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Rodgers C, Bertini V, Conway MA, Crosty A, Filice A, Herring RA, Isbell J, Lown DrPH EA, Miller K, Perry M, Sanborn P, Spreen N, Tena N, Winkle C, Darling J, Slaven A, Sullivan J, Tomlinson KM, Windt K, Hockenberry M, Landier W. A Standardized Education Checklist for Parents of Children Newly Diagnosed With Cancer: A Report From the Children's Oncology Group. J Pediatr Oncol Nurs 2018; 35:235-246. [PMID: 29589818 DOI: 10.1177/1043454218764889] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Parents of children newly diagnosed with cancer must acquire new knowledge and skills in order to safely care for their child at home. Institutional variation exists in the methods and content used by nurses in providing the initial education. The goal of this project was to develop a checklist, standardized across institutions, to guide nursing education provided to parents of children newly diagnosed with cancer. A team of 21 members (19 nurses and 2 parent advocates) used current hospital educational checklists, expert consensus recommendations, and a series of iterative activities and discussions to develop one standardized checklist. The final checklist specifies primary topics that are essential to teach prior to the initial hospital discharge, secondary topics that should be discussed within the first month after the cancer diagnosis, and tertiary topics that should be discussed prior to completion of therapy. This checklist is designed to guide education and will set the stage for future studies to identify effective teaching strategies that optimize the educational process for parents of children newly diagnosed with cancer.
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Affiliation(s)
| | - Vanessa Bertini
- 2 Children's Hospital of the King's Daughters, Norfolk, VA, USA
| | | | - Ashley Crosty
- 4 Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Angela Filice
- 5 McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | - Julie Isbell
- 7 The Children's Hospital at TriStar Centennial, Nashville, TN, USA
| | | | | | - Margaret Perry
- 10 Children's National Medical Center, Washington, DC, USA
| | - Paula Sanborn
- 11 Nationwide Children's Hospital, Columbus, OH, USA
| | - Nicole Spreen
- 4 Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Nancy Tena
- 12 C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | | | - Abigail Slaven
- 14 Cohen Children's Medical Center Northwell Health, New Hyde Park, NY, USA
| | | | | | - Kate Windt
- 17 Rady Children's Hospital, San Diego, CA, USA
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Hord JD, Lawlor J, Werner E, Billett AL, Bundy DG, Winkle C, Gaur AH. Central Line Associated Blood Stream Infections in Pediatric Hematology/Oncology Patients With Different Types of Central Lines. Pediatr Blood Cancer 2016; 63:1603-7. [PMID: 27198806 DOI: 10.1002/pbc.26053] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/15/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Central line associated bloodstream infections (CLABSIs) are a significant cause of morbidity and mortality in pediatric hematology/oncology (PHO) patients. Understanding the differences in CLABSI rates by central line (CL) type is important to inform clinical decisions. PROCEDURE CLABSI, using similar definitions, noted with three commonly used CL types (totally implanted catheter [port], tunneled externalized catheter [TEC], peripherally inserted central catheter [PICC]) and CL-specific line days were prospectively tracked across 15 US PHO centers from May 2012 until April 2015 and CLABSI rates (CLABSI per 1,000 CL-specific line days) were calculated. Host and organism characterstics associated with the CLABSI events were analyzed. RESULTS Over the course of 2.8 million line days, 1,113 CLABSI events (397 in inpatients and 716 in ambulatory patients) were noted. The inpatient CLABSI rate was higher than the ambulatory CLABSI rate for each of the CL types: 1.48 versus 0.16 for ports, 3.51 versus 1.38 for TECs, and 3.07 versus 1.16 for PICCs, respectively. TECs and PICCs were associated with higher CLABSI rates than ports, inpatient and ambulatory. CONCLUSIONS We found that CLABSI rates were significantly higher for inpatients compared to ambulatory PHO patients for all CL types. Among ambulatory patients, TECs had the highest CLABSI rate and ports the lowest. Among inpatients, TECs and PICCs had higher CLABSI rates than ports but were not statistically different from one another. Cognizant that host and underlying disease attributes may contribute to these differences, these results can still inform CL choice in clinical practice.
