THE NURSES GROUP POSTER SESSION

Nurse & Allied Health Professionals NP002 RELIABILITY OF CYCLOSPORINE A VALUES TAKEN THROUGH CENTRAL VENOUS LINES, - A QUALITY MANAGEMENT STUDY NP001 A.-M. Berthelsen*,1, M. Nygaard1, K. Nørskov1, H. Sengeløv1 AN EVALUATION OF INFORMATION PROVISION AND 1Hematology dept. BMT unit 4042, RIGSHOSPITALET, PSYCHOSOCIAL SUPPORT FOR HAEMATOPOIETIC STEM Copenhagen, Denmark CELL TRANSPLANT PATIENTS: A SINGLE CENTRE STUDY M. Rennoldson1,1, A. Nield*,1, H. Jessop1, S. Simpson1 Introduction: HSCT patients are routinely treated with 1SHEFFIELD TEACHING HOSPITALS NHSFT, SHEFFIELD, Cyclosporine A (CyA) post-transplant to prevent GvHD. CyA United Kingdom is administered orally or intravenously (IV). We have experienced unexplainable high blood values in Introduction: Background: The intensive nature of Haemo- patients receiving oral or IV CyA. Adherence of CyA to the poietic Stem Cell Transplant (HSCT), sometimes with debilitat- catheter luminal wall is proposed as the cause. We performed ing side effects means it has been associated with a prospective study in order to ensure the validity of CyA considerable distress which can prove detrimental to patients’ concentration measurements in blood samples taken from psychological and physical well-being. Therefore the provision peripheral and central venous catheters (CVC) in HSCT patients of clear information and effective supportive care for HSCT being treated with CyA. patients is particularly important. The aim of this study was to Method: Myeloablative HSCT patients were recruited in the evaluate the effectiveness and acceptability to patients of the period from July to October 2014 at our transplant center. All current information provision and supportive care system in patients have given informed consent. CyA was analyzed our transplant centre, and to identify next steps for service concomitantly from: Peripheral blood (PB), CVC-line not used improvement by gathering feedback from patients for CyA infusion (non CyA-Line) and CVC-line used for CyA themselves. infusion (CyA-line). Method: 2 different questionnaires were developed; the ‘Pre- All samples from CVC were drawn according to our SOP, which Transplant Questionnaire’ was administered pre-transplant includes discharge of the first 10 ml blood drawn from CVC. All (T1) and the ‘Post-Transplant Questionnaire’ at 4-5 months CVC’s are two or three lumen Hickmann catheters. post-transplant (T2). T1 focused upon whether patients Values are compared with paired students T-test, significance believed they had been provided with the right amount of level 0.05. information, and if they felt well prepared for HSCT. T2 focused Results: Part 1; mean CyA values during IV Cya infusion, (N=16 upon satisfaction with the support patients had received samples): during their recovery. T1 were given to 19 consecutive PB Non-CyA-line p CyA-line p patients undergoing HSCT during the two month study 249 ug/l 253 ug/l 0.86 951 ug/l o0.001 period. T2 were given to 29 consecutive surviving patients who had undergone HSCT 4-5 months prior to the 2-month Part 2; Mean Cya values after discontinuation of IV CyA study period. Data was analyzed using summary statistics and infusion, while on oral CvA (N=5 patients): thematic analysis. Days after Results: 12 (63%) T1 questionnaires were returned, 3 iv CyA PB Non-CyA-line p CyA-line p allogeneic and 9 autologous transplants. All 12 respondents 5 364 ug/l 389 ug/l 0.43 756 ug/l 0.01 indicated they had received the ‘right amount’ of information 13 275 ug/l 305 ug/l 0.12 391 ug/l 0.03 about the medical procedures involved and 11 respondents agreed that they ‘felt well prepared’. 3 respondents reported PB-value is reference for p-values. not getting sufficient information on coping emotionally with Conclusion: their transplant. Suggestions for improvement focused around During IV CyA infusion: information about facilities available in isolation rooms. Blood samples drawn for CyA analysis from non- CyA-line are T2 results: Overall there was a very high level of satisfaction comparable to PB values. In contrast, CyA-measurements of with the support provided. Patients drew on many sources of blood drawn from CyA-line are significantly higher, despite use support which were reported to be effective in addressing of the SOP procedure. difficulties, suggesting the support patients are receiving After IV infusion (CyA administered orally): CyA values from matches their needs which was mostly drawn from those with non-CyA-line are in full correlation with values from PB. whom the patient has regular contact with. Access to support Both 5 and 13 days after last infusion of CyA, blood samples groups and information centres was limited by fatigue and from the CyA-line contain significantly higher levels of CyA. travelling distances. Lack of certainty about who to contact for We conclude that our practice of using the non-CyA-line for support following discharge post-transplant was also CyA measurements is justified. Use of the CyA-line for blood apparent. samples will produce incorrectly high values. Conclusion: The volume and content of information pre Importantly, falsely elevated CyA-values in the Cya-line are still transplant appears to be appropriate for the majority of obtained weeks after discontinuation of CyA infusion, which patients. Although contact information about sources of could lead to incorrect dose adjustment of CyA. We are support is provided prior to transplant, this should be currently continuing this study in order to establish a more provided again at discharge. Doctors and Co-ordinators are exact time frame for the elimination of CyA from the catheter most frequently accessed for support, and are best placed to lumen in CVC lines previously used for CyA infusion. initially support help seeking. Disclosure of Interest: None Declared. Disclosure of Interest: None Declared.

