Discharge Planning
1. Discharge teaching starts while the patient is recovering the PICU and
continues on 6B.
a. Post-op nursing teaching check list: available in e-docs
b. Post-op nursing pathway to go with the order set: available in e-docs
c. Post-op teaching book: available from transplant coordinator and
also in the family resource center given to family
d. Dry erase board: available in each patient room on 6B to write
medicine names and doses down
e. Post-op nursing to go over medication list and dosages daily
f. Medication Sheets: available from transplant nurse in combination
with child life. They contain the volume amount and mg amount as
well as pictures of the syringe for each dose of medication. Done the
day before discharge to be placed in the post-op teaching book.
Available on-line at www.medactionplan.com
g. Transplant Pharmacist: will come to the bedside the day before d/c to
reinforce medication education and will document a note in the chart.
h. Transplant Coordinator: coordinator will do frequent teaching
during the inpatient stay and document a note in the chart of
teaching.
2. Discharge follow up is documented in the discharge summary in WIZ
Discharge.
a. All medication doses are listed in milliliters on patient instruction
sheets, so that patients are not confused on how much medicine to
give.
b. A return visit for liver transplant clinic is scheduled. Call 936-7882
for appointments or message basket the request to “Transplant AA”.
They are scheduled on Friday mornings 8-12.
c. The patient must be instructed to bring their morning
immunosuppressant with them to clinic to be taken right after the
blood is drawn.
d. Labs are arranged by the liver transplant (page: 831-8156)
coordinator and must include:
i. CBC/plt
ii. CMP, GGT, MG, D-bil
iii. Tacrolimus level
iv. And/or CMV/EBV PCR based on protocol in e-docs
3. Discharge prescriptions:
a. Prescriptions to be delivered to patient bedside by pre-arranged
pharmacy of patient’s choice. Nurse Practitioner coordinator calls
pharmacy and takes care of all these prescriptions.
b. Prevacid and Valganciclovir need to be prior authorized 72 hours
before discharge or they will not be filled.
c. Routine medications: write for 6 refills
d. Valganciclovir X 90 days for fresh transplants, see protocol
Reviewed 7/16/2010
e. TMP-SMZ, see protocol, bactrim for life
f. Aspirin 6mo to 1yr after transplant. 1 year for those under 1yr of age.
g. Pain medications as needed, no refills
Long Term Follow-Up “At a Glance”
Post-Transplant
1 mo
2 mo
3 mo
4-6 mo
7-12 mo
12-16 mo
16-24 mo
Clinic Visits
Weekly
Q 2 weeks
Q month
Every 6-8 weeks
Every 6-8 weeks
Q 4 months
Q6-12 months
Lab
Frequency
Weekly
Weekly
Q 2 weeks
Q 3 weeks
Q Monthly
Q 2 Months
Q 3 Months
CMV PCR
Quant hi risk
Monthly
Monthly
Monthly
Monthly
Monthly
Q Yearly/PRN
Q Yearly/PRN
EBV PCR
Quant hi risk
Q2 weeks
Q2 weeks
Q2 weeks
Monthly
Monthly
Q 3 Months
Q 3 Months
1. Resume immunizations between 3-6 months. No live viruses after transplant.
Vaccines to make sure they get or have gotten are:
a. Flu- annual or the series depending on age
b. Pneumococcal 27 valent to those over 2 yrs every 5 yrs X2 and
Prevnar series under age 2
c. Hepatitis B series
d. Hepatitis A series
e. Meningiococcal vaccine for splenic dysfunction and for college-bound
children.
2. Assess EBV and CMV as per protocol and PRN febrile illnesses and elevated
liver enzymes w/ no source identified. Always check for enlarged lymph
nodes and tonsils on exam.
3. Reassess need for fat-soluble vitamins and minerals depleted by
immunosuppressants
a. Vitamin D twice yearly
b. Magnesium every lab draw
4. Assess nutrition status and growth
5. Dental work should be held off for first 6 months, then q 6 months visits w/
antibiotic prophylaxis 1st yr and lifetime if there are artificial shunts in place.
Avoid dental work when patient is on high dose steroids if possible.
6. Bone density studies are every 3 years.
7. Assess health maintenance
a. Use of sunscreen
b. Avoiding risking behaviors
c. Med compliance
d. Annual primary care visits
e. Annual pap if applicable
Reviewed 7/16/2010
f. Annual derm visits if applicable
8. Assess renal status:
a. GFR is calculated using the Schwartz method
b. Urine dip every clinic visit
9. Special note: all patient on their first annual visit get a child-life consult and
special celebration at clinic with a photo taken (consent scanned into chart.
Reviewed 7/16/2010