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Affiliation(s)
- Jeffrey D Hord
- Showers Family Center for Childhood Cancer and Blood Disorders, Akron Children's Hospital, Akron, Ohio
| | - John Lawlor
- Children's Hospital Association, Alexandria, Virginia
| | - Eric Werner
- Children's Hospital of the King's Daughters and Children's Specialty Group, Norfolk, Virginia
| | - Amy L Billett
- Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, Massachusetts
| | - David G Bundy
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Aditya H Gaur
- St. Jude Children's Research Hospital, Memphis, Tennessee
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Barysauskas C, Bundy DG, Gaur AH, Hord JD, Miller MR, Werner EJ, Winkle C, Billett A. Burden of bloodstream infections among ambulatory pediatric hematology/oncology patients with a central line. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
262 Background: Pediatric hematology/oncology (PHO) patients are at high risk of bloodstream infections (BSI). The burden of BSI in PHO patients in the ambulatory setting has not been well documented. Methods: The Children’s Hospital Association leads the Childhood Cancer and Blood Disorders Network, a multicenter United States quality improvement collaborative, working to reduce the incidence of inpatient and ambulatory Central Line-Associated BSI (CLABSI) among PHO patients. Positive blood culture events (+BCE) were adjudicated as CLABSI, single positive blood cultures (SPBC) with potential commensals, or secondary BSI (attributed to source other than the central line) following standardized National Healthcare Safety Network definitions. Our study investigated the prevalence of +BCE among all centers with 90% complete monthly reporting of both +BCE and central line days (CLD) for at least one year (n=25) between January 2012 and September 2014. Ambulatory and inpatient BSI rates and 95% confidence intervals (CI) were calculated as the number of +BCE per 1,000 CLD per month. Results: A total of 1,747 +BCE and 4,883,413 CLD were reported among our target ambulatory population, whereas 1,095 +BCE and 353,259 CLD were reported among our corresponding inpatient population [Table]. While the CLABSI and SPBC rates were significantly lower in the ambulatory setting compared to inpatient (p<0.001), the total number of ambulatory CLABSI and SPBC events was 2.0 and 1.6 times higher than inpatient events, respectively. Conclusions: Our findings from a large multicenter collaborative demonstrate the burden of BSI among ambulatory PHO patients and identify benchmarks for future quality improvement work.Further investigation is necessary to develop effective infection reduction strategies for ambulatory PHO patients with central lines. [Table: see text]
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Affiliation(s)
| | | | - Aditya H. Gaur
- St. Jude Children's Research Hospital, Infectious Diseases, Memphis, TN
| | | | | | - Eric J. Werner
- Children's Hospital of The King's Daughters, Pediatric Hematology/Oncology; Eastern Virginia Medical School, Pediatric Hematology/Oncology, Norfolk, VA
| | - Cindi Winkle
- The University of Texas Southwestern Medical Center, Pediatrics, Dallas, TX
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Gaur AH, Bundy DG, Gao C, Werner EJ, Billett AL, Hord JD, Siegel JD, Dickens D, Winkle C, Miller MR. Surveillance of hospital-acquired central line-associated bloodstream infections in pediatric hematology-oncology patients: lessons learned, challenges ahead. Infect Control Hosp Epidemiol 2013; 34:316-20. [PMID: 23388370 DOI: 10.1086/669513] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Across 36 US pediatric oncology centers, 576 central line-associated bloodstream infections (CLABSIs) were reported over a 21-month period. Most infections occurred in those with leukemia and/or profound neutropenia. The contribution of viridans streptococci infections was striking. Study findings depict the contemporary epidemiology of CLABSIs in hospitalized pediatric cancer patients.
