THE NURSES GROUP POSTER SESSION
NP002 RELIABILITY OF CYCLOSPORINE A VALUES TAKEN THROUGH CENTRAL VENOUS LINES, - A QUALITY MANAGEMENT STUDY A.-M. Berthelsen*,1, M. Nygaard1, K. Nørskov1, H. Sengeløv1 1 Hematology dept. BMT unit 4042, RIGSHOSPITALET, Copenhagen, Denmark
Nurse & Allied Health Professionals NP001 AN EVALUATION OF INFORMATION PROVISION AND PSYCHOSOCIAL SUPPORT FOR HAEMATOPOIETIC STEM CELL TRANSPLANT PATIENTS: A SINGLE CENTRE STUDY M. Rennoldson1,1, A. Nield*,1, H. Jessop1, S. Simpson1 1 SHEFFIELD TEACHING HOSPITALS NHSFT, SHEFFIELD, United Kingdom Introduction: Background: The intensive nature of Haemopoietic Stem Cell Transplant (HSCT), sometimes with debilitating side effects means it has been associated with considerable distress which can prove detrimental to patients’ psychological and physical well-being. Therefore the provision of clear information and effective supportive care for HSCT patients is particularly important. The aim of this study was to evaluate the effectiveness and acceptability to patients of the current information provision and supportive care system in our transplant centre, and to identify next steps for service improvement by gathering feedback from patients themselves. Method: 2 different questionnaires were developed; the ‘PreTransplant Questionnaire’ was administered pre-transplant (T1) and the ‘Post-Transplant Questionnaire’ at 4-5 months post-transplant (T2). T1 focused upon whether patients believed they had been provided with the right amount of information, and if they felt well prepared for HSCT. T2 focused upon satisfaction with the support patients had received during their recovery. T1 were given to 19 consecutive patients undergoing HSCT during the two month study period. T2 were given to 29 consecutive surviving patients who had undergone HSCT 4-5 months prior to the 2-month study period. Data was analyzed using summary statistics and thematic analysis. Results: 12 (63%) T1 questionnaires were returned, 3 allogeneic and 9 autologous transplants. All 12 respondents indicated they had received the ‘right amount’ of information about the medical procedures involved and 11 respondents agreed that they ‘felt well prepared’. 3 respondents reported not getting sufﬁcient information on coping emotionally with their transplant. Suggestions for improvement focused around information about facilities available in isolation rooms. T2 results: Overall there was a very high level of satisfaction with the support provided. Patients drew on many sources of support which were reported to be effective in addressing difﬁculties, suggesting the support patients are receiving matches their needs which was mostly drawn from those with whom the patient has regular contact with. Access to support groups and information centres was limited by fatigue and travelling distances. Lack of certainty about who to contact for support following discharge post-transplant was also apparent. Conclusion: The volume and content of information pre transplant appears to be appropriate for the majority of patients. Although contact information about sources of support is provided prior to transplant, this should be provided again at discharge. Doctors and Co-ordinators are most frequently accessed for support, and are best placed to initially support help seeking. Disclosure of Interest: None Declared.
Introduction: HSCT patients are routinely treated with Cyclosporine A (CyA) post-transplant to prevent GvHD. CyA is administered orally or intravenously (IV). We have experienced unexplainable high blood values in patients receiving oral or IV CyA. Adherence of CyA to the catheter luminal wall is proposed as the cause. We performed a prospective study in order to ensure the validity of CyA concentration measurements in blood samples taken from peripheral and central venous catheters (CVC) in HSCT patients being treated with CyA. Method: Myeloablative HSCT patients were recruited in the period from July to October 2014 at our transplant center. All patients have given informed consent. CyA was analyzed concomitantly from: Peripheral blood (PB), CVC-line not used for CyA infusion (non CyA-Line) and CVC-line used for CyA infusion (CyA-line). All samples from CVC were drawn according to our SOP, which includes discharge of the ﬁrst 10 ml blood drawn from CVC. All CVC’s are two or three lumen Hickmann catheters. Values are compared with paired students T-test, signiﬁcance level 0.05. Results: Part 1; mean CyA values during IV Cya infusion, (N=16 samples): PB Non-CyA-line p CyA-line p 249 ug/l 253 ug/l 0.86 951 ug/l o0.001 Part 2; Mean Cya values after discontinuation of IV CyA infusion, while on oral CvA (N=5 patients): Days after iv CyA PB Non-CyA-line p CyA-line p 5 364 ug/l 389 ug/l 0.43 756 ug/l 0.01 13 275 ug/l 305 ug/l 0.12 391 ug/l 0.03 PB-value is reference for p-values. Conclusion: During IV CyA infusion: Blood samples drawn for CyA analysis from non- CyA-line are comparable to PB values. In contrast, CyA-measurements of blood drawn from CyA-line are signiﬁcantly higher, despite use of the SOP procedure. After IV infusion (CyA administered orally): CyA values from non-CyA-line are in full correlation with values from PB. Both 5 and 13 days after last infusion of CyA, blood samples from the CyA-line contain signiﬁcantly higher levels of CyA. We conclude that our practice of using the non-CyA-line for CyA measurements is justiﬁed. Use of the CyA-line for blood samples will produce incorrectly high values. Importantly, falsely elevated CyA-values in the Cya-line are still obtained weeks after discontinuation of CyA infusion, which could lead to incorrect dose adjustment of CyA. We are currently continuing this study in order to establish a more exact time frame for the elimination of CyA from the catheter lumen in CVC lines previously used for CyA infusion. Disclosure of Interest: None Declared.
NP003 FOLLOW-UP BY PHONE WITHIN 24 HOURS AFTER DISCHARGE FOR HEMATOLOGIC PATIENTS W. van de Kar1, J. van Steeg1, A. Mank*,1 1 Department Hematology F6-south, Academic Medical Centre, Amsterdam, Netherlands Introduction: The results from a customer satisfaction survey conducted by the Dutch Federation of Academic Medical Centers (NFU) show proof that there is a lot of room to improve the quality of the procedures of discharge. This is in agreement with our own observations at the department hematology (F6zuid). Many times questions arose after the discharge of the patient and their relatives, for instance medication or how to act in daily practice regarding infection prevention. The Board of Directors has conﬁrmed that every clinically admitted patient would get the guarantee to be called within 24 hours after being discharged. The main objective is to improve the provision of consulting services to patients and their relatives through follow-up by phone. Method: To reach this goal a workgroup has been started on our department.On F6-south this has been done according to a form. This is part of the electronic patient ﬁle (EPD). Questions in the developed form are ‘‘how are you, do you still have questions regarding your discharge or any other question in general.Additionally, the entire procedure with regard to the follow-up by phone has been documented.At the transfer between night- and dayshifts there is an overview of the discharged patients from the last 24 hours. One of the nurses get the responsibility to call. Each call will be reported in the EPD. Results: The number of patients that have received a phonecall has been between 80-85% per year since the workgroup has been started. The patients reacted positive on the followup, one example: ‘‘How generous that you even think of me, even when I already left the hospital ‘‘ was one of the cheered up reactions. In practice workload to ﬁnd the time and accessibility was the most difﬁcult. The results show that patients at the ﬁrst intake have been the most insecure. When they return home, they mostly had questions about their medication. Patients also asked questions about nutrition, fatigue and their regimen. In some cases, complications such as dehydration and malnutrition has been prevented by giving advice related to these matters. In other cases, it seemed that follow-up appointments were not passed on- thanks to the phone call this was realized nonetheless. In a few cases, the speciﬁc medical questions had to be answered by the doctor.After the reported feedback, the discharge checklist has been further improved, to ensure that the patient will be instructed as good as possible before and after discharge. Conclusion: Overall, the follow-up by phone has led to appreciation by the patient and his relatives. When questions are answered, a lot of the insecure feelings at home have dropped. Complications could be (partly) prevented, causing a drop in readmissions.The results have clearly shown that this way of service has great merits. Disclosure of Interest: None Declared. NP004 COMPARI˙SON AND EVALUATION OF QUALI˙TY OF LI˙FE OF ACUTE MYELOID LEUKEMIA AND ACUTE LYMPHOBLASTIC LEUKEMIA PATIENTS WHO HAD RECEIVED HAPLOIDENTICAL OR ALLOGENEIC STEM CELL TRANSPLANTATION WITH FUNCTI˙ONAL ASSESSMENT OF CANCER THERAPY (FACT-G) SCALE ¨ zdas¸1, Z. Gu¨lbas¸1, U. G. O ¨ zer1, E. Birtas¸ Ates¸1, B. Sarıtas¸*,1, T. O 2 C. Bal 1 Anadolu Medical Center, Kocaeli, 2Osmangazi University, Eskisehir, Turkey Introduction: We aimed to evaluate and compare the quality of life of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) patients who had underwent allogeneic
(Human Leukocyte Antigen (HLA) identical) or haploidentical ( at least 2 HLA mismatch) hematopoietic stem cell transplantation (HSCT). Method: Eighty-ﬁve AML and ALL patients who had underwent allogeneic HLA identical or haploidentical (at least 2 HLA mismatch) HSCT in Anadolu Medical Center Bone Marrow Transplantation Center between 2010 and 2012 and were beyond 100th day post-transplantation were enrolled to the study. Data were collected via a questionnary developed by researchers, including 10 questions aiming to demonstrate social and demographic structure of the patients and FACT-G scale.For statistical analysis SPSS 15.0 was used. Shapiro Wilk’s, Mann Whitney U, Chi-square test were used analysis. Results: From 85 AML and ALL patients who were evaluated for the study, 7 patients relapsed, 29 patients died and 4 patients were lost to follow-up. Consequently, 45 patients were included in the study. Thirty-one of the patients were allogeneic and 14 of the patients were haploidentical HSCT patients. While, 20 (44%) of the patients were female, the rest 25 (56%) were male. 7 of female patients and 7 of male patients had undergone haploidentical, 13 of female patients and 18 of male patients had undergone HLA identical HSCT. 67% of the patients (30 patients) were 18-45 years old and 33% of the patients (15 patients) were 46-65 years old. While, 36 patients (80%) were married, 9 patients (20%) were single. 4 of 9 single patients and 10 of 36 married patients had received haploidentical and 5 of single pateints and 26 of married patients had received HLA-identical HSCT. The marriage status of the allogeneic and haploidentical HSCT patients were not signiﬁcantly different (P40,05). Likewise, educational levels of the 2 groups were not signiﬁcantly different (P40,05). Total FACT-G score of haploidentical HSCT patients were 54,6±5,83 points and total FACT-G score of allogeneic HSCT patients were 55,2±7,72 points. There were no statistically signiﬁcant difference between haploidentical HSCT and allogeneic HSCT groups in terms of days (P=0,377), fact-g body status (P=0,587), fact-g social life and family status (P=0,503), fact-g activity status (P=0,538), fact-g emotional status (P=0,162) and total score (P=0,539). Conclusion: There is no statistically signiﬁcant between quality of life of allogeneic and haploidentical HSCT patients in terms of FACT-G scores. (P40,05). To conclude the type of transplantation (HLA-identical or haploidentical) does not have an impact on quality of life in transplantation patients. Disclosure of Interest: None Declared. NP005 EVALUATION OF SIDE EFFECTS EXPERIENCED BY THE DONORS AND PATIENTS RECEIVING GRANULOCYTE COLONY STIMULATING FACTOR FOR STEM CELL MOBILIZATION B. Virdil*,1, S. Kural1, N. Tiryaki1, E. Birtas Atesoglu2, D. Cekdemir1, Z. Gu¨lbas1 1 Anadolu Medical Center Hospital, Bone Marrow Transplantation Center, 2Department of Internal Medicine, Hematology Department, Kocaeli University Medical School, Kocaeli, Turkey Introduction: In the present study, we aimed to evaluate the side effects experienced by the donors and patients receiving granulocyte colony stimulating factor (GCSF) for stem-cell mobilization. Method: The present study included 150 patients and donors aged between 18 and 80 years old undergoing peripheral stem-cell harvesting between July 2013 and March 2014. Data from the patients and donors were collected through a questionnaire. Pain was assessed using Visual Analogue Scale (VAS). The data were evaluated statistically using SPSS software package. Results: Of the 150 subjects included in the present study, 63 (42%) were female and 87 (58%) were male, and mean age was 52 ±15 years for the females, and 43±15 years for the males. Of the subjects 48 (32%) had multiple myeloma (MM), 22 (15%) had Hodgkin’s lymphoma (HL), 19 (13%) had non-
Hodgkin lymphoma (NHL), and 61 (40%) were healthy donors. The study included 81 (54.0%) subjects receiving chemotherapy (CT)+GCSF, 8 (5.3%) receiving CT +GCSF+Plerixafor, 61 subjects (40.7%) receiving GCSF. Eighty nine patients (1 x 30 MU) and 61 donors (2 x 48 MU) in the study received GCSF. Of the 88 patients, 43 (48.9%) developed side effects and 45 (51.1%) did not. Rate of side effects by disease was 50.0% for MM, 45.5% for HL, and 47.4% for NHL. Of 61 donors, 52 (85.2) developed side effects and 9 (14.8%) did not. For the subjects receiving CT+GCSF, the day of receiving GCSF didn’t affect rate of occurrence of the side effects. No signiﬁcant difference was found when the side effects were compared between genders (P=0.51). While, pain of 6 to 10 points on VAS was reported in 41.4% of the subjects, pain of 1 to 5 points on VAS was reported in 19.3% of them. In the present study, bone pain was seen in 47 of 61 donors (76%) and 36 of 89 patients (40.9%). Dyspnea, vomiting, constipation and oral mucositis was not seen neither in the patients nor in the donors. Conclusion: No signiﬁcant difference was found when side effects were evaluated by diseases and genders. The most common side effects was bone pain. Bone pain was seen in half of the donors, being secondary to GCSF. Bone pain is more common in the healthy donors, being attributed to using higher dose of GCSF. Disclosure of Interest: None Declared. NP006 THE ROLE OF OCCUPATIONAL THERAPY WITHIN THE BMT SERVICE AT GREAT ORMOND STREET HOSPITAL C. Kermarrec*,1 1 Occupational Therapy, Great Ormond Street Hospital, London, United Kingdom Introduction: The role of Occupational Therapy (OT) within the BMT Service at Great Ormond Street Hospital (GOSH) is unique as it screens development of all children under 5 years old. The screening process involves assessments such as the Ages and Stages Questionnaire or the Bayley Scales of Infant and Toddler Development (3rd ed). These assessments explore cognitive, language and gross and ﬁne motor development. The assessment takes place Pre BMT to get an accurate measure of the under 5’s abilities. If developmental delay is identiﬁed then therapy intervention is provided during the child’s in-patient stay. A developmental review is provided six months post discharge. Intervention enables the under 5’s to engage in play in order to optimise their quality of life while in BMT isolation. If there are developmental concerns with an under 5, therapy input can educate, support and assist parents/carers to enable their child to maintain or achieve developmental milestones within BMT isolation. The signiﬁcance of assessing and monitoring development in the under 5’s in the BMT Service is multi-factorial: The ﬁrst years of life are a crucial developmental stage. Children coming into BMT are hospitalised for a period of time. This means the under 5’s are not experiencing the varied environments and routines they would normally. A number of the under 5’s may be at risk of developmental delay secondary to their underlying condition for example, Hurler’s Syndrome or Osteopetrosis. The following provides examples of OT input within the BMT service: Example 1. Osteopetrosis – the nature of this condition is bone fragility and visual impairment. These factors can cause developmental delay. OT assessment determines if developmental delay is present. Advice includes optimal handling of a child with fragile bones, a positioning programme to strengthen muscles and aid development and advice on sensory toys to utilise limited vision and ﬁne motor skills. Example 2. Hurlers Syndrome – skeletal deformities including thoracolumbar kyphosis present with this syndrome. Positioning for play advice is provided and specialist seating to correct,
correctable deformities and/or reduce the potential for skeletal abnormalities to worsen. Conclusion: OT has a unique, structured and holistic role within the BMT Service at GOSH. Pre BMT the development of all children under 5 years old is assessed with a standardised measure. If developmental delay is identiﬁed therapy intervention is provided during the child’s in-patient stay. Six months post discharge a developmental review is provided. The OT role is important in helping the under 5’s maintain and/or achieve further developmental skills during BMT. Input enables quality of life for the under 5’s in BMT isolation and supports parents/carers to interact with their child normally in a medical environment. Disclosure of Interest: None Declared. NP007 REINFORCING STAFF COMMUNICATION TO IMPROVE SYMPTOM MANAGEMENT IN POST BONE MARROW TRANSPLANT PATIENTS S. Levy1, C. Shamir*,1, N. Abu-Shakura1, R. Or1, G. Sapir2, R. Radiano2 1 Bone Marrow Transplant, 2Nursing Directorship, Hadassah Medical Organization, Jerusalem, Israel Introduction: The post Bone Marrow Transplant period is characterized by a wide spectrum of symptoms, affecting quality of life and length of hospitalization (Conen et al, 2012)1. Different symptoms accumulate at different times in the process and require ongoing assessment and care. Although managing patients’ symptoms is a major nursing goal, continuity of care is not easy to maintain, partly due to ineffective communication within a multi-disciplinary staff. Our intention is to develop a novel system whereby patients’ most severe and debilitating complaints are clearly communicated to the entire medical team. Once a patient’s acute symptoms are explicitly conveyed, increased intra-staff collaboration and communication can be promoted. Treatment plans can be tailored to allow caregivers to provide the optimum care for patients and their individual needs. Method: Upon admission to our department, ﬁfty posttransplant patients completed a self reported symptom inventory questionnaire, consisting of thirteen items established for hematology and oncology patients. It is available in four languages for the beneﬁt of our diverse patient population. We designed two generic, easy-to-use adhesive stickers, with bright red, stand-out borders and room for nurses to detail patients’ self-reported most severe symptoms. The stickers were positioned on the nursing report cards as well as on the inside cover of patient’s medical ﬁle. The stickers remained on the nursing cards and in patients’ ﬁles for fourday cycles. Results: A pilot study was initiated from November 2013 to April 2014. The study assessed the effect of the quality assurance process in two ways: Firstly, range and severity of symptoms and trends at each time point as reported by patients: cognitive symptoms, such as frailty / exhaustion, worry / anxiety, inability to sleep and mouth dryness (thought to be related to anxiety) were most commonly reported, as opposed to physical symptoms (such as constipation, nausea and mouth sores) which were reported less. The only physical symptom to be reported more was pain. Secondly, the nursing and multi-disciplinary staff’s compliance to the implemented symptom management program. After the ﬁrst four-day cycle, there was a 70.3% alleviation of reported patients’ symptoms. 11.1% showed a worsening of their previously reported symptoms. Conclusion: The outcomes of our pilot study allowed us to evaluate the full impact of using striking red stickers to underscore the symptoms reported by the patient as being most severe. The pilot study determined that this technique encourages the multi-disciplinary staff to practice effective symptom management and effected better intra-staff
