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886 A quality improvement program to achieve independence in home central line care by paediatric oncology families
  1. Chris Wong1,
  2. Constance Barysauskas2,
  3. Marie Desrochers3,
  4. Margaret Brill-Conway3,
  5. Riley Mahan3,
  6. Kelly Eng3,
  7. Amy Billett3
  1. 1Dana-Farber/Boston Children’s Cancer and Blood Disorders Centre, US
  2. 2Dana-Farber Cancer Institute, US
  3. 3Blood Disorders Centre, US

Abstract

Background Central line associated blood stream infections (CLABSI) occur frequently in the paediatric oncology (PO) population increasing morbidity, mortality, and costs. Families in the home provide a large portion of PO external central line (CL) care with limited opportunities to develop skills that maximise best practice bundle adherence, key to infection prevention.

Objectives To achieve >90% of families with documented independence in CL flushing by 12 months.

Methods Plan-do-study-act cycles were used to test changes from April 2016-June 2017 after identifying drivers in a pilot (June 2015-March 2016) to develop a family-centred learning curriculum. This involved return-demonstration [teach-backs (TBs)] of CL skills in front of a nurse coach during routine clinic visits and use of CL care cognitive aids. Key interventions: culture change-new expectation of TB participation until independent; embedding TBs into routine care with a dedicated nurse champion; developing checklists to standardise content, approach, performance, and proficiency evaluation with documentation. Statistical process control charts tracked changes over time.

Results During the pilot, 12.9% (22/171) participated in the TB program and 4.7% (n=8) had documented independence. After April 2016, special cause variation shifted the centre line of families’ independent from 6% to 89%. Participation increased to 87.9% (181/206) with 82.5% (n=170) independent, sustaining the improvement at >90% since October 2016.

Conclusions Ensuring families’ independence with CL care in the home is a safety priority which can be achieved through a teach–back program embedded into routine care. Determining impact on families’ CL care-associated distress and ambulatory CLABSI rates is in process.

Abstract 886 Figure 1

Statistical process control chart (p-chart) 3 sigma

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