In this section
Definition of Terms
Education and Training
The home-based pre/post hydration model of care was developed to expand provision of local and home - based care for paediatric cancer patients with osteosarcoma to ensure best practice is provided as close to home as possible. The program enables an osteosarcoma patient to have the majority of their care at home pre and post receiving the chemotherapy agent methotrexate .The model of care expands paediatric oncology treatment to be available outside the primary cancer services.
The aim of this guideline is to provide a comprehensive overview of the model of care for osteosarcoma patients receiving pre and post hydration for Methotrexate in the home.
All oncology patients diagnosed with osteosarcoma should be assessed for suitability for pre and post hydration for Methotrexate in the home, based on the criteria below, (fig.1). The home – based model of care is an ‘opt in’ program, if a patient or their family does not wish to participate, care will be provided as normal within the hospital setting.
The initial assessment outlines the selection process for a patient to be eligible for homecare (fig 1a), this includes:
Figure 1.a. Initial Patient Eligibility Criteria
Further assessment is required to continue home - based treatment after the first cycle, (fig 1.b).
Figure 1.b. Continuing Patient Eligibility Criteria
This cycle of chemotherapy currently requires a 5 day inpatient stay and the patient receives multiple cycles throughout the course of their treatment.
Following the home - based model of care, on Day 0, the patient is reviewed in clinic by a consultant, port is cannulated in Day Oncology and then the patient travels home, with Wallaby nursing staff visiting them that evening to commence the IV fluids. Day 1 the patient returns to RCH in the morning for 4 hour methotrexate infusion, once completed they return home again, to continue IV hydration until Day 4 (fig.2). Regular visits from Wallaby nursing staff are scheduled throughout this time.
The parent, carer and/or patient are required to manage aspects of care following education and assessment of capability and comprehension. This includes administering pre and post hydration fluids via a Bodyguard IV pump, other supportive care such as antiemetics and folinic acid (oral medication), managing urine output and urinalysis, documentation of fluid balance, medication administration and identifying complications, along with escalation of concerns in a time appropriate manner, (fig.3).
Figure 2 Osteosarcoma Home Care Protocol Clinical Team Checklist
Parents, carers and where appropriate, patients are educated on how to troubleshoot problems, identify complications and where to seek help when necessary. They are advised to always contact Wallaby staff on 9345 4770, except in the case of an emergency where they should immediately call 000. Wallaby staff will liaise with the oncology team as outlined in (fig. 3).
If the complication is a Grade 3 the family are advised to present to the emergency department. All home care osteosarcoma patient will be triaged as a category 2 or higher when presenting to emergency. Each patient will have a fast track card that is shown at presentation and in addition, an alert on their EPIC medical records.
If unresolved complications occur out of hours patients contact the Wallaby ward number which will automatically transfer to the emergency department (ED). Patients will be advised to attend the ED for further management.
If the complication is related to a simple pump problem, Emergency department staff are encouraged to notify Kookaburra staff as they have the relevant training to manage the ‘Body Guard pumps’. Otherwise the pump should be changed to a standard RCH pump to ensure no delay to adequate fluid management.
Figure 3. Osteosarcoma Home Protocol – Phone Advice Tip Sheet
If in doubt or for all other signs and symptoms contact the Solid Tumour Fellow on 55153 for further advice. After hours, contact the covering oncology consultant/fellow through switch.
Nursing staff training is divided into three levels according to responsibility and involvement in the patient’s care.
Level 1: Core Super Users
Role: provide face-to-face training to parents and/or nursing staff.
Level 2: Key points of contact
Role: provide phone advice to parents or provide nursing support at home, but do not provide primary training.
Level 3: General users
Role requires awareness of protocol, but do not provide parent training or phone advice. May be involved in supporting inpatient care.
All training requirements (fig.4) are supported by the Osteosarcoma Home Care Learning Package Pre and Post Hydration for Methotrexate and the Oncology Clinical Nurse Educator.
Figure 4. Osteosarcoma Home - based care – Training Requirements
Attend 1 hour training session
(may require 2 x 1 hour sessions)
The nominated carer (or carer’s) in the home environment are trained during an inpatient stay by allocated nursing "trainers" from the Children’s Cancer Centre (CCC), to manage the care required at home. Once trained, assessed and deemed competent the carers are supported within the home
environment by Wallaby nurses.
Evidence Table for this guideline can be found here.
Osteosarcoma Home Care Learning Package Pre and Post Hydration for Methotrexate, Royal Children’s Hospital
Please remember to read the
The development of this nursing guideline was coordinated by Kylie Moon, Clinical Nurse Consultant Nursing Innovations, Lisa Barrow, Clinical Nurse Educator Children's Cancer Centre, Tracy James PICS Project Lead Quality & Service Improvement, and approved by the Nursing Clinical Effectiveness Committee. First published August 2018.