collaboration. The program is presently being adapted for the computerized systems in our department. Disclosure of Interest: None Declared. NP008 GETTING TO ZERO: SUCCESSFUL PREVENTION OF HEALTHCARE-ASSOCIATED INFECTION RATE IN THE HSCT WARD C.-F. Chang*,1, J.-L. Tang1, C.-C. Li1, J.-H. Liu1 1 Tai-Cheng stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan, Province of China Introduction: Patients undergoing transplantation are highly susceptible to infection. Because of hematopoietic stem cell transplantation (HSCT) patients’ compromised immunity after transplant, infection is a major cause of morbidity and mortality.Our aim is to reduce the healthcare-associated infection rate in Tai-Cheng Stem Cell Therapy Center, National Taiwan University Hospital. Method: We implied the following strategies to reduce the infection rate: (1) Regular examination and disinfection of equipment to keep the temperature, humidity, pressure, particle count of high-efﬁciency particulate air ﬁlters and water within normal range. (2) Isolation of patient with any history of resistant bacteria colonization in the past six months upon the admission until a negative culture screening result to avoid multiple-drug resistant organisms outspread. (3) Strict enforcement of infection control guideline. (4) Use of ‘‘central line bundle’’ strategy of patients’ Center Venous catheters and well central line dressing to prevent central venous catheterrelated bloodstream infection (CLABSI) since 2012 January. Results: Total 303 cases had been transplanted between 2010 march to 2014 September. Healthcare-associated infection rate among HSCT patients keep zero for more than four years. The CLABSI rate dropped from 1.29% in 2012 to % in January to September 2014. Conclusion: We recognize that a nurses’ role in infection control is very important. The efﬁcacy of speciﬁc isolation and barrier precautions in preventing healthcare-associated infections in HSCT patients was notable and important. The encouraging results in our infection control of HSCT ward demonstrate an example of how improving training and materials in nursing care standards can beneﬁt the outcome of patients receiving HSCTs. Disclosure of Interest: None Declared. NP009 THE EXPERIENCE OF ORAL AND WRITTEN INFORMATION ABOUT SEX AND RELATIONSHIPS IN ADULTS TREATED FOR MALIGNANT BLOOD DISEASES C. E. Wendt*,1, E. Idvall2, S.-A. Månsson3 1 University Hospital in Lund, Sweden, Malmo¨ University, Faculty of Health and Society, 2Malmo¨ University, Faculty of Health and Society, 3Malmo¨ University, Faculty of Heath and Society, Malmo¨, Sweden Introduction: One of the most important needs of cancer patients is to receive thorough and honest information about their disease, treatment and chance for cure. Additionally, important aspects are possible treatment related to side effects and also the impact on patient’s sexual health. Most patients consider it is important to address the problems of sexual nature with health professionals, but results show that nurses and physicians do not address the issues of sexuality in the context of cancer therapy. The purpose of this study was to assess how information worked in practice, both oral and written. This study is also a result from an earlier presentation of the booklet ‘‘Sex and relationships in the treatment of blood diseases’’ as a poster at the EBMT in Vienna 2010. Method: A study speciﬁc questionnaire was developed for patients with malignant blood diseases. It contained questions
about information on sex and relationships as well as on the developed booklet. Results: As to our knowledge this is the ﬁrst study in Sweden examining patients’ experience of oral and written information about sexual issues. Two hundred and sixteen patients participated in this descriptive study. It included 135 men and 80 women with a mean age of 59 years. Most of the patients had not received information about sexual issues and a majority also considered oral information as important as written information. The result showed a very low input from health professionals. Only sixteen nurses (8.5%) and ten physicians (5.3%) had given oral information to the patients. The vast majority of patients were highly satisﬁed with the booklet, and considered it as being useful in general. Conclusion: It is concluded that patient with malignant blood diseases do not get information about sex and relationships as much as they wanted. Therefore health professionals need necessary training to feel conﬁdent in the conversation about sexuality and knowing how treatment affect sexuality. The result also showed that patients wanted written information and that the booklet could be helpful in communication with health professionals. Disclosure of Interest: None Declared. NP010 EDUCATIONAL TOOLS TO PREVENT COMPLICATIONS AFTER AUTOLOGOUS AND ALLOGENEIC STEM CELLS TRANSPLANT C. Soliman*,1, M. Brambilla1, M. Osorio1, S. Cuccaro1, S. Barbarani1, S. Agazzi1, V. La Terra1, F. Berruto1, M. T. Lupo Stanghellini1, S. Marktel1, C. Corti1, F. Ciceri1 1 Ematology and BMT Unit, IRCCS San Raffaele Scientiﬁc Institute, Milano, Italy Introduction: This study has the aim to give patients and their caregivers theoretical knowledge and practical skills necessary to safety cope daily life activities at home, in order to permit them to early recognize dangerous complications symptoms during the ﬁrst months after autologous and allogeneic SCT. Method: In 2012, our previous outpatients study underlined the needs of discharged patients after autologous and allogeneic stem cells transplant (SCT), in order to acquire the strategies to develop the Health Literacy (HL). HL is the capacity to take effective and aware decisions concerned health in different context of life (at home, in community, at work, in health system) and to offer useful health promotion tools for all people. Recent studies proved that low levels of HL adversely inﬂuence health state of people, increase inequalities and health system costs [Ferro E., Tosco E.; 2012]. The study involves the discharged autologous and allogeneic SCT patients and their caregivers, from April to October 2014. We wrote an informative discharged brochure, translated in different languages, aimed to inform and train patients/ caregivers about the speciﬁc behavioral recommendations (hand washing, mask wearing, oral hygiene, drugs taking, nutrition, central venous catheter management, early symptoms), in order to prevent possible complications and infections. Before discharge, the nurses met patients/caregivers, explained the speciﬁc home behaviors and gave them the informative brochure. In the ﬁrst week after discharge, the nurses checked the patients/caregivers learned information and abilities and ﬁlled together a short survey in hospital. Results: 48 patients were involved, 4 had not the interview after discharge because of clinical and organizational issues. Of 44 patients, the theoretical knowledge and practical skills were fully acquired in 69% of cases; partially acquired in 17%; not acquired in 8% and not evaluated in 6%. The answers that were not evaluated concerning the central venous catheter management, because of the early removal of it. Upon the whole of investigated topics, the nutrition was fully acquired in 95% of cases. Conclusion: The study shows that the stable use of an informative brochure and the executions of dedicated
individual talks increase the patients/caregivers knowledge and skills levels and can promote the HL process development. The nutrition is a topic particularly in depth known by the studied sample, probably for social and cultural reasons related to the country of origin. In the future, we could plan patients/caregivers groups meetings to share opinions about partially acquired and not acquired topics and to debate of speciﬁc issues with experts contribute. Disclosure of Interest: None Declared. NP011 ALLOGENEIC CORD BLOOD AND HAPLOIDENTICAL FAMILY DONOR TRANSPLANT, WHO DEVELOPED MULTIDRUGRESISTANT KLEBSIELLA PNEUMONIAS SEPSIS AND PHLEGMON. A NURSE CHALLENGE L. Galgano1, C. Boglione*,1 1 Reparto TMO, A.O.U.C. Careggi, Florence, Italy Introduction: A 25 years old man, suffering from acute lymphoblastic leukemia in May 2013, during induction cycle develops pulmonary aspergillosis, which leads him almost to death; when ﬁnally the white cells count arises, he is sent to the transplant. Being an only child, he was offered, given the previous hospitalization accompanied by a very long period of aplasia,an allogenic transplant from cord blood plus a transplant from haploidentical family donor. Method: Conditioning regimen: (RIC) Fludara 30 mg/mq from day -7 until -3; Atg 1,5 mg/kg at -7, -5, -3, -1; melphalan 70 mg/ m2 at -3, -2; Gcsf 5 mcg/kg since day +1. On the sixth day after reinfusion his rectal swabs are positive for multidrug-resistant Klebsiella pneumonias, sensitive to tigecycline and gentamicin, starts antibiotics and granulocytes; after onset of an axillary painful wound swab positive for Klebsiella pneumonias, and clinical worsening hypoxia, he starts alternate use of CPAP (Continuous Positive Airway Pressure) mask and the Venturi mask. From the perspective of engraftment we witnessed a transient neutrophil recovery at+15, together with a subsequent decline in values, but the aspirate of bone marrow and chimerism, performed at+30, resulted 100% cord blood with negative Minimal Residual Disease. At 1 month and a half after transplantation he was still hospitalized and developed mitral regurgitation with signs of pulmonary hypertension induced by drugs toxicity. The performance status improves, but the left axillary wound becomes a phlegmon of 4 cm for 5 cm, that could contain almost 10cc of saline, and,after consulting the wound care nurse and surgeons, starts a successful treatment with a negative pressure wound (VAC) therapy. He had a long period of time in bed which caused an important reduction of mobility and subsequent physiotherapy programme. Results: After 96 days from the admission patient leaves the ward in a wheelchair, without GVHD and the phlegmon almost heal. Conclusion: Assistance was multidisciplinary, but from a nursing point of view, the staff had to improve their knowhow and ﬁnd new supportive psycological strategies in an emotionally fragile patient. One year after the transplant, the patient is still alive and well. Disclosure of Interest: None Declared. NP012 LONG-TERM SIBLING DONORS’ FEEDBACK AFTER GRAFT COLLECTION FOR ALLOTRANSPLANT IN ADULTS: A PROSPECTIVE EVALUATION AT THE CHU OF NANTES D. Issarni*,1 and Ghislaine Francois, Melaine Leclercq, Rachel Lebreton, Veronique Stocco, Pascale Dupuy, Thierry Guillaume, Jacques Delaunay, Pierre Peterlin, Philippe Moreau, Patrice Chevallier 1 CHU, NANTES, France Introduction: Evaluation is a key element of quality management. So far, few studies have considered the long-term
donors satisfaction in terms of quality of life, mental distress or requests after giving stem cells. Method: Adult sibling donors, collected prospectively between September 2012 and December 2013 at the CHU of Nantes, were asked to respond, at distance of the graft collection (median: 15 months), to an anonymous questionnaire between June and September 2014. This included sociodemographic data, scale of the long-term impact of donor collection on physical and psychologic aspects and type of support received. As indicator, scales ranging from very bad to very well were used. Other open questions invited donors to give their personal opinions and comment on their difﬁculties or their satisfactions. We sought also to establish whether the service and information given regarding the stem cells donation met donor’s expectations. Results: 39 donors have been identiﬁed and the questionnaire was sent at their domicile. Twenty-nine cases responded (male n=14, median age 53 years) and analyses have been performed in October 2014. Twenty-four donors have received granulocyte colony stimulating factor for mobilisation of peripheral blood stem cells (PBSC) while collection of bone marrow graft was performed in 5 cases. Physically and mentally, the percentage of patients feeling very well, well or enough well were: 72.4% and 69%, 24.1% and 24.1%, 3.4% and 6.9%, respectively. No differences were noted between donors giving bone marrow or PBSC. Also 2/3 of the donors (n=17) have no medication at time of analyses while the rest was treated for one or more chronic diseases (essential hypertension, hypercholesterolemia, diabetes, allergy or depressive disorder). As a reﬂection of good feeling, half of the donors have not performed control samples as required after graft collection and most of them haven’t seen their family doctor for a while. Fifteen donors commented on their difﬁculties or satisfactions considering the graft collection procedure. All of them were volunteers for giving stem cells.All but one agreed that information and care provided were of high quality. Conclusion: Most of the siblings were volunteers for the stem cells donation and were satisﬁed of the procedure organization. Long-term consequences of the stem cells donation are mild. New indicators, such as early evaluation of pain or fatigue, should be considered in a larger cohort of donors as it may represent a better way to improve practice. Questionnaires will continue to be used as a prospective evaluation of our sibling donors every three months during one year from the stem cells donation. Also, the feeling regarding donor lymphocytes donation after transplant, if done, will be integrated in the questionnaire. Disclosure of Interest: None Declared. NP013 ’’PATIENT- SAFETY DURING THE PICU TRANSFER’’ E. Trigoso*,1, C. Dolz1, V. Riera1, E. Alberola1, A. Almodovar1 1 Hospital U y P "LA FE", Agencia Valenciana de Salud, Ribarroja del Turia, Spain Introduction: Background: "It is generally agreed that patient´s safety can be deﬁned as freedom for a patient from unnecessary or potential harm associated with health care’’ * Through the process and, due to the intensity of the therapy, BMT is still associated with a variety of complications that may require admission to paediatric intensive care. The average of HSCT children admitted in PICU varies between 10% and 20%, although peaks of 44% have been reported. The main causes were: Severe sepsis, ﬂuid overload, and respiratory distress. Paediatric Transplants Unit from Hospital Universitario y Polite´cnico ‘‘La Fe’’ carries out an average of 25 HSCT a year autologus, alogeneics (related and undreleated donors) and haplo.* and the average of patients who need to be transfer to PICU is similar to other Centers. Objectives: - To increase the transplanted patient´s safety during the transfer from the HSCT ward to the PICU, by
systematizing information, developing a continuity of care report and following a checklist in order to increase the quality and effectiveness of information transfer. - To avoid the mistakes in the information transfers getting an efﬁcient communication among health care professionals. - Work team between both Units in order to assure the continuity of the care and, therefore, this team work is vital during all the transplant process. Method: METODOLOGY - Bibliography review in order to know the scientiﬁc evidence about this topic. - We have also valued our daily professional experience. - Periodic meetings among nurses from both units have been established. - The Project aim is to elaborate a standardized operating procedure with the information required in order to guarantee the patient´s safety during that process. It has been developed based in the Human Needs Model from Virginia Henderson and the IDEAS techniques. Conclusion: COMMENTS: Regarding the continuity of the cares and the patient-safety periodically, we think that working parties among intensivists physicians and nurses, hemato-oncologist nurses and physicians as well as others health care professional, are of vital importance and should be mandatory. Jacie: B2.1.1 The inpatient program shall have an intensive care unit or equivalent coverage available. B126.96.36.199 There shall be written guidelines for clear communication and prompt transfer during and ongoing monitoring of the transfer of patients to an intensive care unit or equivalent coverage. Checklist assessment should be made within a reasonable period of time. Disclosure of Interest: None Declared. NP014 IS FILGRASTIM BIOSIMILAR ZARZIO SIMILAR TO FILGRASTIM ORIGINATOR NEUPOGEN? E. Bystricka*,1, R. Brandejsova1, S. Vokurka1, A. Jungova1, P. Hlinkova1, J. Skardova1, P. Vodickova1 1 Haemato-Oncology, UNIVERSITY HOSPITAL IN PILSEN, Plzen (Pilsen), Czech Republic Introduction: Filgrastim is a human granulocyte colony stimulating factor (G-CSF) and is widely used for chemotherapy-induced neutropenia, hematopoietic stem cells mobilization and leucocytes recovery in hematopoietic stem cells transplantations. Neupogen (Amgen) is the original G-CSF stimulating factor and Zarzio (Sandoz) is ﬁlgrastim biosimilar approved in 2009 to have the same clinical effect. Daily practice clinical data are further needed to verify the safety and efﬁcacy of biosimilar products. We decided to present our experience focusing to nursing care predominantly. Method: Pre-printed questionnaire was distributed to our ward transplant nurses (n=8) to compare Zarzio and Neupogen in respect to nursing care issues: storage, administration, manipulation, side effects and technical complications occurrence. The quality of variables were compared using a scale of 1–5 ( 1=much better; 2=better; 3=the same; 4=worse; 5=much worse). Neutrophils recovery was observed in 148 autologous transplantation patients treated with Zarzio and was compared to historical control group of 148 patients treated with Neupogen. The Zarzio and Neupogen dose was 5 mg/kg/day administered subcutaneously during neutropenia post-transplant till neutrophils recovery (&1,5x10e9/l). Zarzio and Neupogen were used as original pre-ﬁlled syringes of 300 and 480 micrograms (30 and 48 MiU). Results: No signiﬁcant differences were observed between Zarzio vs. Neupogen group in respect to: mediane age, gender and chemotherapy protocols ( 62 vs. 60 years, 47% vs. 45% females, BEAM 35% and HD-Melphalan 65% vs. BEAM 30% and HD-Melphalan 70%). No signiﬁcant difference was observed
between Zarzio vs. Neupogen group in respect to neutrophil engraftment: the neutrophil count of 1,0x10e9/l was reached on median day 12 (9-14) vs. 12 (9-14) post-transplant. All nurses (8/8) assessed Zarzio vs. Neupogen as being the same in respect to storage, administration and side effects in patients, however, in respect to manipulation 1/8 of nurses assessed Zarzio vs. Neupogen as being the same, 4/8 as being better, 3/8 as being much better. No nurse experienced any technical complication related to Zarzio administration. No signiﬁcant side effects, but skeletal pains in granulopoesis recovery, were observed both in approximately 10% of Zarzio and Neupogen treated patients. Conclusion: Based on our observation we can conclude that Zarzio demonstrated similarity to the Neupogen in respect to neutrophils count recovery post-transplant and no signiﬁcant side effects. Zarzio was assessed as better (safer, respectively) by nurses in respect to manipulation because of the innovative automatic needle safety cover that passively locks for protection against needle stick injury and for safer disposal. Disclosure of Interest: None Declared. NP015 SAFE DISCHARGE OF A NON-ENGLISH SPEAKING FAMILY FROM THE INTERNATIONAL PAEDIATRIC HSCT UNIT AT GREAT ORMOND STREET HOSPITAL F. Palk*,1 1 Bone Marrow Transplant, Great Ormond Street Hospital, London, United Kingdom Introduction: Discharge planning is routine following an admission to hospital but should be planned and individualised (Department of Health, DOH, 2004). Discharges can either be simple and nurse-led or complex, requiring a multidisciplinary approach. The planning of a child’s discharge fron the Stem Cell Unit fallls imto the latter category. As children are unable to meet their own needs, it is vital that parents are fully informed, educated and involved in the preparation for being discharged (DOH, 2004). On the International Private Patients’ Unit this becomes even more complex as the clientele is predominantly Arabic speaking and sponsored by a funding body. Therefore the Unit relies on an interpreting service to ensure the family’s information needs are met in preparation for a safe and timely discharge (Nursing and Midwifery Council, 2008). Method: OBJECTIVES: To teach parents in the safe administration of their child’s medications in preparation for discharge To ensure that the teaching requirements are met in a safe, effective and individualised manner prior to the discharge date To educate parents about post-BMT cares and to recognise when their child is unwell and medical help needs to be sought. To reduce re-admission to hospital METHOD: A discussion with the family is initiated at least two weeks before agreed discharge date and a verbal agreement is sought from the parents to start practising administration of medications with a qualiﬁed nurse The use of a discharge checklist is initiated (pic) A brief medical report is sent to the relevant funding body to inform of imminent discharge A request is made for any medical equipment, specialised teaching and medications for going home A medicine planner is completed, translated into Arabic or a photographic book is done for parents who are illiterate – a copy is given to parents (pic) Planned sessions with an interpreter for the discharge talks to be done Results: RESULTS: Feed back questionnaires from nurses and parents on how they feel that the discharge planning is working - awaited Re-admission to the unit within 72 hours is zero