S511 NP003 (Human Leukocyte Antigen (HLA) identical) or haploidentical ( FOLLOW-UP BY PHONE WITHIN 24 HOURS AFTER at least 2 HLA mismatch) hematopoietic stem cell transplanta- DISCHARGE FOR HEMATOLOGIC PATIENTS tion (HSCT). W. van de Kar1, J. van Steeg1, A. Mank*,1 Method: Eighty-five AML and ALL patients who had under- 1Department Hematology F6-south, Academic Medical Centre, went allogeneic HLA identical or haploidentical (at least 2 HLA Amsterdam, Netherlands mismatch) HSCT in Anadolu Medical Center Bone Marrow Transplantation Center between 2010 and 2012 and were Introduction: The results from a customer satisfaction survey beyond 100th day post-transplantation were enrolled to the conducted by the Dutch Federation of Academic Medical study. Data were collected via a questionnary developed by Centers (NFU) show proof that there is a lot of room to researchers, including 10 questions aiming to demonstrate improve the quality of the procedures of discharge. This is in social and demographic structure of the patients and FACT-G agreement with our own observations at the department scale.For statistical analysis SPSS 15.0 was used. Shapiro Wilk’s, hematology (F6zuid). Many times questions arose after the Mann Whitney U, Chi-square test were used analysis. discharge of the patient and their relatives, for instance Results: From 85 AML and ALL patients who were evaluated medication or how to act in daily practice regarding infection for the study, 7 patients relapsed, 29 patients died and 4 prevention. The Board of Directors has confirmed that every patients were lost to follow-up. Consequently, 45 patients clinically admitted patient would get the guarantee to be were included in the study. Thirty-one of the patients were called within 24 hours after being discharged. The main allogeneic and 14 of the patients were haploidentical HSCT objective is to improve the provision of consulting services patients. While, 20 (44%) of the patients were female, the rest to patients and their relatives through follow-up by phone. 25 (56%) were male. 7 of female patients and 7 of male Method: To reach this goal a workgroup has been started on patients had undergone haploidentical, 13 of female patients our department.On F6-south this has been done according to and 18 of male patients had undergone HLA identical HSCT. a form. This is part of the electronic patient file (EPD). 67% of the patients (30 patients) were 18-45 years old and Questions in the developed form are ‘‘how are you, do you still 33% of the patients (15 patients) were 46-65 years old. While, have questions regarding your discharge or any other 36 patients (80%) were married, 9 patients (20%) were single. 4 question in general.Additionally, the entire procedure with of 9 single patients and 10 of 36 married patients had received regard to the follow-up by phone has been documented.At haploidentical and 5 of single pateints and 26 of married the transfer between night- and dayshifts there is an overview patients had received HLA-identical HSCT. The marriage status of the discharged patients from the last 24 hours. One of the of the allogeneic and haploidentical HSCT patients were not nurses get the responsibility to call. Each call will be reported significantly different (P40,05). Likewise, educational levels of in the EPD. the 2 groups were not significantly different (P40,05). Total Results: The number of patients that have received a phone- FACT-G score of haploidentical HSCT patients were 54,6±5,83 call has been between 80-85% per year since the workgroup points and total FACT-G score of allogeneic HSCT patients has been started. The patients reacted positive on the follow- were 55,2±7,72 points. There were no statistically significant up, one example: ‘‘How generous that you even think of me, difference between haploidentical HSCT and allogeneic HSCT even when I already left the hospital ‘‘ was one of the cheered groups in terms of days (P=0,377), fact-g body status (P=0,587), up reactions. In practice workload to find the time and fact-g social life and family status (P=0,503), fact-g activity accessibility was the most difficult. The results show that status (P=0,538), fact-g emotional status (P=0,162) and total patients at the first intake have been the most insecure. When score (P=0,539). they return home, they mostly had questions about their Conclusion: There is no statistically significant between medication. Patients also asked questions about nutrition, quality of life of allogeneic and haploidentical HSCT patients fatigue and their regimen. In some cases, complications such