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Affiliation(s)
- Aditya H Gaur
- St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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Billett A, Gaur AH, Werner EJ, Winkle C, Hord JD, Brown R, Bundy D, Miller MR. Moving prevention of central line associated bloodstream infection efforts beyond the hospital walls: A multicenter pediatric hematology/oncology collaborative. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.34_suppl.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
86 Background: Elimination of central-line (CL) associated blood stream infections (BSI) (CLABSI) in the inpatient setting has been a focus for many healthcare organizations. Little is known about the rate of CLABSI in the ambulatory setting or the optimal improvement strategies. We systematically expanded CLABSI prevention efforts for children with underlying pediatric hematology/oncology (PHO) disease from inpatient to ambulatory settings and describe the related process (definitions, improvement change packages, compliance assessment) and outcome measures (CLABSI and other BSI rates). Methods: The evidence-based CL care and maintenance bundles developed for the Children’s Hospital Association Quality Transformation Network PHO inpatient multisite collaborative were adapted for the ambulatory setting. Teams self-reported compliance with bundle elements (daily goals, line entry/dressing/ port needle/ tubing change processes) and submitted total CL days for the PHO cohort in their care. National Healthcare Safety Network (NHSN) defined CLABSI, secondary BSI (as per NHSN definitions), and single positive blood cultures (SPBC) (currently not captured by NHSN) were tracked. All process and outcome measures were collected using an online data entry system. Results: Prospective data collection and ambulatory bundle implementation began in Nov. 2011; to date 24 of 36 hospitals participating in the inpatient PHO CLABSI prevention collaborative have successfully implemented the ambulatory component to their program. As of May 2012, accrued data from the ambulatory setting exists for 214 ambulatory CLABSI, 30 secondary BSI, and 72 SPBC in patients with 719,637 CL in situ (not CL accessed) line days. To date self-reported compliance with bundle elements is > 80%. Conclusions: We demonstrate a successful multisite expansion of CLABSI prevention efforts to the ambulatory setting in PHO patients. Given the limitations of the current NHSN CLABSI definitions in the PHO population and the goal to reduce all BSI, not just CLABSI, we also propose tracking of secondary BSI and SPBC and discuss how this contextual information can be helpful.
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Affiliation(s)
- Amy Billett
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Pediatric Hematology/Oncology, Boston, MA
| | - Aditya H. Gaur
- St. Jude Children’s Research Hospital, Infectious Diseases, Memphis, TN
| | - Eric J. Werner
- Children’s Hospital of The King’s Daughters, Pediatric Hematology/Oncology; Eastern Virginia Medical School, Pediatric Hematology/Oncology, Norfolk, VA
| | - Cindi Winkle
- The University of Texas Southwestern Medical Center, Pediatrics, Dallas, TX
| | | | - Richard Brown
- Children’s of Alabama, University of Alabama, Division of Pediatric Hematology/Oncology, Birmingham, AL
| | - David Bundy
- Johns Hopkins University, Pediatrics, Baltimore, MD
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Winkle C, Hirschey G. Development and implementation of a new graduate pediatric hematology/oncology nursing internship. J Pediatr Oncol Nurs 2002. [DOI: 10.1053/jpon.2002.0190070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Winkle C, Hirschey G. Development and Implementation of a New Graduate Pediatric Hematology/Oncology Nursing Internship. J Pediatr Oncol Nurs 2002. [DOI: 10.1177/104345420201900244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Winkle C, Hirschey G. Are You a Nurse or a Teacher ... Maybe Both? J Pediatr Oncol Nurs 2001. [DOI: 10.1177/104345420101800231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cindi Winkle
- Center for Cancer and Blood Disorders, Children's Medicine Center of Dallas, Dallas
| | - Gretchen Hirschey
- Center for Cancer and Blood Disorders, Children's Medicine Center of Dallas, Dallas
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