Conclusion: DISCUSSION: BENEFITS Nursing staff is better informed about the medications, which increases their conﬁdence to teach the parents The use of the checklist ensures individualised needs are met CHALLENGES Delay in authorisation of medication from funding body Workload and time available for nursing staff to spend with the parents Lack of an in-patient Nurse Specialist on the unit to coordinate the discharge Child not medically ﬁt for discharge on agreed date Disclosure of Interest: None Declared. NP016 COMPLEX CARE OF A PATIENT WITH MENTAL RETARDATION UNDERGOING BONE MARROW TRANSPLANTATION FOR FANCONI ANEMIA F. Erdog˘an*,1, A. Duyan1, G. Koca1, S. Kaya1, K. Yalc¸ın1, A. Ku¨pesiz1 1 AKDENI˙Z UNI˙VERSI˙TY, ANTALYA, Turkey Introduction: Fanconi anemia (FA) is a rare, phenotypically heterogeneous, inherited disorder clinically characterized by congenital abnormalities, progressive bone marrow failure (BMF), and a predisposition to develop malignancies. Hematopoietic stem cell transplantation (HSCT) still represents the only curative option for FA. Results of unrelated donor HSCT have been less encouraging because of many complications but better results have recently been reported. In our centre we have performed 42 BMT for FA with success rate: 70% survival and disease free survival. Method: The 15 year old boy was diagnosed with FA at 2 years ago. Treatment protocol with: Cy 200 mg/kg; Fludara 150 mg/kg. GVHD prophylaxis was: CyA 2 mg/kg; ATG 90 mg/ kg; Metil-PND 2 mg/kg. Also as a novel procedure in our clinic, we used hyaluronic acid for hematuria prophylaxis. The donor was the HLA-A mismatch unrelated. Chimerism reached 100% donor. In post BMT period, clinical complications were: intestinal GVHD III; fever, skin GVHD III; hematemesis, hematuria, diarrhoea and CMV re-activation. Results: The socio-economic and educational degree of the family was very low. Beside this, patient had mental retardation. In such a complex condition, nursing management was very hard. Also, many complications made it harder. During the aplastic phase great attention was given to the patient’s systemic and local infections. His mother was encouraged to be more careful about hygiene. Nursing management included: education of mother, skin protection during skin GvHD, intensive diarrhoe monitoring and rehydration during skin GvHD, intensive blood/platelets transfusions, intensive pain control and infection control. At the end of the BMT hospital admission days both skin and intestinal GVHD were resolved. Conclusion: It was very difﬁcult to ensure the care of a patient with mental retardation. By the intensive care and affection of nurses, best quality treatment was achieved. Disclosure of Interest: None Declared. NP017 KNOWLEDGE AND PRACTICE OF NEUTROPENIC INPATIENT’S INFORMAL CAREGIVERS ON NEUTROPENIC PATIENT CARING G. Bagcivan*,1, B. Masatoglu1, Z. Topcu1 1 Gu¨lhane Military Medical Academy, School of Nursing, Ankara, Turkey Introduction: Neutropenic patient care is an important issue for preserving complications that are linked with neutropenia and shortening of neutropenia duration. Cooperation of informal caregivers on neutropenic patient care is very
important. Ensuring this cooperation depends on the knowledge of informal caregivers about caregiving. There is not currently any study about knowledge and practice about neutropenic patient care of informal caregivers of neutropenic cancer inpatients. This study aims to specify knowledge and practices on neutropenic patient care of informal caregivers of neutropenic cancer inpatients. Method: This descriptive study was conducted at a University Hospital in Ankara, Turkey on December 2012 and July 2013, where research was conducted in twenty beds of the Medical Oncology and Hematology clinic. This study includes interviews with 100 informal caregivers of inpatients who become neutropenic at least two days ago. Patients who had an absolute neutrophil value under 2.000/mm3 were accepted as neutropenic. The SPSS software was used for statistical analysis. The descriptive statistics were presented by numbers (n) and percentages (%), and by mean (standard deviation). Results: All informal caregivers indicated that they had knowledge of and practiced the following rules of patient care, including ‘washing hands’, ‘preservation of dirty objects from clean ones’, ‘attention to personal cleaning of informal caregivers’ and ‘following infection symptoms and controlling’. Besides, most of the informal caregivers (more than 80%) indicated that they have knowledge of and practiced the following rules of patient care: ‘important matters about food’, ‘not keeping live plant in patient’s room’, ‘patient’s mouthwash at least three times in day’, ‘putting on a mask’, ‘preservation of catheter’, ‘not touching infected persons’, ‘not keeping too many objects in the room’ and ‘not accepting visitors’. The least well-known and practiced rules by informal caregivers included ‘cleaning patient’s armpits and groin area two times in day’, ‘having bath every other day with consideration of patient’s other blood rates’ and ‘not feeding patient with slim crusted fruits, if given, they should be peeled.’ Conclusion: In the current study, while all or most of the informal caregivers were aware of and implemented some of the rules associated with the care of neutropenic patients, it was seen that some were known but implemented a lesser extent. It is recommended that standard education programs be launched for caregivers, who play an important role in patient care, and so should be provided with regular training. Furthermore, it is recommended that informal caregivers be observed when engaged in their routines, and any deﬁciencies that are identiﬁed should be addressed under the supervision of nurses. Disclosure of Interest: None Declared. NP018 AN INSIGHT INTO HURLERS (MPS1) TRANSPLANTATION AT THE ROYAL MANCHESTER CHILDRENS HOSPITAL H. Webster1, H. Heartﬁeld*,1 1 BMT unit, Royal Manchester Childrens Hospital, manchester, United Kingdom Introduction: The Royal Manchester Children’s Bone Marrow Unit (BMTU) at the Central Manchester University Hospitals in the United Kingdom (UK) are a leading centre of excellence, on a national and international level, in transplantation of non malignant enzyme deﬁciency mucopolysaccharide disorders (MPS) Hurlers Syndrome. In 1980, UK doctors pioneered Bone Marrow Transplantation for MPS, with Manchester performing their ﬁrst transplant in 1985. Advances and success with MPS Bone Marrow Transplant (BMT) at The Royal Manchester Hospital have developed over the years to the present time. The collaboration of the centralised care within the hospital, working with a large multidisciplinary team, other centres and the establishment of MPS stem cell research laboratory at Manchester have contributed to such developments. Although there is no speciﬁc screening for MPS, there is increased awareness and early detection is therefore
improving. There has been a signiﬁcant increase in the number of MPS transplants performed at Manchester over the past 20 years, averaging 8 transplants per year with a success rate of 90% engrafted survival. Once diagnosed the pathway to transplant at Manchester can then be initiated. This involves; initial consultation with consultant, and support from Bone Marrow Coordinator, intensive conditioning, resulting in potential side effects of infection, Graft verses Host Disease and organ toxicity, and ﬁnally post transplant long term care. Nursing management, care and support are paramount throughout this period and contribute hugely throughout the process of transplantation. Conclusion: Advances in transplantation in MPS at the Royal Manchester Children’s Hospital are evident, therefore leading to greater knowledge and expertise within this nursing ﬁeld. Our goal is to improve therapies and with future developments in screening and Gene Therapy, and our excellent collaboration of care, this is possible. The immediate future builds on what we have learnt from our immediate past. Disclosure of Interest: None Declared. NP019 A LOW VOLUME CD34+ RICH PRODUCT CAN BE ACHIEVED THROUGH COLLECT PUMP MANIPULATION WHEN USING CMNC FOR AUTOLOGOUS STEM CELL HARVESTS H. Keane*,1 1 Apheresis, UCLH, London, United Kingdom Introduction: Product volume in autologous transplants can be a problem due to overall return volume and DMSO concentration for the patient as both can lead to adverse events during reinfusion. Additionally large product volume is a storage burden in cryopreservation laboratories which is a resource issue for both cost and long term access to storage space. With the recent introduction of the Continuous Mononuclear Cell (CMNC) protocol on Spectra Optiat there is an opportunity to directly inﬂuence ﬁnal product volume by direct control of collect pump ﬂow rate. Method: We methodically investigated the potential to reduce product volume by step-wise reduction in collect pump ﬂow rate during individual procedures and the impact on overall yield / dose and collection efﬁciency of targeted CD34+ cells. Results: 31 procedures have been performed to date with patients being divided into 3 separate groups with the aim of testing the effect on efﬁciency of using 3 different collect pump ﬂow rates; 1.0 ml/minute (default) against 0.8 ml/minute and 0.6 ml/minute. There was no signiﬁcant difference between the patients in each arm of the study and the median starting peripheral blood CD34+/ul ranged from 42 in the 1.0mls/min to 31 and 34 respectively in the 0.8 ml and 0.6mls/min patient groups. As expected the smaller collect rate resulted in a signiﬁcantly smaller product volume with the median product volumes being 199mls (1.0 ml/min), 160mls (0.8mls/min) and 120mls (0.6 ml/min). CD34+ CE1%
Collect pump ﬂow rate (ml/minute) Number Min Median Max
1 13 43.0% 68.7% 101.9%
0.8 8 28.0% 55.0% 88.3%
0.6 9 29.5% 54.2% 69.9%
Despite a stepwise reduction in CD34+ CE1% when using lower collect ﬂow rates from 68.7% at 1.0 ml/min to 55.0% at 0.8 ml and 54.2% at 0.6 ml/min. This did not reach statistical signiﬁcance until comparing the difference between 1.0 ml/ min against 0.6 ml/min (Po0.01). The drop in efﬁciency of the overall CD34+ cell dose harvested/kg was not signiﬁcantly
different when comparing 0.6mls/min to 1.0 mls/min and did not affect the overall aim of achieving a transplantable dose of 2x10^6/Kg in the smallest volume possible. Conclusion: There was a reduction in collection efﬁciency in the lower collect rates, but this drop in efﬁciency was smaller than might be expected especially when comparing the median CD34+ CE1% for 1.0ml/min and 0.6 ml/min collections which gave a net reduction of 21%. This is signiﬁcantly less than the corresponding reduction in the median harvested product volumes of 1.0 ml (199 mL) and 0.6 ml (113 mL) procedures which gives a net reduction of 43%. Therefore, a collect rate of 0.6mls/min can be used when harvesting cells using CMNC to attain a high concentration, low product volume. However, this is at the risk of some loss of CD34+ cells due to the decreased extraction efﬁciency. Disclosure of Interest: None Declared. NP020 AN INITIAL INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY, AND HEALTH (ICF) CORE SET IN PATIENTS WITH STEM CELL TRANSPLANTATION BASED ON NURSING DOCUMENTATION H. A. Stallinga*,1, H. Wyma2, S. J. Haan2, P. F. Roodbol1 1 School of Nursing & Health, University of Groningen, University Medical Center Groningen, 2Hematology, University Medical Center Groningen, Groningen, Netherlands Introduction: In patients with stem cell transplantation, biomedical oriented healthcare falls short in generating all the information, required for determining healthcare provision, to improve patients’ health status. A more holistic approach, by using the International Classiﬁcation of Functioning, Disability and Health (ICF), focusing on patients status of functioning, seems more appropriate, especially for nurses. Objective: To develop an initial ICF core set for patients with stem cell transplantation based on nursing documentation. An ICF core set is a short list of ICF categories relevant to a health condition. The core set can serve as a guide in assessing patients’ health status, relevant for clinical decision-making in healthcare provision. The initial ICF core set is the ﬁrst phase in the development of a comprehensive core set, in which evidence from follow-up studies (a systematic review, an expert survey, ﬁeld testing) will be integrated. Method: Mixed methods; 1) through a peer-reviewed procedure, nurse documented patient information was linked to ICF categories using standardized linking rules established for the ICF: 2) absolute and relative frequencies of ICF categories were reported. Included were 31 records of patients admitted for stem cell transplantation between March 2013 and September 2013 at the department of hematology in a Dutch University Medical Centre. Two researchers, trained in nursing care for patients with stem cell transplantation and in using the ICF, collected and analyzed the data. Results: 2372 meaningful concepts were identiﬁed of which 2298 could be linked to 76 ICF categories of which 49 were classiﬁed into body functions, 14 into anatomical structures, 8 into activities and participation and 5 into external factors. Sensation of pain (ICF code: b280), defecation functions (ICF code b525), sensations associated with the digestive system (ICF code b535) and ingestion functions (ICF code b510) were the most frequently reported categories. Eighty-three percent of the documented information was related to body functions and structures; ten percent was related to activities and participation, and seven percent was related to environmental factors. Conclusion: Almost all patient information, documented by nurses can be linked to ICF. However, the majority of nursing documentation was related to the component of body functions and structures, representing biomedical oriented healthcare provision. This may indicate that nurses are lacking to document psychosocial information corresponding to the component of activities and participation and environmental factors. An ICF core set, which included all relevant biomedical
and psychosocial aspects of patients with stem cell transplantation, may be a useful tool for nurses representing their holistic approach to healthcare provision. Disclosure of Interest: None Declared. NP021 SODIUM CITRATE (SODIUM CITRICUM 4%) AS CENTRAL VENOUS CATHETER LOCK TO KEEP THE CATHETER LUMEN FROM OCCLUSSION IN PATIENTS AFTER ALLOGENEIC STEM CELL TRANSPLANTATION J. Skardova*,1, E. Bystricka1, S. Vokurka1, H. Petra1, M. Karas1, P. Vodickova1 1 Haemato-Oncology, University Hospital in Pilsen, Plzen (Pilsen), Czech Republic Introduction: To protect CVC lumen from intraluminal occlusion is one of the most imporant tasks in the CVC care. No data are available about the safety and efﬁcacy of 4% sodium citrate locks administered into central venous catheter (CVCs) in patients after allogeneic stem cell transplantation (SCT). OBJECTIVE: To verify the reliability and safety of sodium citrate 4% locks. Method: Prospective study, sodium citrate (sodium citricum 4%, "Citra-Lock") was administered intraluminally for 24– 72 hours into multi-lumen CVCs (Arrows) in patients after allogeneic SCT in cases where at least one lumen is no longer needed for continuous administration of infusions. The citrate volume corresponded to the volume of the CVC lumen. Results: 91 lumens in 43 CVCs in 43 patients were observed. The median number of days of observation of a single CVC lumen was 6 ( 2–32 ), and the number of locks administered per lumen was 3 (1–13 ). The exchange interval between administering two locks was 24 hours in 49% of cases, 48 hours in 19%, and 72 hours in 32%. At the end of the monitoring period, from 6 days out to a maximum of 32 days, and including 3 or more lock applications (maximum 13 applications) in half the patients, patency was maintained in 58% of the lumens, was partial in 22% and was completely obstructed in 20%. After converting the results per 10 applications of the locks, complete obstruction of the lumen occurred in 6% of cases (6% complete obstructions per 10 administrations of the lock). After converting the results per 10 days of using the locks, complete obstruction of the lumen occurred in 7% of cases (7% complete obstructions per 10 days of lock use). Blood cultures taken from the lumen prior to the ﬁrst lock administration and at the end of monitoring were positive in 4% and 9% of cases (P=0.35), respectively. No complications related to CVC lock application were observed. Conclusion: We can conclude that the use of a 4% sodium citrate lock every 24 to 72 hours in patients with multi-luminal CVCs is safe and the risk of obstruction of the lumen is relatively small - 6% and 7% per 10 applications or 10 days of using this method, respectively. Disclosure of Interest: None Declared. NP022 LOOKING FORWARD TO ADOLESCENTS AND YOUNG ADULTS SPECIFIC CARE IN SPAIN J. Ruiz*,1, P. Herreros1, S. Martı´n-Ventas1, R. Lorenzo1, V. Linde1, S. Aleza1, E. Trigoso2 1 Oncohematology and BMT Unit, Nin˜o Jesus Hospital Madrid, Madrid, 2BMT Unit, La Fe Hospital, Valencia, Spain Introduction: In Spain the incidence of cancer in adolescents considering ages between 15 to 19 is around 450 cases. Then number of patients treated in our unit, Nin˜o Jesu´s Hospital, Madrid, above 12 in 2013 was 28, which is around 30% of all patients seen. Nurses detect needs that are different from those of our smaller patients, we detect these different needs because we are beside patients 24 hours a day. Being concerned about this situation, we started working wiht the Spanish Asssociation of Adolescents and young adults with
cancer (AAA). Last year a Nurse Board was created and we took our ﬁrst steps. Objectives: Investigate needs of nurses attending adolescentes and young adults with cancer and at the same time, needs that nurses may detect of these patients. Method: A survey was submitted for nurses from different hospitals in Spain. 46 hospitals answered the survey. 20 items were studied in the survey that were divided into 4 points: Training, information, resources and needs, our proper needs and the needs we think that adolescents and young adults have. Results: We received 46 surveys of responsibles of the units, and 234 surveys of assistant nurses. 40% of the units were pediatric units and 60% were adult units. Resources: adolescentes and young adults should be treated at pediatric units 60%, at adult units 46%. 88% of the facilities do not have an speciﬁc area for adolescents and young adults. Information:80% did not know where to acceed to information resources for adolescentes and youg adults, and information resources to assist professionals. 100% considered that it would be interesting to have a website or similar available to guide and seek questions about these patients. Training: only 31% of nurses think they have enough training and knowledge. 97% consider that speciﬁc training is important. 46% of the total of nurses feel unqualiﬁed. 93% consider that adolescents and young adults with cancer need our attention, and 100% think that it is neccessary to develope speciﬁc care teams for adolescents and young adults. Needs: 60% of the nurses do not know about their rights. 88% believe that adolescents and young adults should receive all the information of their disease and treatment and 96% consider that they must take decisions and participate with the team. Conclusion: Nurses need training, speciﬁc health education for professionals including treatment and care, physical, psychologycal and social development of this group and a platform to guide professionals and patients. Nurse board of AAA is organizing a course for Spanish professionals that will be held on May 2015 and is participating at the AAA platform providing expert information. Efforts in Spain must continue, to create the adecuate environment, units for adolescents and young adults with speciﬁc care and listening to their greatest desire that is to "keep their life as normalized as possible". Disclosure of Interest: None Declared. NP023 SETTING UP A TRIAGE AND ASSESSMENT (T&A) UNIT IN CLINICAL HAEMATOLOGY – THE CHALLENGES OF MEETING THE COMPLEX NEEDS OF PATIENTS WITH MALIGNANT AND NON-MALIGNANT HAEMATOLOGICAL DISORDERS O. Brokka1, J. Garneau*,1, K. Bradley1 1 Haematology Outpatient, IMPERIAL COLLEGE HEALTHCARE NHS TRUST, LONDON, United Kingdom Introduction: The haematology unit at Imperial College Healthcare NHS Trust (ICHNT) launched a T&A unit in February 2014 as the ﬁrst phase of transforming the way in which haematology services are delivered. The T&A unit within Haematology Day Care also incorporates a pain service for Haemoglobinopathy patients. It is planned that the full launch of Ambulatory Care will follow in February 2015 and will include Stem Cell Transplants.The T&A has 4 designated treatment spaces and is staffed by experienced haematology nurses who have been trained in the use of UKONS (UK Oncology Nursing Society) Triage tool. Method: There are two dedicated helplines that provide rapid access to advice and initial assessment 24/7. This helpline is also used by GPs and other primary care agencies. All patients are being assessed using UKONS assessment tool, except the Sickle Cell patients calling the pain service. They are assessed using a modiﬁed and customised pain assessment tool. The patients are encouraged to seek advice via this service rather than presenting unannounced on the unit, which previously disrupted the day care service resulting in prolonged stays and poor patient experience.