in terms of FACT-G scores. (P40,05). To conclude the type of as dehydration and malnutrition has been prevented by giving transplantation (HLA-identical or haploidentical) does not have advice related to these matters. In other cases, it seemed that an impact on quality of life in transplantation patients. follow-up appointments were not passed on- thanks to the Disclosure of Interest: None Declared. phone call this was realized nonetheless. In a few cases, the specific medical questions had to be answered by the NP005 doctor.After the reported feedback, the discharge checklist EVALUATION OF SIDE EFFECTS EXPERIENCED BY THE has been further improved, to ensure that the patient will be DONORS AND PATIENTS RECEIVING GRANULOCYTE instructed as good as possible before and after discharge. COLONY STIMULATING FACTOR FOR STEM CELL Conclusion: Overall, the follow-up by phone has led to MOBILIZATION appreciation by the patient and his relatives. When questions B. Virdil*,1, S. Kural1, N. Tiryaki1, E. Birtas Atesoglu2, D. Cekdemir1, are answered, a lot of the insecure feelings at home have 1 dropped. Complications could be (partly) prevented, causing a Z. Gu¨lbas 1Anadolu Medical Center Hospital, Bone Marrow Transplantation drop in readmissions.The results have clearly shown that this 2 way of service has great merits. Center, Department of Internal Medicine, Hematology Depart- Disclosure of Interest: None Declared. ment, Kocaeli University Medical School, Kocaeli, Turkey Introduction: In the present study, we aimed to evaluate the NP004 side effects experienced by the donors and patients receiving COMPARI˙SON AND EVALUATION OF QUALI˙TY OF LI˙FE OF granulocyte colony stimulating factor (GCSF) for stem-cell ACUTE MYELOID LEUKEMIA AND ACUTE LYMPHOBLASTIC mobilization. LEUKEMIA PATIENTS WHO HAD RECEIVED Method: The present study included 150 patients and donors HAPLOIDENTICAL OR ALLOGENEIC STEM CELL aged between 18 and 80 years old undergoing peripheral TRANSPLANTATION WITH FUNCTI˙ONAL ASSESSMENT OF stem-cell harvesting between July 2013 and March 2014. Data CANCER THERAPY (FACT-G) SCALE from the patients and donors were collected through a B. Sarıtas¸*,1,T.O¨ zdas¸1,Z.Gu¨lbas¸1,U.G.O¨ zer1, E. Birtas¸ Ates¸1, questionnaire. Pain was assessed using Visual Analogue Scale C. Bal2 (VAS). The data were evaluated statistically using SPSS 1Anadolu Medical Center, Kocaeli, 2Osmangazi University, software package. Eskisehir, Turkey Results: Of the 150 subjects included in the present study, 63 (42%) were female and 87 (58%) were male, and mean age Introduction: We aimed to evaluate and compare the quality was 52 ±15 years for the females, and 43±15 years for the of life of acute myeloid leukemia (AML) and acute lympho- males. Of the subjects 48 (32%) had multiple myeloma (MM), blastic leukemia (ALL) patients who had underwent allogeneic 22 (15%) had Hodgkin’s lymphoma (HL), 19 (13%) had non-

S512 Hodgkin lymphoma (NHL), and 61 (40%) were healthy donors. correctable deformities and/or reduce the potential for skeletal The study included 81 (54.0%) subjects receiving chemother- abnormalities to worsen. apy (CT)+GCSF, 8 (5.3%) receiving CT +GCSF+Plerixafor, 61 Conclusion: OT has a unique, structured and holistic role subjects (40.7%) receiving GCSF. Eighty nine patients (1 x 30 within the BMT Service at GOSH. Pre BMT the development of MU) and 61 donors (2 x 48 MU) in the study received GCSF. Of all children under 5 years old is assessed with a standardised the 88 patients, 43 (48.9%) developed side effects and 45 measure. If developmental delay is identified therapy inter- (51.1%) did not. Rate of side effects by disease was 50.0% for vention is provided during the child’s in-patient stay. Six MM, 45.5% for HL, and 47.4% for NHL. Of 61 donors, 52 (85.2) months post discharge a developmental review is provided. developed side effects and 9 (14.8%) did not. For the subjects The OT role is important in helping the under 5’s maintain receiving CT+GCSF, the day of receiving GCSF didn’t affect rate and/or achieve further developmental skills during BMT. Input of occurrence of the side effects. No significant difference was enables quality of life for the under 5’s in BMT isolation and found when the side effects were compared between genders supports parents/carers to interact with their child normally in (P=0.51). While, pain of 6 to 10 points on VAS was reported in a medical environment. 41.4% of the subjects, pain of 1 to 5 points on VAS was Disclosure of Interest: None Declared. 