No Replacement for Preparation

Cross-department kidney-marrow transplant breaks ground and communication barriers

stethoscopeThis February, Johns Hopkins became one of very few leading medical centers in the country to perform a groundbreaking procedure: the combined transplant of bone marrow and a kidney from the same donor. Nursing played a key role from the beginning as teams across departments including Surgery, Oncology, and Hematology coordinated care amid a host of special circumstances.

The procedure was the first of six to be performed as part of the ACCEPTOR study, sponsored by the Immune Tolerance Network and led by Lode Swinnen, MD, Ephraim Fuchs, MD, and Robert Montgomery, MD. The goal is to induce tolerance in transplant patients and ideally eliminate the need for lifelong immunosuppression by allowing the host and donor immune systems to be simultaneously present in the patient, reducing the risk of solid organ rejection.

“The best approach that we can take for clinical trials is to integrate it into our existing systems,” says Tracy Douglas, MSN, RN, nurse manager at Weinberg 5C and 5D and consultant on the study. “We don’t want to reinvent the wheel. At the same time, we knew it would require a lot of education and planning to collaborate across specialties in order to meet the special needs of the patient.” Six months before the transplant, nursing leadership began working to review protocols and to meet regularly with nurses and clinical staff to prepare seamless care.

Lori Tony, BSN, RN, senior research nurse in Hematology, was tapped to facilitate the process. “We did 16 in-services to make sure that we reached every department that would touch the patient’s experience. It was so critical that we educate each other thoroughly.” Nurses compared standard procedures for renal and bone marrow transplant care, working together to resolve incompatibilities. Notes Tony, “Things are so different for the two transplants. But everyone was really willing to go outside their comfort zones to make this work.” Solutions included making special arrangements to send Weinberg nurses to Zayed to deliver chemo infusions without having to move the patient. Tony often worked on a laptop in a break room near the patient so that she could be available to the clinical nurses for questions.


“The best approach that we can take for clinical trials is to integrate it into our existing systems. We don’t want to reinvent the wheel.” -Tracy Douglas, MSN, RN


Each day, physicians and nurses rounded together to ensure that someone from each team made a daily visit, and teams communicated every day in person and in writing brief patient care summaries. “We’ve been a cross-check for each other,” says Tony. “I might point out something that worried me about the kidneys, and it might turn out to be normal, but that kind of dialogue gave us confidence that nothing would be overlooked.”

As the study team prepares for the next procedure, the nursing cross-team structure that emerged from this first transplant will provide a model for future collaboration. It’s also inspired new thought about workflow outside the trial. “It’s opened up new avenues of communication,” says Douglas. “We can improve care for patients and donors when our departments continue to learn from one another.”