The pain service is designed to reduce the need for in-patients admission by offering rapid access to pain relief in the event of a mild to moderate Sickle Cell Crisis. This has proved to reduce the number of emergency admissions and associated prolonged hospitalisation. The patients that access this service have individualised treatment protocols which enables the nurse to initiate treatment on arrival. For the malignant haematology group the service provides rapid access to advice, assessment and medical review, which may or may not necessitate direct hospital admission. Depending on the result of the initial assessment based on the UKONS tool, some patients might be asked to attend the unit for further investigation and treatment. On arrival the patient’s health records will be available for reference and a nurse assessment will be undertaken that includes recording of vital signs, blood tests and cannulation. After the initial assessment the patient will be review by the departmental physician who will decide on further treatment options. The Triage nurse will assist with investigations and promptly administer prescribed treatments to comply with national guidelines for the management of sepsis. Results: Since the T&A unit opened we have faced the challenge of increasing numbers of patients accessing the service, which was further compounded by the closure of the hospital’s EU department September 2014. Conclusion: Future plans include nurses being trained in advanced assessment, further development of patient group directives and nurse prescribers. Disclosure of Interest: None Declared. NP024 NOVICE TO EXPERT – IMPROVING NURSES KNOWLEDGE BASE BY INTERNAL ROTATION O. Brokka1, K. Logan*,1 1 Haematology Outpatient, IMPERIAL COLLEGE HEALTHCARE NHS TRUST, LONDON, United Kingdom Introduction: Nursing today has grown very complex especially in acute care settings. The need for more experienced nurses in an outpatient setting has increased due to acuity levels as well as decreased length of hospitalisation of patients. Increased complexity and needs of the patient requires highly skilled and competent nurses. Being a novice nurse can leave you with feelings of inadequacy and lack of knowledge in a speciﬁc speciality such as haematology. Through guidance, support and education it will enhance the knowledge and capabilities of the nurse therefore improving standards of care. Clinical judgement is essential for every healthcare professional. Being able to assess, plan and implement necessary nursing interventions can only come through experience and training of the nurse. Method: Haematology services at Imperial College Health Care NHS Trust (ICHNT) has developed and moved forward with the opening of ambulatory care and triage and assessment unit. In order to function effectively and provide safe, effective and high quality nursing care, the nurse needs to have a good understanding of haematological conditions as well as knowing the up to date treatment options available. To ensure the unit was staffed by experienced and knowledgeable nurses it was decided to send nurses to the inpatient ward on internal rotation to gain a better understanding of patient’s pathways. The rotation lasted for 3 months and included a stay on two transplant wards encompassing both autologous and allogeneic transplants. By spending several weeks in the wards and working with more experienced nurses, it ensured that the nurses were able to follow several transplant patients from admission to discharge. They experienced the patients various complex treatment protocols and how the side effects of these regimes and the impact it had on the patient and patient state of mind. Results: The nurses that took part in the internal rotation reported increased conﬁdence and abilities when dealing with patients coming from the inpatient setting to the outpatient
setting. They were able to make more informed judgements when implementing nursing care. This seems to be beneﬁcial to nurses working in the department and is an idea going forward to be introduced to newly appointed nurses coming into the department. Conclusion: Through professional development nurses are able to enjoy autonomy and quality time with patients and with continued practice the nurse can move from novice to competent performer. Disclosure of Interest: None Declared. NP025 PLERIXAFOR AS A SINGLE AGENT FOR MOBILISATION OF AUTOLOGOUS HAEMATOPOIETIC PROGENITOR CELLS AND TWO DAY PERIPHERAL BLOOD STEM CELL COLLECTION FROM A 10 YEAR OLD BOY WITH T-CELL ANGIOIMMUNOBLASTIC LYMPHOMA AND A HISTORY OF LIVER TRANSPLANTATION K. R. Stephen*,1, M. Gabriel2, P. Shaw2, B. Ozgur2, V. Antonenas3 1 BMT/Oncology, 2The Children’s Hospital Westmead, 3BMT Laboratory, Westmead Hospital, Westmead, Australia Introduction: The successful collection of stem cells requires adequate mobilisation of stem cells into the peripheral blood. Stem cell mobilisation can occur with using 1) cytokines, 2) chemotherapy with cytokines, with the addition of Plerixafor to either option. Plerixafor is a CXCR4 chemokine antagonist that has been shown to increase the number of circulating CD34’s in donors when administered alone or with GCSF. Method: We report the successful mobilisation with Plerixafor 0.24 mgs/kg alone and the subsequent two day collection using the Optia Spectra MNC procedure of Autologous HSC’s from a 10 year old boy with a history of liver transplantation – adult split graft. Following a complicated history he was diagnosed in December 2013 with malignant T-cell monomorphic lymphoproliferative disorder. This was treated with Cyclophosphamide in March 2014. In September 2014 the patient was referred to the BMT/ Apheresis team here at the CHW for Autologous PBSC collection. Due to his history of chest inﬁltrates with mediastinal lymphadenopathy as well as lung inﬁltrates with effusions requiring chest drainage it was decided by the team to use Plerixafor alone. This decision was made to not provoke further lung inﬁltrates and injury with the prolonged increased white cell count associated with the minimum of 4-5 days of GCSF for mobilisation. Conclusion: The peripheral CD34 count was monitored hourly throughout the procedure from 6 hours post Plerixafor dose until the end of the procedure each day. The total harvested CD34+ cells collected was 2.9x10/6/kg with the thawed CD34+cells=1.7x10/6/kg. This case demonstrates that it is possible to mobilise complex patients with plerixafor alone. Disclosure of Interest: None Declared. NP026 THE RAPID NURSING INITIATION OF FIRST LINE ANTIBIOTICS FOR NEUTROPENIC PATIENTS EXPERIENCING PYREXIA AND / OR SUSPECTED SEPSIS: USING PATIENT GROUP DIRECTION (PGD) IMPROVES PATIENT OUTCOME AND EXPERIENCE S. D. Clare1, S. Rowley1, D. Comerford1, K. White*,1, G. Walters1, S. Thomas1, J. Derbyshire1, S. Jordan1 1 Haematology, University College London Hospitals NHS Foundation Trust (UCLH), London, United Kingdom Introduction: For every hours delay in septic patients receiving intravenous antibiotics the chances of survival reduce by 7.6% (Kumar et al 2006). This is likely to be even greater in the neutropenic population. A review of the time it took haematology/HSCT patients to receive ﬁrst line antibiotics at UCLH in London (’Spike to needle time’) for
suspected neutropenic sepsis identiﬁed signiﬁcant delays over and above the recommended 60 minute maximum. Delays were mainly as a result of the wait for busy doctors to attend the patient. While these delays often occurred at night, surprisingly, delays also occurred in daytime hours. To reduce this critical period, the service developed and introduced a Patient Group Direction (PGD) in order for haematology nurses to initiate and administer the ﬁrst line antibiotic of Tazobactum or Ceftazadine. Method: A pre and post intervention clinical audit of ﬁrst line antibiotic delivery was conducted across haematology inpatient units. Haematology/HSCT staff were surveyed regarding the use of PGD and their level of competency. A competency based training resource was developed and the antibiotic-PGD was mandated across the service. Results: Pre-PGD, ﬁrst line antibiotics were appropriately delivered 46% of the time. The nursing survey reported 80% non-PGD givers would like to be trained, 85% would like to see more PGD prescribers and 70% wanted more PGD education. One year on the average time to 1st line antibiotic delivery has dropped to 26 minutes, based on a revised target time of 30 minutes (n=200). ’Spike to Needle’ times reduced signiﬁcantly and have been maintained with 100% nursing administration. Conclusion: These improvements only served to highlight continued delays in the delivery of 2nd line antibiotic (Gentimycin or Ciproﬂoxacin). A second PGD has subsequently been developed for 2nd line antibiotics. To address concerns of nurse prescribing of nephrotoxic antibiotics the latest PGD includes an electronic algorithm that nurses can use to safely determine dosage. Disclosure of Interest: None Declared. NP027 EVALUATION OF SOPHROLOGY AS SUPPORTIVE CARE BY PATIENTS DURING AN HEMATOPOIETIC STEM CELL ALLOTRANSPLANTATION M. Zygar1, L. Tardieu*,1, C. Philippon1, M. Otmane Cherif1, M. P. Gourin1, J. Abraham1, S. Girault1, P. Turlure1, D. Bordessoule1 1 hospital, chu limoges, Limoges, France Introduction: Hematopoietic stem cell(HSC) allotransplantation can improve the prognosis in many cases of severe malignant hemopathy, but generally at the cost of long hospitalizations, a difﬁcult experience for patients(P), both physically and mentally. Sophrology(S) is a relaxation method that could prove interesting for those P’ care. S’s objective is to improve the P’s well-being by focusing their attention on sensations to reinforce physical and mental comfort. Beyond any preconceived idea, the aim of our work is to have P evaluate the beneﬁts brought by S during their stay at the hospital for an allotransplantation. Method: Prospective, descriptive and analytical study of the impact of S on the experience of transplanted P who have beneﬁted from a S session. Surveys (Q) elaborated by a steering committee were distributed to all consecutive P taken in S, with anonymized gathering of demographic data and anxiety evaluation10-points scales measured before and after care. Statistical analysis were done with Excel. Results: Between 11/2011 and 09/2013,45 P were allotransplanted with at least one S session,37/45 Q(82%) have been completed and analyzed. Population: sex ratio 0.68,median age 56[18–68],for myeloid(76%) and lymphoid(24%) pathologies. Characteristics of allograft were geno(30%)/ pheno(70%) donors;myeloablative(38%),non-myeloablative(62%);peripheral HSC graft(76%), bone marrow(14%),umbilical cord(11%). Acute GVH disease was present in 41% of the P. P knew S before their disease in 43% of the cases. Duration of a S session on average:30 min in 76% of the cases with inclusion of music in 81%. Anxiety on a scale of 0 to 10 (maximum anxiety) falls from 5/10 to 2/10 before and after the S session. The beneﬁts of S listed by the P (n=89) are,divided into
relaxation of the body:n=31 (35%), well-being: n=29 (33%), decrease of stress:n=16 (18%), learning how to breathe: n=9 (10%), other: n=4 (4%); 95% of the P were satisﬁed by the sessions and 81% wished to pursue them. Conclusion: In a hematology department,which performs highly technical procedures such as allotransplantation,sophrology had to be integrated progressively,as part of a global multi-profession cohesive project. The goal is to develop nondrug-related means for a quality care,and to help the P retain their well-being during a physically and mentally taxing therapeutic procedure. Disclosure of Interest: None Declared. NP028 THE EFFICIENCY OF SINGLE-NEEDLE VERSUS DOUBLENEEDLE DELIVERY OF EXTRACORPOREAL PHOTOPHERESIS (ECP) TREATMENT TO ADULT PATIENTS WITH GRAFT VERSUS HOST DISEASE (GVHD. L. Robertson*,1, M. Foster1, T. Maher1, R. Goodgrove1, C. Swift1, C. Rushton1, J. Mayo1, H. Denney1, A. Alfred1, P. Taylor1 1 Rotherham Photopheresis Unit, The Rotherham NHS Foundation Trust, Rotherham, United Kingdom Introduction: As demand for ECP increases, together with a broader eligibility, it is important to establish the most efﬁcient method to deliver effective ECP treatment to patients with GvHD. Patient’s presenting for ECP with GvHD repeatedly present a challenge to the ECP team due to poor venous access resulting from previous therapies and skin changes. This may often result in multiple cannulation attempts on a regular basis, leading to bruising, haematoma, transient pain and syncope. The insertion of a tunnelled Hickman line catheter presents alternative problems, with increased incidence of infective episodes and blocked catheter lumens often resulting in the deferral of treatment. In both situations treatment delivery may be adversely affected with multiple alarms and extended treatment times. Method: To ascertain the most efﬁcient method of delivery of ECP treatment, we performed a retrospective analysis of both single and double needle mode treatment delivery via either a 16G peripheral IV cannula or a tunnelled Hickman line catheter. This will consequently enable us to ensure we are fully optimising the efﬁciency of the Rotherham Photopheresis Service. The retrospective study analysed 317 Photopheresis treatment procedures which were completed at The Rotherham NHS Foundation Trust on adult patients with GvHD, during a 3 month period between 1st July 2014 and 30th September 2014. All procedures were completed using the Therakos Cellex Photopheresis System (Version 4.1), allowing for both single and double-needle treatments to be compared. Results: Of 317 treatments, 250 (78.9%) procedures were completed using cannulation compared to 67 (21.1%) recorded Hickman Line procedures. Median treatment times were 2hr15min in single-needle cannula (n=217, 68.4% of all treatments), 2hr30min in single-needle Hickman (n=45, 13.8%), 1hr50min in double-needle cannula (n=34, 10.4%) and 1hr55min double-needle Hickman line (n=24, 7.2%) treatments. The overall median treatment duration for patients treated over the 3 months was 2hr15mins. Conclusion: The data collected is in agreement with the data from Therakos, the manufacturer of the photopheresis device, that double needle treatment may decrease treatment time in comparison to single needle treatment by approximately 30 minutes. However, out of 317 treatments, only 17.6% were completed in double needle mode due to problems with peripheral vascular access and Hickman line patency. Patient preference also played a role in treatment mode selection. Therefore, in order to fully optimise the ECP service at The Rotherham NHS Foundation Trust, each patient should continue to be individually and holistically assessed at each visit to ensure optimal treatment and patient satisfaction. Disclosure of Interest: None Declared.