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 NP007 (40.9%). Dyspnea, vomiting, constipation and oral mucositis REINFORCING STAFF COMMUNICATION TO IMPROVE was not seen neither in the patients nor in the donors. SYMPTOM MANAGEMENT IN POST BONE MARROW Conclusion: No significant difference was found when side TRANSPLANT PATIENTS effects were evaluated by diseases and genders. The most 1 *,1 1 1 2 common side effects was bone pain. Bone pain was seen in S. Levy , C. Shamir , N. Abu-Shakura ,R.Or, G. Sapir , R. Radiano2 half of the donors, being secondary to GCSF. Bone pain is 1 2 more common in the healthy donors, being attributed to Bone Marrow Transplant, Nursing Directorship, Hadassah using higher dose of GCSF. Medical Organization, Jerusalem, Israel Disclosure of Interest: None Declared. Introduction: The post Bone Marrow Transplant period is characterized by a wide spectrum of symptoms, affecting NP006 quality of life and length of hospitalization (Conen et al, 2012)1. THE ROLE OF OCCUPATIONAL THERAPY WITHIN THE BMT Different symptoms accumulate at different times in the SERVICE AT GREAT ORMOND STREET HOSPITAL process and require ongoing assessment and care. Although C. Kermarrec*,1 managing patients’ symptoms is a major nursing goal, 1Occupational Therapy, Great Ormond Street Hospital, London, continuity of care is not easy to maintain, partly due to United Kingdom ineffective communication within a multi-disciplinary staff. Our intention is to develop a novel system whereby patients’ Introduction: The role of Occupational Therapy (OT) within most severe and debilitating complaints are clearly commu- the BMT Service at Great Ormond Street Hospital (GOSH) is nicated to the entire medical team. Once a patient’s acute unique as it screens development of all children under 5 years symptoms are explicitly conveyed, increased intra-staff colla- old. The screening process involves assessments such as the boration and communication can be promoted. Treatment Ages and Stages Questionnaire or the Bayley Scales of Infant plans can be tailored to allow caregivers to provide the and Toddler Development (3rd ed). These assessments explore optimum care for patients and their individual needs. cognitive, language and gross and fine motor development. Method: Upon admission to our department, fifty post- The assessment takes place Pre BMT to get an accurate transplant patients completed a self reported symptom measure of the under 5’s abilities. If developmental delay is inventory questionnaire, consisting of thirteen items estab- identified then therapy intervention is provided during the lished for hematology and oncology patients. It is available in child’s in-patient stay. A developmental review is provided six four languages for the benefit of our diverse patient months post discharge. population. We designed two generic, easy-to-use adhesive Intervention enables the under 5’s to engage in play in order stickers, with bright red, stand-out borders and room for to optimise their quality of life while in BMT isolation. If there nurses to detail patients’ self-reported most severe symptoms. are developmental concerns with an under 5, therapy input The stickers were positioned on the nursing report cards as can educate, support and assist parents/carers to enable their well as on the inside cover of patient’s medical file. The stickers child to maintain or achieve developmental milestones within remained on the nursing cards and in patients’ files for four- BMT isolation. day cycles. The significance of assessing and monitoring development in Results: A pilot study was initiated from November 2013 to the under 5’s in the BMT Service is multi-factorial: The first April 2014. The study assessed the effect of the quality years of life are a crucial developmental stage. Children assurance process in two ways: coming into BMT are hospitalised for a period of time. This Firstly, range and severity of symptoms and trends at each means the under 5’s are not experiencing the varied time point as reported by patients: cognitive symptoms, such environments and routines they would normally. A number as frailty / exhaustion, worry / anxiety, inability to sleep and of the under 5’s may be at risk of developmental delay mouth dryness (thought to be related to anxiety) were most secondary to their underlying condition for example, Hurler’s commonly reported, as opposed to physical symptoms (such Syndrome or Osteopetrosis. as constipation, nausea and mouth sores) which were reported The following provides examples of OT input within the BMT less. The only physical symptom to be reported more was pain. service: Secondly, the nursing and multi-disciplinary staff’s compliance Example 1. Osteopetrosis – the nature of this condition is bone to the implemented symptom management program. After fragility and visual impairment. These factors can cause the first four-day cycle, there was a 70.3% alleviation of developmental delay. OT assessment determines if develop- reported patients’ symptoms. 