities will require transfusions regardless if platelets fall below
<10,000). Pt’s still need to use the bathroom, and eat, etc. If the Hgb and Hct
is <7 or < 20 (respectively) we discuss pt’s overall status with the RN after a
thorough chart review. The hgb and hct guidelines are not “firm” guidelines.
I’ve had pt’s with hgb of <7 walk a mile at a time with no assistance.
We must also consider the pt’s cardiovascular function, PMH, PLOF etc, when
treating with such low counts. How is that pt’s EF? Do they have any
arrhythmias? I’m sure these are all things that YOU as a physical therapist are
thinking about as it pertains to skilled therapy, that the RN’s may not be
considering. Unfortunately, at times RN goals are for patients to ambulate, and
the refer to us to get this done for them. There is no blame here, as RN’s are
VERY busy, but we offer more than this, and our clinical decision making is
what puts us apart as it pertains to rehabilitation.
In terms of “official” guidelines, I’m not sure of any, but I did find this
article which reviews a few of the specific papers I've referenced in the past
for exercise in the BMT population. I’ve used these articles to educate on
rehab therapists, and RN staff when it pertains to what we do.
https://www.tandfonline.com/doi/full/10.1080/16078454.2020.1730556 ;
[tandfonline.com]<https://urldefense.com/v3/__https:/www.tandfonline.com/doi/full/10.1080/16078454.2020.1730556__;!!FkC3_z_N!eARB2GpSRhbKnHPknc7dos98LiB6ypCduXY85VizcauyXYwCu-RX6qM4lKusmg$>
I hope I’ve helped a little bit, although I know a part of me has made this
political and takes this a bit further than anyone would have liked. I do
believe it’s important to educate the RN staff about what we do know, and use
evidence as a guideline.
Shai Sewell, PT, DPT
University of Florida Health
Shands Cancer Hospital
Inpatient Hematology Oncology and Bone Marrow Transplant
415.299.2086
On Aug 12, 2020, at 8:10 PM, Allison Brookins
<brookina@xxxxxxxx<mailto:brookina@xxxxxxxx>> wrote:
Hi!
I’m a new member of this group.
We are developing some guidelines for our PT/OT team when treating our general
oncology patients and also for our BMT patients.
We generally use the Academy of Acute Care Physical therapy Laboratory Values
Interpretation Resource (Updated 2017) as our reference point. Lately we are
having some challenges with our RN colleagues “pushing us” to see patients who
we might feel are not physiologically ready/stable enough for certain
activities.
Does anyone have/is anyone developing an Oncology-specific lab values resource?
One of our PTs today had 2 patients whose platelets were 5,000 or below.
(diagnoses were AML and lymphoma)
In both cases, our RN colleagues were not-so-gently pushing for us to engage
these patients in activity.
Thanks for your input!
Allison Brookins, PT
Staff PT and Clinical Educator
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