NP029 TRANSFUSION SURVEILLANCE OF STEM CELL TRANSPLANTATION: TRACKING OF HPC INFUSION L. Russo*,1, G. Cusumano1, N. Meliambro1, T. Gangemi1, M. Scirto`1, M. Monorchio1, R. Avenoso1, I. Repaci1 1 Azienda Ospedaliera Bianchi Melacrino Morelli, CTMO, Reggio Calabria, Italy Introduction: As part of an approach aimed at risk management in the CTMO of Reggio Calabria has been adopted and implemented a quality management system that has mapped the diagnostic and care pathways to improve patient management, catering to identify the critical issues and activities involving more to adopt measurable indicators for monitoring of key processes. One of the activities of major signiﬁcance in the context of a bone marrow transplant center is the infusion of stem cells (Hemopoietic Progenitor Cell-HPC) autologous or allogeneic collected after apheresis or bone marrow withdrawal. Method: The infusion is divided into two phases with precise responsibilities of the medical and nursing staff: nurse follows the procedure, providing for the detection of vital signs preinfusion, staging principals of emergency, the recognition of the generality of the patient and the characteristics of the product to be infused. In order to share with the laboratory and handling with Transfusion Servicer (SIT) traceability of adverse events or reactions related to the infusion of HPC, was created and shared a record called "feedback transfusion reaction." This form is completed by the physician in charge of the infusion and subsequently validated by the nurse after 2448 hours; recordings are stored by the LAB-MC CTMO, at the end of the year and the report of the cellular products infusions, is transmitted to the SIT that participates in outcome of such assessments. Results: From 2013 to today were made 160 of autologous infusions and 76 of allogeneic cellular products. Complications in relation to autologous transplants occurred in only 4 patients, while in the allogeneic transplants occurred in 5 patients. The reactions were managed with medical therapy alone and consisted of febrile reactions; in only one case was found a hypertensive episode and probably a reaction to the DMSO solved with medical treatment and temporary suspension of the infusion. Conclusion: The implementation of a program of clinical governance within the transplant route has proven to be an indispensable tool for the correct classiﬁcation of risk management. Although not currently institutionalized a phase of monitoring structures related to the infusion of HPC, the adoption of a recording adapted to detect the occurrence of adverse events, was a great tool for validation of security, traceability and efﬁciency transfusion in the context of cellbased therapies. Disclosure of Interest: None Declared. NP030 MEDICATION NON-ADHERENCE IN HEMATOLOGICALONCOLOGICAL PATIENTS IN THEIR HOME SITUATION L. Bouwman*,1, C. M. Eeltink1, O. Visser1, J. M. Maaskant2,3 1 Hematology, VU University Hospital Amsterdam, 2Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, Academic Medical Center and University of Amsterdam, 3 Emma Children’s Hospital, Academic Medical Center, Amsterdam, Netherlands Introduction: Medication non-adherence is associated with poor health outcomes, and increased health care costs caused by more frequent visits to doctors and frequent and longer stays in hospitals. Adherence in cancer patients ranges between 16% and 100%, which illustrates a serious problem. Although there is a lot of knowledge about medication nonadherence and risk factors of medication non-adherence, this issue has not been investigated in hematological-oncological patients in their home situation. This study aims to explore the
prevalence of medication non-adherence and to identify potential risk factors for medication non-adherence in hematological-oncological patients in their home situation. Method: This is an exploratory cross sectional study, carried out between February and April 2014. 472 patients were sent questionnaires containing questions on patients’ characteristics, medication adherence, beliefs about medication, anxiety, depression, coping, and Quality of Life. Finally, 259 questionnaires were useful for analysis. We performed a univariable analysis, followed by a multivariable analysis to predict medication non-adherence. Results: In the univariable analysis, 9 variables were found signiﬁcantly related (P=o0,20) to medication non-adherence. In the multivariable analysis we found lower age, living alone and insufﬁcient social support to be signiﬁcantly related (P=o0,10) to medication non-adherence. These three variables explain 7,9% of the variance in non-adherence (R2=0,079). Conclusion: With this study we achieved to gain more knowledge about the prevalence of non-adherence in hematological-oncological patients in their home situation. Despite these results it remains difﬁcult to predict nonadherence. Disclosure of Interest: None Declared. NP031 ASSESSMENT OF FATIGUE IN HEMATOPOIETIC AUTOLOGOUS STEM CELL TRANSPLANT PATIENTS L. Pomper*,1 1 Clinical Hospital Merkur, Zagreb, Croatia Introduction: Fatigue is expected problem in hematopoietic autologous stem cell transplant (ASCT) patients (pts) and can last for longer period after SCT. Fatigue is subjective and individual expression that adversely affects multidimensional aspects of quality of life (QoL) like physical, cognitive and emotional fatigue. Aim: to determine severity, frequency, duration and impact of fatigue on quality of life in hematopoietic autologous stem cell transplant patients before, during and after SCT. Method: We evaluated fatigue of pts during and after ASCT with a standardized questionnaire of self-assessment (yFatigue symptom Inventory‘‘). The questionnaire consisted of 14 questions about the severity and impact of fatigue on QoL (min. 0 to max. 10), related to weekly (0 to7 days), daily fatigue frequency (min.0 do max.10), and the pattern of fatigue frequency during the day. On level 0-10, fatigue 1-3 was graduated as minor, 4-6 as middle and 7-10 severe. We’ve analyzed reports of 10 consecutive hospitalized autologous SCT pts from September to November 2014. (7 MM, 2 NHL, 1 MH). Median years was 54.5 (41-69); F:M ratio was 5:5. Conditioning protocols were: HD-melphalan (7) and BEAM (3). Control group were employees of the Hematology Department. We’ve analyzed all data individually and as group. Results: The highest degree of fatigue and the biggest impact on QoL was during the hospitalization (4 and 3), as well as during the ﬁrst 7 days after discharge (3,5 and 2,75). One month after the discharge the level of fatigue returned closely to the pre-transplant level (2) for most of the pts. Seven of ten pts complained on severe fatigue during the SCT, while moderate fatigue experienced one pts. During the 7 days after discharge 3 of 9 pts complained on severe fatigue, while 4 of 9 pts reported moderate fatigue. One month after discharge, moderate fatigue experienced 3 of 6 pts. Fatigue was most present in the ﬁrst week after discharge (6 of 7 days), while one month after discharge was present in 5 of 7 days. The biggest impact of fatigue on QoL was in general level of activity and normal work activity (both 5,5), one week after discharge, but also a month after discharge (4 and 5). Level of fatigue was signiﬁcant in all control groups except nurses employed less than a year. That fatigue was shorter and didn’t have signiﬁcant impact on QoL.
Conclusion: These data have shown that the fatigue is present even a month after the discharge for most of the transplant pts and has negative impact on multidimensional presentation of QoL. Nurses should be aware how to recognize the fatigue and the risk factors. The assessment should be individualized and multidimensional. Patient who is informed about the fatigue, it’s impact on QoL, and education how to handle with it, has less worry and better control over everyday life. We will continue prospective research with more pts. Disclosure of Interest: None Declared. NP032 A RETROSPECTIVE OBSERVATIONAL STUDY TO EVALUATE THE INFECTION MANAGEMENT IN THE TRANSPLANT CENTER L. Cappucciati*,1 on behalf of Hematology, R. Scopelliti1, D. Petrucci1, G. Pattini1, C. Gozzo1, S. Fava1, S. Sbizzirro1, R. Patras1, S. Gandolﬁ1, L. Cavanna1, D. Vallisa1 1 Hematology, H. G. da Saliceto, Piacenza, Italy Introduction: BACKGROUND The management of hospital infections in the Transplant Centers has become over the years more and more relevant. The involvement of the nurses as a major player in the collection of cultural tests, allows to deﬁne strategic choices both at diagnostic as well as at therapeutic level. PURPOSE OF REVIEW The ﬁrst goal that we set as a team of ‘‘U.O. Ematologia e Centro Trapianti ’’ was to analyze infections data of patients undergoing transplant procedures from 2012 to 2013. The retrospective observational study is aimed at identifying the correlation between surveillance swabs and possible infection developing during the transplant procedures. Method: All patients, who underwent autologous or allogeneic transplants, upon admission were subjectedt to surveillance Swabs (nasal, perianal, coproculture, skin swab site central venous catheter if any). In case of Temperature4=38 1C, we proceeds with peripheral blood cultures equal to 3 samples at a distance of 30 minutes from each other. If the patient is a carrier of Cvc/Picc, the ﬁrst blood cultures are performed in duplicate, one sample from peripheral blood and one sample from the catheter. Colonization status is established by a positive surveillance swab. Infection is deﬁned according during to T4=38 1C twice. During the course of infection, we always run blood culture, while culturing of feces, urine and sputum only in case of symptomatic patients Results: From 2012 to 2013, 72 patients underwent transplant procedures: - 24 allogenic transplants and 48 autologous ones - 11 patients among allogenic tranplantations (46%) presented colonization while 14 ones in the setting of autotransplant (29%) - Fever with or without isolates (i.e. infection) developed in 19 allotransplants (80%), in 22 autotranspalnts (46%) - In allotransplant setting colonization predicts a risk of infection of 90% while in auto of 50% - three patients had infection correlated with the isolated swabs surveillance Conclusion: In our patients, who underwent transplant procedures, the evaluation of a possible colonization at the beginning of the procedure may predict the risk of an infective complication afterwards, although the last one may be supported by different bacteria from the previous ones.Our data suggest that this observation is particularly true in the setting of the allo-transplants. Also the mortality appears to be related to colonization status at the beginning. However, according to our policy, when fever appears in a transplanted neutropenic patient, empirical therapy takes into account the results of the previous swabs until new isolates grow up. Disclosure of Interest: None Declared.
NP033 TRANSITION TO A TOTALLY NURSE-LED BMAT SERVICE FOR OUT PATIENTS INCREASING EFFICIENCY – IMPROVING PATIENT EXPERIENCE M. Glover*,1, D. Collier1 1 UCLH McMillan Cancer Centre, UCLH, London, United Kingdom Introduction: In 2010 nurses started performing some bone marrow aspirate and trephines (BMAT) at UCLH. Now in 2014 the nurses run a bi weekly clinic & perform most of the BMATs, excluding those with sedation using Midazolam. In 2014 the Royal College of Anaesthetists updated their guidance on sedation with Midazolam requiring increased monitoring and training so that it would not be possible to use Midazolam in the nurse-led paradigm. At the same time increasing demand for the nurse-led BMAT service & pressures on bed usage meant 50% oxygen/50% nitrous oxide gas (Entonox) was proposed as the alternative. We used the Donabedian (2) model to help us assess the quality of our clinical care and identify areas for improvement under these drivers of change. Method: Using a survey we gathered information on ‘outcomes’ to establish a baseline before changing to Entonox: 1. If patients receive information from the hospital prior to coming for the test. 2. How patient reported levels of pain associated with having a BMAT in our clinic compared with other reported surveys. 3. If the patients overall experience was better or worse than they expected. Results: 1. Most of the patients surveyed did receive information from the hospital prior to their BMAT 2. We looked at patients reported pain scores for everyone that was surveyed 46 respondents fell into the LA only group, nearly 2/3rds of this group reported a pain score between 0-5 (65%). In the LA+Entonox group none of the respondents reported a pain score greater than 6 3. overall the reported pain scores from our clinic were better than those reported in an online poll 3.In general, most respondents said that the experience of attending the clinic was better than they had expected Conclusion: Conclusions &The survey was useful to get a ‘snapshot’ of some aspects of our BMAT service. &We did not seek a direct comparison of pain scores between LA only and LA+ Entonox in this instance but have obtained a base line for doing so when the new practice is embedded. &There are many factors other than the actual procedure that can affect a patient’s perception of pain (reference); previous experiences, pre-procedure preparation, anxiety levels. &Most people ﬁnd the procedure acceptable with LA only. &In general patient feed back is positive and procedure associated pain is in line with other reported pain scores. Disclosure of Interest: None Declared. NP034 THE IMPACT OF EARLY DOSING OF PLERIXAFOR ON BED OCCUPANCY AND APHERESIS SLOTS M. Farrell*,1 1 BartshealthNHS Trust, London, United Kingdom Introduction: Plerixafor is approved for stem cell mobilization in patients who have Multiple Myeloma and Non Hodgkin’s Lymphoma. However the administration of Plerixafor can prove problematic for the patient and clinicians. The recommended administration protocol, that is, administration at midnight before the scheduled harvest the following morning necessitated admission to the inpatient ward for surveillance of side effects. This proved to be difﬁcult in terms of the frequency of bed shortages. A solution was required in order for Plerixafor to remain an option. What we discovered was that our experience was not uncommon and that a solution was already being practiced successfully. By bringing the administration time forward from midnight to 17.00 hours, these groups reported having overcome the practical barriers associated with the pharmaceutical
company’s recommended dosing schedule without negative impact upon the harvest yield. At this time, we were not aware of any other UK centre using an altered schedule such as this but felt the evidence reported was worthy of trial. We were able to make use of our Day unit to administer the Plerixafor at 7pm and to observe the patient for an hour post for any reactions. Patients could opt to go home or stay in the ambulatory care hostel for the night to return for Apheresis at 9am the following morning. Method: A total no of 45 patients with Myeloma and Lymphoma received the early administration of the Plerixafor from April 2011 to April 2013. There was an equal distribution of male and female patients within both disease groups, although patients with Lymphoma were amongst the youngest in the audit the median age remained the same for both group of patients. Data was sourced retrospectively from patients clinical notes, chemotherapay diary, Apheresis diary, laboratory results, stem cell laboratory and admission dairy. This data was then collated in treatment prior to mobilisation, mobilisation strategy, apheresis sessions and stem cell yeild. Results: The study showed that 55 days of bed occupancy was saved alomg with 49 Apheresis sessions. Two patients were admitted however due to vascular access and the need for subsequent harvest the next day. Incidental ﬁndings also showed no difference in stem cell yeild compared to standard dosing. Conclusion: The main reason for conducting the study was to assess the actual impact of early administration of Plerixafor on bed occupancy and Apheresis slots. The study showed that bed occupancy was virtually eliminated and Apheresis slots were managed more efﬁciently resulting in patients proceeding directly to transpant without delay. There was a positive impact on the patient experience. Disclosure of Interest: None Declared. NP035 IMPLEMENTING PATIENT ACUITY SCORING IN AMBULATORY CARE T. Marler-Hausen1, M. Encinas*,1, R. Blackwood1, N. Lewin1 1 Ambulatory Care, University College Hospital London, London, United Kingdom Introduction: In our Ambulatory Care Unit we treat patients having allogeneic and autologous transplants alongside high dose chemotherapy. Increasing numbers of patients are now identiﬁed as being suitable for ambulatory care and with our service growing we decided to look closer at the acuity of our patients and to identify stafﬁng levels that match the total acuity score rather than the number of patients being treated. Nationally there has been a focus to implement the Safer Care Nursing Tool (SNCT) to help wards understand the acuity and dependency of their patients. However this tool has not been validated in an ambulatory care setting and so we have adapted an acuity scoring system that was developed at the Cleveland Clinic Cancer Centre. This model ﬁts closely with the nursing interventions carried out in our Ambulatory Care Unit. Method: We have scored our nursing interventions between level 1-4, with 1 being the lowest level, i.e. a simple IV infusion and level 4 being the highest level, i.e. a stem cell return. By calculating the total score the shift coordinator can then measure the total unit acuity against the levels of nursing. The prospective scoring of each patient appointment allows the nurse coordinator to anticipate potential days when the unit will require more nurses; conversely it can also identify days that are less busy and adjust stafﬁng accordingly. Understanding the acuity of the unit will also give us a better idea of what our patient capacity is, and should allow us to schedule patients appropriately. Scoring patients both prospectively and at the end of the shift allows us to identify differences and trends in our planned acuity and actual acuity. This gives us further insight into the
potential complexity of our patients and aids forward planning. We are also validating our acuity scoring system by asking the nurses to review the stafﬁng level and asking them to propose the number of staff they feel would be adequate to deliver safe nursing care. Using the expert opinion of our own nurses to suggest safe nursing levels is an empowering way to involve nurses in the development of our service. Conclusion: This project is helping us to understand patient acuity in an ambulatory care setting and we are developing an evidence base to ensure nursing levels are matched to the needs of patients to ensure safe care. Disclosure of Interest: None Declared. NP036 HOSPITALITY AS A LEAD FOR IMPROVING CARE OF PAEDIATRIC SCT PATIENTS M. Koster*,1, H. Verweij-Baars, 1, H. Mekelenkamp1, L. Ball1, M. de Taeye-Veldhuijzen1, W. Kollen1, A. Lankester1 1 Paediatric Stem Cell Transplantation Unit, Leiden University Medical Centre, Leiden, Netherlands Introduction: Hospitality is an ‘‘emotion’’ of hospital ‘‘guests’’, based on experiences, some lasting only seconds. The experiences in question are of two types, namely hosting and guest orientation. As an organisation, an ‘‘hospitable’’ hospital should be experienced as a warm and welcoming environment. Patients and their families, health care professionals and all other visitors, should be treated as individuals by employees using a cohesive, collaborative approach. Paediatric Stem Cell Transplantation (SCT) requires lengthy periods of intensive treatment. The experience of hospitality is an integral part of the care provided to children and their families. We aim to optimise sustained hospitality in our SCT unit and as such we explored families experiences and initiated a speciﬁc training program aimed at all members of staff. Method: As part of a general healthcare innovation plan, hospitality training was provided to selected staff of the children’s hospital. Training was provided to managers, physicians, nurses, secretaries, nutrition assistants and others who have patient contact. They were trained to be ‘‘ambassadors of hospitality’’ in order to motivate and inspire remaining colleagues by their exemplary behaviour. Each ambassador received 6 days of training and 3 individual coaching sessions. Each identiﬁed ‘‘buddies’’, with whom they shared the information and insights gained. Parents experience of hospitality was measured before and after this staff training by use of a standard questionnaire. Results: Twenty-eight parents of patients in our children’s hospital completed the questionnaire before hospitality training. They rated hospitality at 8.6 out of 10 and quality of care provided at 8.5. Sixty-eight percent of respondents reported their expectations of hospitality had been surpassed. Respect, helpfulness and commitment scored highest while punctuality scored lowest. Re-assessment, post training is being undertaken. An increase in self-perception of staff as not only providing medical care but functioning as ‘‘hosts’’ to patients and parents, resulting from the ambassador function was recorded. Similarly, children’s experience of hospitality was for example improved by providing them with a ‘‘teddybear ambulance’’ allowing ‘‘acting-out’’ in play physical examination and medical procedures. Conclusion: A hospitable organisation is effective in hosting as well as guest orientated. Speciﬁc hospitality training of all hospital employees, independent of background, is an effective method to achieving this goal. Creating ‘‘ambassadors’’ able to inspire and motivate colleagues facilitates rapid dissemination of a cultural and attitude change, intended to improve the experience of patients and families. An ongoing awareness of the guest’s needs and experiences is needed to increase and sustain quality of care. Disclosure of Interest: None Declared.
NP037 COMPARATIVE STUDY OF THE COLLECTION EFFICIENCY OF CONTINUOUS MONONUCLEAR CELL COLLECTION (C-MNC) SPECTRA OPTIA APHERESIS SYSTEM DEVICE VERSUS AMICUS CELL SEPARATOR DEVICE IN MONONUCLEAR CELL COLLECTION (A-MNC) M. GUMOGDA*,1, H. KEANE1, A. JUMAH1 1 Haematology, University College London Hospital NHS Foundation Trust, LONDON, United Kingdom Introduction: AIM: The aim of the study is to determine the collection efﬁciency of Continuous Mononuclear Cell Collection (C-MNC) Spectra Optia Apheresis System versus Amicus Cell Separator Device in Mononuclear Cell Collection (MNC) in the Autologous patient population at the University College London Hospital (UCLH). Method: METHODS: Apheresis harvest records and stem cell laboratory data were analysed retrospectively from 20 randomly selected autologous patients on C-MNC and 20 autologous patients undergoing Amicus MNC Collection. The two cohorts were matched in terms of diagnosis, and the Pre and post peripheral white blood cell count, duration of MNC procedure and CD34% yield/blood volume processed were compared and analysed. Results: RESULTS: There were a total of 40 patients reviewed with 20 patients in each arm, they had a median age of 57 years (range of 25-71yrs) with 14 Non-Hodgkin Lymphoma (NHL) and 26 Myeloma patients in total. The priming regimens were varied across the different patient subsets however this is reﬂected in both patient populations. All patients underwent a 2.5 total blood volume stem cell harvest.