11.1% showed a worsening of mental delay is present. Advice includes optimal handling of a their previously reported symptoms. child with fragile bones, a positioning programme to Conclusion: The outcomes of our pilot study allowed us to strengthen muscles and aid development and advice on evaluate the full impact of using striking red stickers to sensory toys to utilise limited vision and fine motor skills. underscore the symptoms reported by the patient as being Example 2. Hurlers Syndrome – skeletal deformities including most severe. The pilot study determined that this technique thoracolumbar kyphosis present with this syndrome. Position- encourages the multi-disciplinary staff to practice effective ing for play advice is provided and specialist seating to correct, symptom management and effected better intra-staff

S513 collaboration. The program is presently being adapted for the about information on sex and relationships as well as on the computerized systems in our department. developed booklet. Disclosure of Interest: None Declared. Results: As to our knowledge this is the first study in Sweden examining patients’ experience of oral and written information NP008 about sexual issues. Two hundred and sixteen patients GETTING TO ZERO: SUCCESSFUL PREVENTION OF participated in this descriptive study. It included 135 men HEALTHCARE-ASSOCIATED INFECTION RATE IN THE HSCT and 80 women with a mean age of 59 years. Most of the WARD patients had not received information about sexual issues and a majority also considered oral information as important as C.-F. Chang*,1, J.-L. Tang1, C.-C. Li1, J.-H. Liu1 1 written information. The result showed a very low input from Tai-Cheng stem Cell Therapy Center, National Taiwan University, health professionals. Only sixteen nurses (8.5%) and ten Taipei, Taiwan, Province of China physicians (5.3%) had given oral information to the patients. The vast majority of patients were highly satisfied with the Introduction: Patients undergoing transplantation are highly booklet, and considered it as being useful in general. susceptible to infection. Because of hematopoietic stem cell Conclusion: It is concluded that patient with malignant blood transplantation (HSCT) patients’ compromised immunity after diseases do not get information about sex and relationships as transplant, infection is a major cause of morbidity and much as they wanted. Therefore health professionals need mortality.Our aim is to reduce the healthcare-associated necessary training to feel confident in the conversation about infection rate in Tai-Cheng Stem Cell Therapy Center, National sexuality and knowing how treatment affect sexuality. The Taiwan University Hospital. result also showed that patients wanted written information Method: We implied the following strategies to reduce the and that the booklet could be helpful in communication with infection rate: (1) Regular examination and disinfection of health professionals. equipment to keep the temperature, humidity, pressure, Disclosure of Interest: None Declared. 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 NP010 upon the admission until a negative culture screening result to EDUCATIONAL TOOLS TO PREVENT COMPLICATIONS avoid multiple-drug resistant organisms outspread. (3) Strict AFTER AUTOLOGOUS AND ALLOGENEIC STEM CELLS enforcement of infection control guideline. (4) Use of ‘‘central TRANSPLANT line bundle’’ strategy of patients’ Center Venous catheters and C. Soliman*,1, M. Brambilla1, M. Osorio1, S. Cuccaro1, well central line dressing to prevent central venous catheter- S. Barbarani1, S. Agazzi1, V. La Terra1, F. Berruto1, related bloodstream infection (CLABSI) since 2012 January. M. T. Lupo Stanghellini1, S. Marktel1, C. Corti1, F. Ciceri1 Results: Total 303 cases had been transplanted between 2010 1Ematology and BMT Unit, IRCCS San Raffaele Scientific Institute, march to 2014 September. Healthcare-associated infection Milano, Italy rate among HSCT patients keep zero for more than four years. The CLABSI rate dropped from 1.29% in 2012 to % in January Introduction: This study has the aim to give patients and their to September 2014. caregivers theoretical knowledge and practical skills necessary Conclusion: We recognize that a nurses’ role