NP039 THE COMBINED TRANSPLANT COORDINATOR AND CASE MANAGER MODEL IN HEMATOPOIETIC STEM CELL TRANSPLANTATION M. Baydoun*,1, R. Nehme 1, S. Okaily 1, A. Ali1, R. Kawas1, A. Bazarbachi 1 1 American University of Beirut Medical Center, Beirut, Lebanon
Median Min / Max Mean±SD T-Test2
Optia CMNC All (n=20) 49.88 33.71/79.58 50.19±11.22 P=0.003771
tumors and relapse. An appropiate an adapted monitorization check list is necessary which will help the nurse to identify all arising events. Finally the nurse should be able to educate patients after the transplant in order to diagnose complications as soon as posible as well as to contribute to improvement quality care in administering treatments by following standard operating protocols. Method: In order to select variables to be analyzed a literatura review: PubMed, CINAHL, LILACS, CUIDEN. In this project the NANDA, NIC and NOC taxonomy were used as well as, the the Standard Operating Procedures Manual of our transplant Unit and and the quality standards set by JACIE. Results: This nurse plan is been aplied to our out patient clinic. In our Unit we performed on 2013 131 transplants (70 allogeneic, related and unrelated and 61 autologous). Median number of allogeneic patients at the out patient clinic per day is 17.5. Patients are followed always after transplant at the Unit. Conclusion: In conclusion nurse has a crucial role in the outpatient care after a hematopoietic stem cell transplantation. Standardizing the nurse activity through a protocolized work plan, helps in reaching effective and quality cares. The training of nurses in this activity and the characteristics of these complex patients allows it to quickly identify problems and to coordinate a multidisciplinary team in the early diagnosis and the treatment. In turn this helps decreasing the time from when symptoms occur until they are overcome, including an improvent in the quality of care and the patients life quality. Disclosure of Interest: None Declared.
Amicus All (n=20) 35.35 15.8/72.7 37.04±14.8
By conventional criteria, this difference is considered to be statistically signiﬁcant. T-Test2=one sample t test comparing CD34% yield / blood volumes processed on 2.5 TBV MNC harvest on OPTIA CMNC or Amicus cell separators. Conclusion: CONCLUSION: Both the Amicus MNC and OPTIA CMNC programme are safe and effective devices in harvesting mononuclear cells. However, the data indicates that the Amicus was not as efﬁcient as the OPTIA MNC programme for CD34+ collections. Disclosure of Interest: None Declared. NP038 NURSING PROCEDURES IN THE OUTPATIENT UNIT AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION M. Garcia*,1, M. Salinero Peral2, B. Rodriguez1, D. Caballero Barrigon1, 3, L. Vazquez1, E. Pe´rez Lopez1, O. Lopez Godino1, L. Lo´pez Corral1, C. Can˜izo*1, M. Gonzalez Dı´az1 1 Stem cell transplantation unit, Hospital Clı´nico de Salamanca, 2 Stem cell transplantation unit, Hospital Clinico de Salamanca, 3 Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain Introduction: Hematopoyetic stem cell transplant outpatient care requires a nurse activity adapted to the unique characteristics of these patients. The nurse priority consulting receiving ambulatory patients should have a training and a work plan developed in order to permit the nursing process. This program will be able to detect early GVHD, infections, other acute, chronic, long term complications, secondary
Introduction: The modern healthcare recognizes comprehensive care management as a crucial approach for excellence. Considering the complexity of care required for Hematopoietic Stem Cell Transplantation (HSCT) patients, we believe multiple resources should be placed to meet patients’ needs throughout the transplant phases. The transplant coordinator at our center has been responsible for preparing patients for admission and follow-up after discharge. However, we noticed that extra resources are needed to meet patients’ needs. Thus, we aimed to adopt a stafﬁng model to manage patients’ care throughout the transplant phases. Method: To achieve our objective, a stafﬁng model composed of Combined Transplant Coordinator and Case Manager (CTCCM) has been implemented. After introducing the CTCCM model in October 2013, the clinical duties were distributed among the coordinator and case manager to ensure comprehensive care management and meet patients’ needs. To assess the impact of the model, in September 2014, a survey was distributed to 11 out of 13 nurses working in the HSCT unit; two nurses were excluded because they were newly hired. The survey included ﬁve open-ended questions to explore nurses’ perceptions regarding the effect of the model on nurses’ satisfaction and patients’ outcomes. Results: Five nurses returned back the questionnaire. The other 6 nurses did not respond due to either time inconvenience or being on leave. The most three recurrent answers were as follows: - All nurses expressed satisfaction with the model and considered it as an effective strategy to meet patients’ needs. For example, a nurse mentioned that the model made them more comfortable in solving clinical problems. Another nurse said that the model covers patients’ needs throughout the transplant phases.
- Four nurses expressed that the model enhanced a better patient education process, and made the discharge planning more comprehensive and standardized. - A common perception among all participants is that the model has improved operational efﬁciency and reﬂected positively on patients’ outcomes. A nurse said that both the transplant coordinator and case manager roles complement each other to improve patients’ outcomes. Another nurse mentioned that the coordinator and case manager assist nurses through facilitating clinical activities and speeding work processes. Conclusion: The CTCCM model at the HSCT unit was successfully implemented, which reﬂected positively on nurses’ satisfaction and patients’ care. The model has offered a comprehensive care delivery for HSCT patients throughout the transplant process as follows: preparing for admission, patient education, discharge planning, and periodic follow-up after discharge. HSCT centers should always consider revising stafﬁng resources to meet the complex needs of HSCT population throughout the continuum of care. Disclosure of Interest: None Declared. NP040 PATIENT EDUCATION IN HAEMATOPOIETIC STEM CELL TRANSPLANTATION M. Baydoun*,1, A. Ali 1, S. Okaily1, R. Nehme1, R. Kawas1, A. Bazarbachi1 1 American University of Beirut Medical Center, Beirut, Lebanon Introduction: Patient education is a critical part of the process of Hematopoietic Stem Cell Transplantation (HSCT). The HSCT team at the American University of Beirut Medical Center (AUBMC) is a multidisciplinary group of professionals devoted to providing excellence in patient care. At our center, it was noticed that the patient education process is often fragmented, unstandardized and unregulated among providers. Thus, we aimed to achieve a patient education process that is standardized, comprehensive, and addresses patients’ needs within a multidisciplinary approach. Method: A task team was formed from the HSCT multidisciplinary team to identify gaps in the current patient education process and recommend improvements accordingly. Results: The group met ﬁve times and conducted an evaluation of the status quo. The group broke down the problems to two important factors. First, the absence of standardized patient education materials, which leads to inaccurate or discrepant information provided to HSCT patients. Second, the current process does not take into consideration all the transplant aspects that HSCT patients experience, including preparation for the transplant, the admission process, the delivery of health care services, environmental precautions, discharge planning and followup. Therefore, to optimize the patient education process, the multidisciplinary team devised a new patient education material that incorporates all the transplant phases and provides prospective HSCT recipients with standardized, reliable, and comprehensive information. Conclusion: The current project suggests that HSCT centers should continuously revise work processes to meet the complex needs of HSCT recipients. Moreover, addressing patients’ problems in a multidisciplinary approach is always the key for providing high quality care to patients. At our center, we were successfully able to modify the patient education process through our commitment to excellence in patients care and multidisciplinary collaboration. From our view, this will enhance better patients’ outcomes and quality of care. Disclosure of Interest: None Declared.
NP041 OUT OF HOURS OPEN ACESS TO CARE DURING HAEMATOPOIETIC STEM CELL TRANSPLANT RECOVERY M. Rowe*,1, S. Dodd1 1 NHS, Newcastle upon-Tyne, United Kingdom Introduction: Children are referred to Newcastle for HSCT from a wide geographical area within the UK and overseas. This distance can delay discharge home due to the ability of non specialist teams to manage transplant related concerns. Our service uses a number of local Trust rented properties to accommodate the child and family allowing the child to leave hospital and enabling the parents to regain conﬁdence and control of their child’s care. Appointments for review on our day unit are given for daily or twice weekly visits. During the ongoing process of recovery, patients commonly self refer to our inpatient unit after the day unit closes with acute pyrexia, naso-gastric tube re-insertion, acute illness or parental anxiety. This increases the workload on the inpatient service and the child and family may be required to wait to have assessment and intervention. Staff have voiced concerns that they do not have the resources to adequately respond to children who may arrive with little warning in a vulnerable condition. Method: A new system of Open Access has been introduced in partnership with the Accident and Emergency Department. The families are given a clear pathway and a passport document which outlines active medical issues and identiﬁes the child’s key workers. Families are assured that the child will have direct access to a cubicle and that medical and nursing staff have been informed of the child’s needs. Early feedback and outcomes suggest that the Open Access Passport system has had a positive outcome for patients and families. The treatment pathway is prompt and the families know exactly what to do if they require any hospital care. The inpatient staff are now able to focus on delivering high standards of care to their inpatients without the additional responsibility of out of hours patient attendance. Conclusion: This presentation will highlight pressures on the service and how this system has streamlined the pathway of care. We will present our documentation and describe patient experiences since the introduction of this service. Disclosure of Interest: None Declared. NP042 UNDERSTANDING AND MANAGEMENT OF DISEASE SPECIFIC COMPLICATIONS BY HSCT NURSES IN MALIGNANT INFANTILE OSTEOPETROSIS DURING THE COURSE OF HSCT N. Cetin*,1, F. Kırac1, E. Ku¨cu¨kyavuz1, B. Tavil1, F. V. Okur1, B. Kus¸konmaz1, D. Uckan-Çetinkaya1 1 Pediatric Hematology- BMT Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey Introduction: Malignant infantile osteopetrosis (MIOP) is a rare inherited disease caused by a defect in osteoclast differentiation and function which results in defective bone resorption. It might show rapid progression and be lethal if left untreated in early infancy. HSCT is the only curative treatment option which maintains donor derived osteoclast function. These children usually have a complicated course of transplantation. Engraftment failure, VOD, pulmonary hypertension, respiratory problems and hypercalcemia are the most important complications seen in patients with MIOP. Nursing care and management of disease speciﬁc complications are of critical importance for these children suffering from multiple fractures, agitation, mucositis and malnutrition. Supporting parents and helping them to understand the disease and teach them how to deal with its complications are also very important. Method: Here we present the summary of 16 patients [mean age; 13,3 months (min-max: 1-56 months), male/female: 9/7 ] with MIOP transplanted from 1995 to 2014 at Hacettepe University Pediatric BMT Unit.
[NP042] Results: Problem
No. of patients
Upper airway obstruction, other respiratory problems Pulmonary hypertension Growth retardation Nutritional problems
Loss of vision
14/16 (unresponsive VEP testing)
3/16 (only the ones needed therapeutic intervention) 15/16(hypocalcemic convulsions, hydrocephaly, cranial nerve deﬁcits,y) 11/16 9/16
Immobilization and pain management Prophylactic measures for handling patients and especially during invasive procedures Mucositis care and prevention and mucosal edema and nasal care Careful monitarization of ﬂuid balance, avoidance of ﬂuid retention/overload, medical treatment (ilioprost, sildenaﬁl,y) Nutritional support, long term follow up Prevention of aspiration during feeding NG/OG feeding tube placement or TPN support Early HSCT Family support, education, speciﬁc discharge instructions Close follow up of serum calcium levels after engraftment Hydration, diuretics, steroids, calcitonin, biphosphanates Symptom-speciﬁc treatment
Bone marrow failure Venoocclusive disease
Conclusion: In HSCT practice most of the guidelines involve general measures and there is a need for development of disease-speciﬁc, patient-oriented approaches for pediatric BMT, particularly for inherited diseases. Training pediatric nurses for disease-related speciﬁc problems carries great importance for optimal treatment of these patients and also for family support. Disclosure of Interest: None Declared.
General measures for management of cytopenias Avoidance of ﬂuid overload, diuretics, deﬁbrotide as prophylaxis or management, NP043 NURSE TRAINING PROGRAM ADJUSTED FOR PEDIATRIC HSCT FOCUSING ON SPECIAL ISSUES IN INHERITED DISEASES ¨ zenc1, F. V. Okur1, B. Kus¸konmaz1, N. Cetin*,1, F. Kırac1, F. O D. Uckan-Cetinkaya1 1 Pediatric Hematology/BMT Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey Introduction: Nursing management in pediatric HSCT necessitates acquisition and maintenance of current knowledge and competency in infant and child care. Based on the heterogeneity of diseases in pediatric transplantation, nurses should be familiar with disease-speciﬁc issues when they take care of children with rare diseases undergone HSCT. Results:
[NP043] ISSUES CHILDHOOD SPECIFIC
Infections Assessment of growth and endocrinopathies Performance scale in children Pain assessment and control Evaluation of nutrional status Assessment and management of mucositis HSC infusion Central venous catheter Social Pediatric donors DISEASESPECIFIC Thalassemia Fanconi anemia Severe immune deﬁciency disorders Neurological (leukodystrophy) MIOP
RECOMMENDATION/EVALUATION Introduction of isolation rules (VRE) Growth charts, follow-up by endocrinologist Lansky score Spesiﬁc scales for children Encouragement of oral intake by behavioral methods, enteral/parenteral feeding), spesiﬁc diets Spesiﬁc measures for oral care Close follow up for ﬂuid overload Size, stabilization, dislocation Family education, school attendance, isolation problems Ethical issues and speciﬁc procedures, long term effects of G-CSF, absence of carier state and/or disease Prior cheletion therapy, ferritin level, tissue/organ damage due to iron overload, high risk for VOD Multiple congenital anomalies, increased risk for toxic effects of conditioning regimen, higher malignacy risk Some patients transplanted without conditioning regimen Survalience for infections, prior BCG vaccination, skin/perineal care Aspiration pneumonia, decreased mobilization, convulsions and PEG feeding High risk for VOD, pulmoner HT, fractures, vision/hearing loss, hypercalcemia
Method: Here, nursing training program used at Hacettepe University Pediatric BMT Unit are summarized. The details are listed in table I. Conclusion: HSCT practice guidelines mostly involve general transplantation measures for adults. Establishment of diseasespeciﬁc, patient-oriented approaches in pediatric BMT practice is needed. Considering critical role of nurses in HSCT team, improving their knowledge regarding childhood speciﬁc topics and their acqusition of practical skills will increase the success and improve the quality of life of children undergone HSCT. The practical points listed here are intended to contribute to training of pediatric HSCT nurses and optimization of practices. Disclosure of Interest: None Declared. NP044 CARE CHALLENGE AND PSYCHO-SOCIAL SUPPORT IN A REFUGEE CHILD UNDERGOING BONE MARROW TRANSPLANTATION ¨ zer1, S. Kaya1, K. Yalc¸ın1, N. Gu¨ltekin Bag˘la*,1, A. Gu¨zel1, H. O A. Ku¨pesiz1 1 AKDENI˙Z UNI˙VERSI˙TY, ANTALYA, Turkey Introduction: Turkey is facing a major increase in the number of Syrian people seeking asylum, of whom approximately a quarter are children.The available literature shows consistently increased levels of psychological morbidity among refugee children, especially post-traumatic stress disorder, depression, and anxiety disorders. We report a refugee child undergoing bone marrow transplantation and his care complexity. Method: We describe here a 15 year AML refugee boy from Syria, diagnosed one years ago. He could not complete his treatment because of the war in Syria. He came to Turkey with his family. He recieved induction therapy in a border city, S¸anlıurfa. Then he was refered to our hospital for BMT. The clinical protocol was: Busulfan and Cyclophosphamide. GVHD prophylaxis: CyA and MTX. Donor was matched HLA related sibling. Engraftment was 100% donor’s 20 days after BMT. Nurses provided patient with direct care, monitoring and hospitalization. Results: Three days after BMT he started to present complications, such as fever, hematuria, hematemesis, diarrhoea, cardiac tamponade, renal failure. I would like to say that the treatment got more complex with the complications related to be a refugee. As a refugee, he and his mother try to cope with complications of BMT, post-traumatic stress disorder related to war and communication problems in a new country. Nursing management should involve psycho-social support for this patient and his mother. To have a nurse spoke patient’s language (Kurdish) is our only chance in this hard situation. Sleep disorders, eating disorder, suicide ideation were the psychological complications we bring up against. To cope with this complications, we made a great teamwork with pediatric psychiatry and nutritionists. Conclusion: In our case, the patient had several BMTcomplications and psychological problems that only experienced professionals can handle. Refugee children have several problems and a complex treatment like HSCT makes them harder but we try to do best for him. Disclosure of Interest: None Declared. NP045 UNIQUE PROTOCOLS AND A TEAM LED BY A SPECIALIZED NURSE TO IMPROVE TREATMENT OUTCOMES AMONG BONE MARROW TRANSPLANT PATIENTS WITH DIABETES: A NEW APPROACH N. Atar*,1, S. Torati1, I. Sabah1 1 The Bone Marrow Transplantation Department, Sheba Medical Center, Ramat Gan, Israel
Introduction: Diabetes is a medical problem that may cause morbidity and mortality in over 18% of cancer patients of all
ages undergoing stem cell transplants. Protocols and treatments administered during and after transplantation and in the treatment of complications may cause disturbances in glucose levels. Malglycemia, which refers to blood-sugar disorders ranging from hyperglycemia to hypoglycemia, may disrupt the transplantation process and cause an increase in the incidents of cardiologic and nephrologic disorders. Several clinical conditions related to transplants can contribute to malglycemia including infection, sepsis, neutropenia, mucositis, graftversus-host disease, high-dose steroid therapy and feeding with TPN. At Sheba we work under institutional protocols in order to control diabetes. While they are standardized for all departments, our department requires unique protocols that adapt to the transplant process. As a result, it became necessary to increase the awareness among the staff, study the subject in depth, consider appropriate treatment alternatives for transplant patients, adopt the selected treatment methods and prepare an appropriate treatment protocol. Aim: To achieve improvement in the short and long term outcomes of treatment via mapping and monitoring diabetic patients, improving patient and staff training and developing treatment protocols appropriate for the combination of diabetes and bone marrow transplant. Method: Patients with diabetes, on TPN and/or receiving steroid treatment were identiﬁed and mapped by a nurse specializing in diabetes, who followed them and conducted checkups based on a set of speciﬁed parameters. Results: In 2014, 48 patients with diabetes were treated at The Bone Marrow Transplantation Department, which accounted for 22% of all transplant recipients that year. The percentage of glucose measurements above 200 mg/dL after these interventions were introduced decreased from 57% in the ﬁrst quarter to 16% in the third quarter. The documentation of glucose measurement increased from 83% in the ﬁrst quarter to 100% in the third quarter. The percentage of patients educated on a low-sugar diet increased from 90% to 98% and the percentage of tests performed on diabetic feet increased from 88% to 100%. Conclusion: A team that is managed by a nurse with clinical knowledge of diabetes performing closer monitoring, training and checkups of glucose levels according to a suitable protocol contributes to the improvement of the treatment results among transplant patients. Disclosure of Interest: None Declared. NP046 NURSING STUDIES ABOUT CENTRAL VENOUS CATHETER CARE: A LITERATURE REVIEW AND RECOMMENDATIONS FOR CLINICAL PRACTICE N. Kalender*,1, N. Tosun1 1 School of Nursing, Gulhane Military Medical academy, Kec¸io¨ren, Turkey Introduction: In 2003, The American society of Clinical Oncology, and in 2004, The Oncology Nursing Society published guidelines for nurses who are the primary responsibles for central venous catheter (CVC) care and contunity. These guidelines present all the relevant evidence on issues such as catheter dressing, maintenance of catheter ﬂow, obtaining blood samples, management of complications, and prevention of catheter-associated thrombus. Evidencebased studies performed by nurses on CVC care are limited in number. The aim of this study was to systematically evaluate the literature data about nurses’ responsibilities on each step of the care of CVC. The study also aimed at determining the gaps in the relevant data or issues to be re-evaluated, which could be helpful in future studies. Method: Primary research evidence published in English between 2007-2012 obtained using pre-deﬁned search criteria in electronic databases MEDLINE, PubMed and SCIENCE