in infection to safety cope daily life activities at home, in order to permit control is very important. The efficacy of specific isolation and them to early recognize dangerous complications symptoms barrier precautions in preventing healthcare-associated infec- during the first months after autologous and allogeneic SCT. tions in HSCT patients was notable and important. The Method: In 2012, our previous outpatients study underlined encouraging results in our infection control of HSCT ward the needs of discharged patients after autologous and demonstrate an example of how improving training and allogeneic stem cells transplant (SCT), in order to acquire the materials in nursing care standards can benefit the outcome of strategies to develop the Health Literacy (HL). HL is the patients receiving HSCTs. capacity to take effective and aware decisions concerned Disclosure of Interest: None Declared. 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 NP009 adversely influence health state of people, increase inequal- THE EXPERIENCE OF ORAL AND WRITTEN INFORMATION ities and health system costs [Ferro E., Tosco E.; 2012]. ABOUT SEX AND RELATIONSHIPS IN ADULTS TREATED FOR The study involves the discharged autologous and allogeneic MALIGNANT BLOOD DISEASES SCT patients and their caregivers, from April to October 2014. C. E. Wendt*,1, E. Idvall2, S.-A. Månsson3 We wrote an informative discharged brochure, translated in 1University Hospital in Lund, Sweden, Malmo¨ University, Faculty different languages, aimed to inform and train patients/ of Health and Society, 2Malmo¨ University, Faculty of Health and caregivers about the specific behavioral recommendations Society, 3Malmo¨ University, Faculty of Heath and Society, Malmo¨, (hand washing, mask wearing, oral hygiene, drugs taking, Sweden nutrition, central venous catheter management, early symp- toms), in order to prevent possible complications and Introduction: One of the most important needs of cancer infections. Before discharge, the nurses met patients/care- patients is to receive thorough and honest information about givers, explained the specific home behaviors and gave them their disease, treatment and chance for cure. Additionally, the informative brochure. In the first week after discharge, the important aspects are possible treatment related to side nurses checked the patients/caregivers learned information effects and also the impact on patient’s sexual health. Most and abilities and filled together a short survey in hospital. patients consider it is important to address the problems of Results: 48 patients were involved, 4 had not the interview sexual nature with health professionals, but results show that after discharge because of clinical and organizational issues. Of nurses and physicians do not address the issues of sexuality in 44 patients, the theoretical knowledge and practical skills were the context of cancer therapy. fully acquired in 69% of cases; partially acquired in 17%; not The purpose of this study was to assess how information acquired in 8% and not evaluated in 6%. The answers that worked in practice, both oral and written. This study is also a were not evaluated concerning the central venous catheter result from an earlier presentation of the booklet ‘‘Sex and management, because of the early removal of it. Upon the relationships in the treatment of blood diseases’’ as a poster at whole of investigated topics, the nutrition was fully acquired in the EBMT in Vienna 2010. 95% of cases. Method: A study specific questionnaire was developed for Conclusion: The study shows that the stable use of an patients with malignant blood diseases. It contained questions informative brochure and the executions of dedicated

S514 individual talks increase the patients/caregivers knowledge donors satisfaction in terms of quality of life, mental distress or and skills levels and can promote the HL process development. requests after giving stem cells. The nutrition is a topic particularly in depth known by the Method: Adult sibling donors, collected prospectively studied sample, probably for social and cultural reasons between September 2012 and December 2013 at the CHU related to the country of origin. In the future, we could plan of Nantes, were asked to respond, at distance of the graft patients/caregivers groups meetings to share opinions about collection (median: 15 months), to an anonymous question- partially acquired and not acquired topics and to debate of naire between June and September 2014. This included socio- specific issues with experts contribute. demographic data, scale