DIRECT. All of the clinical environment such as oncology, haematology or Intensive Care Unit and patients were included in the study. Pediatric patients and patients who have port catheter were excluded. Papers on CVC and nursing care that were in the English language were included in the study. The Randomized Controlled Trials (RCTs) the Nonrandomized Controlled Trials (non-RCTs) and the Quasi Experimental Studies (SES) comprised the systematically studied material. Nine articles met the inclusion criteria. Results: Three prominent themes were identiﬁed in the literature related to: (1) Measures to Prevent Infection (2) Infection Control of central venous catheter, Results, and Other Findings (3) Applications to Sustain Catheter Flow. Conclusion: According to the results of this study, nursing studies on the some subjects are either absent or inadequate such as the type of dressings used in catheter-dressing and the frequency of dressing change, the type of lock solution used. In view of these facts, nurses are required to carry out high-quality evidence-based Randomised Controlled Trials. Disclosure of Interest: None Declared. NP047 TRAMADOL AS PAIN RELIEVER IN CHILDREN AND TEENAGERS WITH ORAL MUCOSITIS AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION O. Ivanova*,1, E. Marina1, G. Julia1, G. Ekaterina1, P. Ivan1, M. Bogomolny1, L. Zubarovskaya1, B. Afanasyev1 1 First Pavlov State Medical University of St. Petersburg, Saint-Petersburg, Russian Federation Introduction: Oral mucositis (OM) is one of the most frequent complications after polychemotherapy (PCT). It manifests with pain that varies in intensity. In our hospital a common practice is to indicate tramadol which mechanism of action is characterized by the presence of opioid and nonopioid components.According to guidelines of World Institute of Pain (FIPP WIP, USA), European Pain Federation (EFIC), in our study we used Patient Controlled Analgesia (PCA) which represents an effective alternative to other methods of anesthesia. Nowadays PCA with tramadol in children and teenagers needs thorough investigation. Method: Sixty-eight patients (5-18 years old, median 10) with stage 2-3 OM in the early posttransplantation period were divided in two groups. Group 1 comprised of 36 patients with continuous intravenous tramadol infusion at the rate of 48 mg/kg/day. Group 2 comprised of 32 patients with PCA parameters consisting of basis 0.1 mg/kg/h, bolus 0.125 mg/kg and 30 minutes lockout. Study methods included visual analogue scale (VAS), questionary for nurses that helped indicate the most appropriate approach for analgesia, that optimize nurse care. Results: Experimental data analysis showed that in both groups pain intensity according to VAS varied from 5 to 10 scores (median 7) prior to initiation of pain relief therapy. The number of night awakenings varied from 0 to 5 with median number of 2. In group 1 pain intensity decreased to 2-5 VAS scores in 28 patients (77.8). The number of night awakenings associated with pain decreased to 0-3. Average duration of tramadol course was 14 days and average tramadol dosage was 7 mg/kg/day. Adequate pain relief was not achieved in 8 (22.2%) patients and morphine was indicated as a next step of WHO analgesic ladder. Adverse events were not registered in this group. In group 2 pain intensity decreased to 1-4 VAS scores in 29 patients (90.6%). The number of night awakenings associated with pain decreased to 0-1. Two patients (6.3%) could not achieve adequate pain relief and morphine was used as further therapy. One patient experienced visual hallucinations (3,1%). Other adverse events were not registered in this group. Average duration of tramadol course was 10 days and average tramadol dosage was 6 mg/kg/day. The data from 21 questionaries revealed that 19 nurses prefer using PCA rather than continuous infusion. PCA was associated with analgesia-free period reduction, stable and rapid
pain relief. Also, PCA effectiveness was enhanced by psychological factor of the patient being able to control the pain. Conclusion: Tramadol is effective and safe analgesic for children and teenagers with OM stage 2-3 after PCT and hematopoietic stem cell transplantation. PCA with tramadol has several advantages such as customized dosage optimization, sleep improvement, anxiety relief, that improves quality of life. Disclosure of Interest: None Declared. NP048 USE OF PERIPHERALLY INSERTED CENTRAL CATHETERS (PICC LINES) FOR THE HOME CARE AFTER ALLOGENEIC HEMATOPOIETIC STEM CELLS TRANSPLANTATION M. Gire1, P. MARTINEZ*,1, C. TRANCHAND1, E. TAVERNIER1, D. GUYOTAT1, J. CORNILLON1 1 Institut de cancerologie Lucien Neuwirth, st Priest en Jarez, France Introduction: Long-term venous access devices are often used for outpatient care after allogeneic hematopoietic stem cells transplantation (HSCT). Tunneled catheters are generally used in this setting. However, infections and thrombosis are recurrent complications. Currently, there is little data in the literature on the use of PICC lines after transplantation, particularly in terms of safety. We have implemented in our unit a systematic use of PICC lines for home care after HSCT. We present here preliminary results of this procedure. Method: This is a prospective single-center study including all patients (N=33) who had an allogeneic HSCT between January and September 2014. A subclavian (SC) non-tunneled central venous catheter was installed during their initial period of hospitalization in the protected area in 31 patients. 2 patients were already equipped with a PICC line because of previous treatments. 22 patients had a single lumen PICC line inserted at discharge from our unit and after neutrophil recovery. The installation was performed under ultrasound guidance. The catheter care was performed through a private home service with prior training of nurses. 9 patients had no PICC line inserted because a Portacaths device was already in place (N=6), early death (1), multiple thrombosis (1) or lack of indication (1). These patients were excluded from the study. Donors were unrelated for 54% of transplants. Conditioning was reduced in 67%. Data were collected daily between the ﬁrst day of conditioning and the date of PICC line removal. Results: For 20 patients, the SC line was removed at the end of the ﬁrst period of hospitalization. Only 2 patients had their line removed prematurely during hospitalization. The cause was inﬂammatory exit site for one and broken tip for the second. In 4 of 24 patients, the PICC line was only used for weekly blood controls. In 20 patients, the PICC line was used at home, for hydration (14 patients), antibiotic administration (5), human immunoglobulin infusion (3), transfusions (5), extracorporeal photophoresis (1). Hydration at home was performed for an average of 29 days. PICC lines were also used in 5 patients after readmission. The catheter was removed from 16 patients after an average of 71 days. The reasons for removal were lack of utility (N=6), patient’s wish (3), suspicion of infection (3), bleeding at puncture site (1), accidental removal (1) and death (2). The 8 remaining patients still had their catheter at the time of evaluation. During this period of study, no infection or thrombosis was ﬁnally described. Conclusion: These preliminary results suggest that the systematic use of PICC line as long-term venous access for home care does not cause signiﬁcant infectious or thrombotic events despite frequent and often prolonged use. However, more patients are needed to conﬁrm these ﬁrst impressions. Disclosure of Interest: None Declared.
NP049 THE DEVELOPMENT OF AN IN HOUSE TRANSPLANT STUDY DAY R. Clout*,1, A. Leather1, R. Angelica1, J. Tomlins1, J. Murray 1, D. Kaye1, D. Sweeney1 1 Haemato Oncology, THE CHRISTIE HOSPITAL, Manchester, United Kingdom Introduction: The Christie Transplantation Study Day was developed to offer a standardised curriculum of education and practice within the ﬁeld of haematopoietic transplant patient care. The day contributes to assurance of adequate nurse training required for JACIE accreditation. Nurses also need to work to the standards set out by the NMC, including continued professional development. The aim is to develop and maintain nurses’ skills and aid in professional development to ensure that nursing staff receive appropriate induction and training. This will contribute to fulﬁlling their role to in caring for this diverse and complex patient group. Method: This day has been repeated on ﬁve occasions to ensure a good attendance of staff. Attendance is open to inpatient haematology and transplant, day unit haematology and transplant, MAU, Critical Care and The Critical Outreach staff. The agenda covered all the key training requirements set out in the JACIE standards. All the subjects were covered by key personnel utilising the transplant team Clinical Nurse Specialists, Nurse Clinicians, Haematology Pharmacist, Dietician, Stem Cell Laboratory Manager, Quality Manager and Clinical Practice Facilitator. Results: Total number overall attendance - 60. The numbers of staff attending ranged from 8-17. Inpatient haematology and transplant staff 34/47 (72%). Private patient inpatient haematology and transplant staff- 8/10 (88%). Rest of the trust - 18. Staff were asked two simple questions How did you ﬁnd the relevance of the sessions arranged? How did you ﬁnd the level of teaching? Comments for each session were asked. The feedback was positive overall, examples of comments were: very interesting and educational, previous knowledge and skills updated and discussions enjoyble, overall a good study day, sessions were engaging and thought provoking, best study day in ages, really good refresher, mini workshops fun and useful, very informative, enjoyed the day, a lot more knowledge over transplants, looking after transplant patients and GVHD, learned a lot from most topics. There were two negative comments: I found the pace too quick, remember there are people with not much haematology experience. Conclusion: Overall the attendance of the days has been good. The feedback has also been positive and the day has been well received by members if the nursing team.The plan for next year is run the day twice to cover any staff that haven’t been able to attend this year, including new staff. The day will also be encouraged with outlying wards with a focus on critical care and the outreach team. The clinical skills rooms have also been booked to set up additional days. These will focus on practical skill sessions some of which require regular updates such as stem cell thawing, antiobiotics PGDs. These days will follow a similar format to the existing training, ensuring a standarised approach to nurse education. Disclosure of Interest: None Declared. NP050 MUSIC THERAPY IN THE MANAGEMENT OF PATIENTS UNDERGOING TO HEMATOPOIETIC STEM CELL TRANSPLANTATION: A PILOT STUDY S. Giuliani*,1, C. Facchini2, M. Bernardi2, C. Matteo2, L. Sarno1, F. Ciceri2 1 Health Clinical Psychology Unit, 2Hematology and Bone marrow transplantation unit, IRCCS San Raffaele Scientiﬁc Institute, Milan, Italy Introduction: Music therapy is an established clinical discipline which is widely used to help people whose lives have been affected by injury, illness or disability. Music therapy can
help in many clinical situations, particularly where communication is difﬁcult due to illness, injury or disability. Patients receiving hematopoietic stem cell transplantation can experience increased distress related to both the treatment intensity and isolation in protected environment. If not addressed, this emotional distress can lead to anxiety, depression, and posttraumatic stress disorder. The purpose of this study is to analyze the efﬁcacy of music therapy in promoting patients’ psychological adjustment during hospitalization towards both a quantitative and qualitative analysis. Method: From September 2013 to September 2014 8 patients undergoing hematopoietic stem cell transplantation were offered music therapy as part of the supportive care. During their hospitalization all patients received music therapy treatment once a week for one month. Before and after this treatment patients were administered standardized questionnaires to investigate their level of distress [Psychological Distress Inventory PDI (Morasso, 1996)], anxiety and depression [Hospital Anxiety and Depression Scale HADS (Zigmond & Snaith 1983)]. Themes reported by all patients after listening to the music during all the 4 sessions were also registered. Results: While quantitative data reported no statistically relevant effects (Po0.05) on the reduction of anxiety, depression and distress, qualitative data referred to the themes reported by the patients showed a better psychological adjustment: while at the beginning of the music therapy intervention patients described images referred to nature and memories of the past where they were alone or played passive role, then they reported images of themselves prone to share their disease experience. Conclusion: This positive result encourages further research in the application of music therapy in onco-hematological settings. The analysis of patients’ themes, emerged during the sessions, suggests that music therapy treatment promotes an elaboration process and reﬂection about the illness condition and represents a safe space suitable for sharing their experiences. Disclosure of Interest: None Declared. NP051 Abstract Withdrawn NP052 THE IMPACT OF THE CHILDREN’S AND YOUNG PEOPLE AUDIT POLICY TOOL (CYPAPT) ON CHILD AND FAMILY CENTRED CARE (CFCC) IN THE PAEDIATRIC STEM CELL TRANSPLANT UNIT (SCT) AT THE GIANNINA GASLINI INSTITUTE (IT) S. Calza*,1,2, A. Bagnasco2, P. Petralia3, M. L. Sperlinga3, L. Fornoni3, S. Del Buono3, U. Rosati3, G. Aleo2, L. Sasso2 1 Paediatric Haematology and Oncology, Giannina Gaslini Institute, 2Department of Health Science, University of Genoa, 3 Giannina Gaslini Institute, Genoa, Italy Introduction: The ‘‘Children’s and Young People Audit Policy Tool’’ (CYPAPT) is a clinical audit tool that measures the level of compliance of paediatric hospitals and service to national standards. Following a rigorous process of linguistic and cultural validation, the Italian version of this tool was used to measure and improve the quality of Child and Family Centred Care (CFCC) at the Giannina Gaslini Institute in Genoa. The aim of the study is to investigate the perception health professionals have of CFCC, change and evaluate the quality of care using the Children’s and Young People Audit Policy Tool in the SCT Unit in Gaslini Institute in Genoa (IT). Method: A descriptive, monocentric study with a mixedmethod design, including multi-professional Focus groups and semi-structured interviews Results: Through the Audit Tool, health professionals reported several differences with the local system, such as the type of facilities, the organization, types of hospital staff, and
legislation. SCT staff perceived an improvement in child and family engagement, the engagement of adolescents, pain management, infection control, communication negotiation of care, higher level trust and respect especially for nurses. Of particular interest, the positive impact on therapeutic education in the Unit. Conclusion: CFCC can profoundly change and improve the current way of providing care to children, and in particular paediatric nurses are in the key position to assess compliance with CFCC using the Children’s and Young People Audit Policy Tool. Education sessions for health professionals will facilitate compliance with CFCC. In the light of our experience, we envisage to spread CFCC also to other SCT Units in Italy, both to improve benchmarking and encourage further research in this ﬁeld. References 1. Coles L, Glasper EA, Battrick C, Brown S. (2010) Assessing NHS trust’s compliance with child health policy standard. British Journal of Nursing 19; 1218-1225 1. Franck LS et al. (2012) Parental involvement in Neonatal pain Management: An empirical and conceptual update. Journal of Nursing Scholarship 44:1; 45-54. 1. Mikkelsen G, Frederiksen K. (2011) Family centred care of children in hospital - a concept analysis. Journal of Advanced Nursing 67(5); 1152–1162. Disclosure of Interest: None Declared. NP053 SUITABILITY OF THE PERIPHERALLY INSERTED CENTRAL CATHETER IN THE MANAGEMENT OF THE HEMATOLOGICAL PATIENT AFTER AN ALLOGENEIC STEM CELL TRANSPLANT S. Navarro Mediavilla*,1, A. Estraviz Chiarelli1, E. Go´mez Rodriguez1, A. Graells-Pique1, E. Machado Lo´pez1, A. Llaurado1, S. Puig Darde1 1 Onco-Heamatology, HOSPITAL CLINIC, BARCELONA, Spain Introduction: The aim of our study is to determine the suitability of the PICC use in hospitalised or out-patients that need a central venous access to get intravenous therapy after having undergone an allogeneic hematopoietic stem cell transplant (HSCT), as few studies have evaluated the PICC use exclusively in this population Method: An observational retrospective study was conducted from January 2013 to July 2014. All patients that had already received an allogeneic HSCT and needed the insertion of a PICC to get treatment were enrolled in the study. All PICCs were inserted by a specialised vascular access nursing team under ultrasound guide. A speciﬁc CVC care and maintenance protocol was strictly followed. We collected sociodemographic data, haematological diagnosis, type of HSCT, reason for the PICC insertion, catheter characteristics, insertion success, duration, removal reason and need for another central venous access. Results: 30 PICCs were inserted in 26 patients (15 men, 11 women; mean age 44’37 years, range 17-68) for a total of 1283 days (mean 44’2, range 0-198). 11 patients (42’3%) had undergone a related allogeneic HSCT, 15 (57’7%) an unrelated allogeneic HSCT. The insertion was successful in the 96’6% of the cases. The reasons for catheter removal were end of treatment 16 (53’3%), need for another central venous access 6 (20%), death 3 (10’%), suspected infection 3 (10’%), tip malposition 1 (3’3%) and catheter pulled out by the patient 1 (3’3%). From the three PICCs removed for suspected infection all the cultures were negative whereas two of the PICCs removed for end of treatment resulted in a positive culture (6’66%). Conclusion: Our results suggest that the use of a PICC is a suitable alternative to conventional central venous catheters even in patients particularly prone to infective and hemorrhagic complications such as patients who have received an allogeneic HSCT; only 6’66% of the cases developed a catheter
related blood stream infection (CRBSI) and no cases of thrombosis or occlusion were found. This low rate of complications also found in other recent studies seems to be related to the improvements in the insertion technique and in the development and strict observance of catheter care and maintenance protocols.Yet, the need to remove the PICC in order to insert a central venous access with more lumens is a fact we can’t ignore because it means a 20% of our sample. The kind of treatment, its duration and the patient characteristics should be carefully considered before choosing a central venous access in order to avoid unnecessary insertions. Disclosure of Interest: None Declared. NP054 THE RETURN HOME AFTER A CHILDS’ HEMATOPOETIC STEM CELL TRANSPLANTATION. THE EXPERIENCES AND COMMITMENTS PARENTS FACE, THE INFLUENCING FACTORS AND THEIR RESULTING NEEDS V. Van de Velde*,1, F. Mussche2, C. Dhooge1, M. Grypdonck3 1 Pediatric Hemato-Oncology and HSCT, 2Specialized Pediatric Unit, University Hospital Ghent, 3Department of Public Health, University Ghent, Ghent, Belgium Introduction: Hematopoetic stem cell transplantation (HSCT) in childhood has improved over the last decades, but remains a hard, painful and stressful experience for the child. Little is known about the care-giving role of the parents, especially after the intensive inpatient period. The objective of this study is to understand how parents experience the post transplant period of their child, to get an insight into their commitments and to describe the inﬂuencing factors and needs they experience in order to improve the overall support that parents are given during post transplant hospital visits. Method: A descriptive qualitative study was conducted in which semi structured interviews were held with 15 parents whose child had undergone an HSCT. During a two year period at least one parent of all HSCT patients participated. The interviews were transcribed and coded (NVivo7). Constant comparison was used to analyse the data. Results: Experiences and commitments: Once home, parents face complete responsibility of care for their child. The continuous monitoring of their child implies a great burden and it requires a great effort to integrate the regimen received from the professionals into their daily routine. The parents experience feelings of insecurity not only about their child’s medical evolution, but also about their quality of life. Most mothers have to interrupt their professional life. Parents long for a ‘‘normal’’ life. Inﬂuencing factors: Factors which can inﬂuence the experiences to a greater or lesser extent are: the disease progression, the duration of the post transplant period, the relationship with the partner, the family situation, social environment, personal background, personal factors, practical and ﬁnancial situation,y The needs: Parents adjust their lifestyle to take care of their child, prioritizing it over their own needs. Depending on these inﬂuencing factors, parents have different needs. What is clear is that a trustful relationship is needed with the professionals. Above all parents have a need for information. They also need psychosocial and practical support, particularly when making decisions. Parents also appreciate help educating the siblings. Some of them need a professional life and time for themselves. Conclusion: Parents face an immense, very complex and extensive commitment when they return home with their child after HSCT. The experiences and challenges they face are strongly intertwined with each other and are inﬂuenced by different factors. Parental needs can be fulﬁlled by friends or neighbours and professionals.
The results of this study create an awareness in professionals and are a ﬁrst step towards improved post transplant consultations. Disclosure of Interest: None Declared. NP055 WHICH TYPE OF THE DRESSING AT THE INSERTION SITE MAY AFFECT THE RATE OF CATHETER INFECTION: GAUZE OR TRANSPARENT SEMIPERMEABLE DRESSING? N. Ozturk1, Y. Eraslan Karadag*,1, Z. Gol1, T. Sen1, D. Gultay1, O. Kilic1, M. Okay1, G. Bolat Sever1, F. Akal1, H. Cinar1, E. Atilla2, P. Ataca2, S. Civriz Bozdag2, S. K. Toprak2, P. Topcuoglu2, M. Kurt Yuksel2, G. Gurman2 1 ANKARA UNIVERSITY DEPARTMENT OF NURSERY, 2ANKARA UNIVERSITY DEPARTMENT OF HEMATOLOGY, ANKARA, Turkey Introduction: Central Venous catheters are the devices most frequently used for vascular access in Hematopoetic Stem Cell Transplantation (HSCT). Although CVC are indispensable in HSCT, they also represent a signiﬁcant source of complications most important of these are bloodstream infections. Our aim is to compare the incidence of Catheter related blood stream infection (CRBSI) with two different dressing two days gauze and seven days sterile transparent dressing. Method: Full aseptic techniques were used before CVC insertion. The catheter site was covered by sterile gauze or a sterile, transparent semi-permeable dressings. Gauze dressings were replaced at least every two days and transparent dressings every seven days. If patients had tenderness at the insertion site or fever without obvious source, the dressing was removed for through examination. Results: Fifty patients whom underwent allogeneic stem cell transplantation were included in this retrospective study. Diagnosis of the patients were as follows: Aplastic anemia(AA) n=4(8%), AA/Myelodysplastic syndrome (MDS) n=1 (2%), Acute Lymphoblastic Leukemia (ALL) n=7 (14%), Acute Myeloblatic Leukemia n=28 (56%), Chronic myeloid leukemia (CML) n=2 (4%), MDS n=2 (4%), Primary myeloﬁbrosis n=1(2%), Mycosis Fungoides n=3 (6%), Non Hodgkin Lymphoma(NHL) n=1(2%), Peripheral T cell Lymphoma (PTCL)n=1 (2%). 18 patients (36%) had noncuffed central venous catheters (nCCVC) placed into external juguler vein and 32 patients (64%) had cuffed tunneled central venous catheters (CCVC) placed into Table 1. Catheters and dressing types, durations, complication ratios Catheter type
Cuffed tunneled CVC (n=32)
Noncuffed CVC (n=18)
Duration during hospitalization period Removal because of infection Bacteremia Dressing type Duration (days) Bacteremia Fever Reasons for catheter removal Infection Death Spontenously Thrombosis No need more Redness of the site
42 days (12104)
39 days (26-96)
14(43.25%) 7 day 42 (24-91) 9(36%) 24((96%)
5(27.7%) 2 day 39(12-104) 10 (40%) 24(96%)
0.264 P value 0.289 0.77 1
1(4%) 2(8%) 1 (4%) 2(8%) 12(48%) 10(40%)
5 (20%) 2(8%) 1 (4%) 0 16(64%) 1(4%)
subclavian vein. No difference detected in fever and redness of the insert site. Dressings were categorized as 2 day gauze (25/50 patients) vs 7 day transparent (25/50 patients). Catheters, dressing types, durations and complication ratios are described in table 1. Conclusion: It has been suggested that the higher colonization rate with transparent dressings may be partly offset by earlier detection of local signs of inﬂammation.In this study although insert site redness was higher in seven day dressing,there was no statistical difference between the blood stream infection rate and fever. Although seven day dressing seems not cost effective than two day dressing, it may reduce the daily work load of the nurses. Disclosure of Interest: None Declared. NP056 BODY IMAGE AND QUALITY OF LIFE IN LEUKEMIA PATIENTS AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION Y.-C. Huang*,1, Y.-T. Dai2, C.-F. Chang1, J.-L. Tang1 1 Tai Cheng Stem Cell Therapy Center, 2Department of Nursing, National Taiwan University, Taipei, Taiwan, Province of China Introduction: After receiving stem cell transplantation, patients went through high-dose chemotherapy, polypharmacy, and graft-versus-host-disease (GVHD). These changes may affect their body image and quality of life (QOL).The purpose was to investigate the relationships among demographic characteristics of stem cell transplantation, conditioning protocol, complications and symptoms after stem cell transplantation, body image, and QOL. Method: This research was a descriptive, cross-sectional study with structured questionnaire; Multidimensional Body-self Relations Questionnaire-Appearance Scale (MBSRQ-AS), the traditional Chinese version of The Functional Assessment of Cancer Therapy- Bone Marrow Transplant version 4 (FACTBMT), and demographic questionnaire. The study recruit 84 leukemia patients who have done allogeneic stem cell transplantation from post-transplantation and hematology outpatient clinics in a stem cell transplantation medical center in northern Taiwan. Results: The major ﬁndings of this study were as follow: An average of MBSRQ-AS total score were 100.35±13.07, and the mean of patients’ body image were not very satisﬁed. An average of FACT-BMT total score were 103.37±23.9, and the mean of patients’ QOL were between middle level and upper level. The essential predictors of FACT-BMT include MBSRQ-AS total score, age, changes of hair, and months after transplantation. As a result, the total amount of (R2) could explain to 46.2%. Body image change is a predictor of QOL for leukemia patients who have received allogeneic stem cell transplantation. Conclusion: Healthcare providers could provide holistic care before patient discharge, and give long-term follow-up on their body image changes in order to help patients acknowledge their body image changes. Hope we can help patients adapt to and promote the QOL after transplantation. Disclosure of Interest: None Declared. NP057 EVALUATION OF FOLLOW-UP BY SPECIALIZED STEM CELL TRANSPLANT (HSCT) NURSES AFTER PAEDIATRIC HSCT Y. Jostemyr*,1, A. Klaesson-Hjelt 1, M. Sundin1 1 Karolinska Huddinge, Pediatric hematology, Stockholm, Sweden Introduction: At Karolinska University Hospital about 25 children per year are undergoing hematopoetic stem cell transplantation (HSCT). Pre- and post transplant care is offered at the Dept of Paediatrics while the transplant procedure is performed at the Dept of Transplantation with isolation facilities. After discharge the follow up is continued at the paediatric day care unit. Until recently children had an
appointment with the paediatrician at every visit and often had to see a nurse for blood-sampling or other procedures. These appointments with nurses were not ‘‘organized’’, but there was an obvious need for both children and parents to get more support and time for personal questions. Appointments were time consuming both for doctors and nurses and information given was sometimes duplicated or conﬂicting. Method: Follow-up by specialized stem cell transplant (HSCT) nurses: To improve the care a new routine was introduced in 2012. Children now meet the paediatrician only once a week and the other visit is scheduled to a specialized nurse. Two paediatric nurses have been trained to become nurse practitioners (HSCT-nurses). An advantage is that the visits mostly are directed to the same nurse and the time for the visit has been expanded. The visit to the HSCT-nurse has been developed and standardized together with the paediatricians to complement the other weekly appointment to the doctor. The ﬁrst follow up is scheduled already at discharge from the transplant unit. An individual rehabilitation plan is made aiming at normalizing life as soon as possible. Each patient ﬁlls in a questionnaire describing all the different problems that can occur after HSCT. At the weekly visits the HSCT nurse does the regular blood-sampling but also performs GVHD assessment and Lansky/Karnofsky score. During weekdays HSCT nurses keep contact with parents by phone or e-mail regarding test results and when needed change prescribed medicine dosage in cooperation with the paediatrician. Results: Evaluation of the follow-up with HSCT nurses was performed with the help of standardized patient questionnaire. Preliminary results show the value of continuity. The patients don’t always meet the same paediatrician at every visit, but the same HSCT nurse every time. A medical advantage when the same person has observed physical reactions of GVHD. Another obvious advantage had been the extra time for the nurses to answer personal questions, explain and support the families in this often very arduous time when focus is changing from ‘‘only to survive’’ to reorganize and ‘‘continue to live’’. Conclusion: Standardized follow-up appointments with specialized stem cell transplant (HSCT) nurses have improved the level of care after HSCT of children. A weekly visit to both paediatricians and nurses has improved our ability to support the family on an individual basis this conveys a feeling of assurance and safeness. Disclosure of Interest: None Declared.
stressful environment of the BMT unit but have rarely experienced the fruits of their labor. Method: During the past ﬁve years, our nurses have had the opportunity to visit some of these patients in their homes several years following their transplants and experience the impact it has had on the families and their communities. Results: The nurses obtained the following information by social interaction with the families of several patients in their homes: Parents who have had to travel long distances over desert roads and stay in the hospital for substantial periods of time, now have been able go back to work and spend time with the other children in the family. A group of adolescents waiting for one of their friends to return from hospital now have a member of their football team who can score goals, an empty Eid celebration last year is now full of meaning with the presence of their child who has been cured of hemophagocytocytic lymphohistiocytosis. A ﬁrst born child with interferon gamma receptor deﬁciency who has spent a year battling tuberculosis is now reunited with her family after a successful transplant. Patient education and awareness via HSCT has also resulted in requests by a few families for premarital genetic testing – a positive step in the direction towards control of these fatal and economically devastating diseases. Conclusion: The joy and happiness that our transplant nurses have experienced to see their patients cured and integrated in society has given them a new perspective to their roles as healthcare providers. Such real-life experiences help to continually motivate and sustain the high standard of nursing care that is required in this very demanding ﬁeld. Disclosure of Interest: None Declared. NP059 THE APPLICATION OF MOIST WOUND HEALING THEORY IN THE SKIN CARE OF A SEVERE GVHD PATIENT Z. Yang*,1 1 Peking University Institute of Hemotology, Beijing, China Introduction: Severe GVHD is one of the most common cause of mortality of hematopoietic stem cell transplantation. Without cautious nursing care, the skin ruptures and ulcerations can easily cause severe infection and lead to adverse outcome. In this case, the skin care for this kind of patients is very important.
NP058 EXPERIENCING THE IMPACT OF HEMATOPOIETIC STEM CELL TRANSPLANTATION ON THE LIVES OF PATIENTS AND THEIR FAMILIES: A MOTIVATIONAL STRATEGY FOR THE TRANSPLANT NURSE Z. M. Al Harthy*,1, C. Lagar1, J. Goes1, S. Wilson1, J. Angelita1, E. Gallardo1, J. Thomas1, B. Mathew1, Y. Al Habsi1, S. Abey1, C.-A. Trampe1, C. Biniza1, M. Mathew1, J. Jobi1, D. Mathew1, R. Kunjan1, I. Al Manthari1, S. George1, R. Varghese1, V. Recto1, K. Al Salimi1, S. Jose1, J. John1, F. Al Abdali1, A. Al Azri1, R. Al Mahrizi1 1 Nursing Service, Sultan Qaboos University Hospital, Muscat, Oman Introduction: Oman is a country with a varied landscape ranging from high jagged mountains, desert, dry, ﬂat plains to a long, spectacular coast-line. Geographical isolation and consanguinity have led to a higher prevalence of hereditary diseases in the country, many of which fortunately are curable with hematopoietic stem cell transplantation (HSCT). In the 20 years since the initiation of the nation’s only HSCT program, we have had the opportunity to offer this service to patients from the capitol to those living in some of the most remote mountainous regions in the country. Our transplant nurses provide state of the art care for our patients within the
We applied skin care based on the moist wound healing theory on a 19 years old, male patient with IV degree skin acute graft-versus-host-disease(GVHD) after the haploid hematopoietic stem cell transplantation. At +23 day after the transplantation, the patient got skin peeling and rupture on his face, neck and chest, accompany with severe pain. We made an individualized care plan for the patinet, using the moist wound healing treatment. Method: The dressing changing method is as follows: 1. To clean the wounds and the surrounding skin with 0.9% saline. 2. To cover the wounds with Vaseline gauzes soaked with 0.5% iodophor. 3. To dress 3 times a day. The vaseline gauze has a good balance on permeability and leakproofness, which can create a moist environment to promote the growth of granulation tissue. The healing time was consequently shortened. On the other hand, the gauzes were easy enough to remove from the wounds while dressing, which signiﬁcantly reduced the pain of the patient. Results: After 2 weeks, the wounds healed and the rupture turned into escharosis. The moist healing environment can speed up the migration of epithelial cells, promote the growth of ﬁbroblasts and endothelial cells, increase cutin cells proliferation, and stimulates the production of capillaries. Conclusion: Vaseline gauzes soaked with 0.5% iodophor is an attempt of moist healing treatment, which might be a good choice for severe skin GVHD patients. Disclosure of Interest: None Declared. NP060 EFFECTS OF SOCIAL SUPPORT ON MOTHERS’ EMOTIONAL AND PHYSICAL RESPONSES DURING THE CHILD’S BMT Z. A. Ibrahim*,1 1 Pedaitroc Stem Cell Transplant, King Faisal Specialist Hospital & RC, Riyadh, Saudi Arabia Introduction: Effects of social support on the mothers’ responses during the child’s bone marrow transplant
When a child has a bone marrow transplant (BMT), mothers are exposed to new stresses. Stress responses of emotional or physical reactions occur when demands are greater than the individual’s resources. Social support is an important resource for individuals who are experiencing stress. The purpose of this prospective study was to determine the impact of a child’s BMT on mothers’ stress reactions and to examine effects of social support on maternal responses over time. Method: Six self-report questionnaires were used to measure mothers’ responses: depressive symptomatology using Centre of Epidemiological Studies Depression Scale, anxiety using State Trait Anxiety Inventory, somatic complaints and sleep behaviour using Health Assessment Scale, social support using Stress Support Scale, severity using Perception of Severity Scale, and worry using Worry Scale. Hundred mothers completed questionnaires on their child’s admission day (T1), on the 2nd (T2), and on 10th (T3) day’s after bone marrow infusion or post conventional chemotherapy for non BMT. Results:.A majority of mothers had depression scores indicating that they were at risk of developing clinical depression. The depression mean scores increased over time. Also a majority of mothers had moderately high anxiety scores all three times. Few somatic complaints and sleep disturbances were reported. The somatic complaint mean scores increased signiﬁcantly over time. Only anxiety mean scores differed signiﬁcantly by level of social support. Anxiety mean scores for mothers with a moderate level of support increased at T2 but declined at T3 while anxiety mean scores for mothers with low or high levels of support increased at T2, and T3. The ﬁndings indicate a child’s BMT is stressful for mothers. Conclusion: Additionally, health care professionals need to provide psychosocial support to assist the mothers cope with stress during the child’s BMT.Nurses cannot eliminate the stress, but they can help Disclosure of Interest: None Declared.
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