of the long-term impact of donor Disclosure of Interest: None Declared. collection on physical and psychologic aspects and type of support received. As indicator, scales ranging from very bad to NP011 very well were used. Other open questions invited donors to ALLOGENEIC CORD BLOOD AND HAPLOIDENTICAL FAMILY give their personal opinions and comment on their difficulties DONOR TRANSPLANT, WHO DEVELOPED MULTIDRUG- or their satisfactions. We sought also to establish whether the RESISTANT KLEBSIELLA PNEUMONIAS SEPSIS AND service and information given regarding the stem cells PHLEGMON. A NURSE CHALLENGE donation met donor’s expectations. Results: 39 donors have been identified and the questionnaire L. Galgano1, C. Boglione*,1 1 was sent at their domicile. Twenty-nine cases responded (male Reparto TMO, A.O.U.C. Careggi, Florence, Italy n=14, median age 53 years) and analyses have been performed in October 2014. Twenty-four donors have received Introduction: A 25 years old man, suffering from acute granulocyte colony stimulating factor for mobilisation of lymphoblastic leukemia in May 2013, during induction cycle peripheral blood stem cells (PBSC) while collection of bone develops pulmonary aspergillosis, which leads him almost to marrow graft was performed in 5 cases. Physically and death; when finally the white cells count arises, he is sent to mentally, the percentage of patients feeling very well, well the transplant. or enough well were: 72.4% and 69%, 24.1% and 24.1%, 3.4% Being an only child, he was offered, given the previous and 6.9%, respectively. No differences were noted between hospitalization accompanied by a very long period of donors giving bone marrow or PBSC. Also 2/3 of the donors aplasia,an allogenic transplant from cord blood plus a (n=17) have no medication at time of analyses while the rest transplant from haploidentical family donor. was treated for one or more chronic diseases (essential Method: Conditioning regimen: (RIC) Fludara 30 mg/mq from hypertension, hypercholesterolemia, diabetes, allergy or day -7 until -3; Atg 1,5 mg/kg at -7, -5, -3, -1; melphalan 70 mg/ depressive disorder). As a reflection of good feeling, half of m2 at -3, -2; Gcsf 5 mcg/kg since day +1. the donors have not performed control samples as required On the sixth day after reinfusion his rectal swabs are positive after graft collection and most of them haven’t seen their for multidrug-resistant Klebsiella pneumonias, sensitive to family doctor for a while. Fifteen donors commented on their tigecycline and gentamicin, starts antibiotics and granulocytes; difficulties or satisfactions considering the graft collection after onset of an axillary painful wound swab positive for procedure. All of them were volunteers for giving stem cells.All Klebsiella pneumonias, and clinical worsening hypoxia, he but one agreed that information and care provided were of starts alternate use of CPAP (Continuous Positive Airway high quality. Pressure) mask and the Venturi mask. Conclusion: Most of the siblings were volunteers for the stem From the perspective of engraftment we witnessed a transient cells donation and were satisfied of the procedure organiza- neutrophil recovery at+15, together with a subsequent decline tion. Long-term consequences of the stem cells donation are in values, but the aspirate of bone marrow and chimerism, mild. New indicators, such as early evaluation of pain or performed at+30, resulted 100% cord blood with negative fatigue, should be considered in a larger cohort of donors as it Minimal Residual Disease. At 1 month and a half after may represent a better way to improve practice. Question- transplantation he was still hospitalized and developed mitral naires will continue to be used as a prospective evaluation of regurgitation with signs of pulmonary hypertension induced our sibling donors every three months during one year from by drugs toxicity. The performance status improves, but the the stem cells donation. Also, the feeling regarding donor left axillary wound becomes a phlegmon of 4 cm for 5 cm, that lymphocytes donation after transplant, if done, will be could contain almost 10cc of saline, and,after consulting the integrated in the questionnaire. wound care nurse and surgeons, starts a successful treatment Disclosure of Interest: None Declared. 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. NP013 Results: After 96 days from the admission patient leaves the ward ’’PATIENT- SAFETY DURING THE PICU TRANSFER’’ in a wheelchair, without GVHD and the phlegmon almost heal. E. Trigoso*,1, C. Dolz1, V. Riera1, E. Alberola1, A. Almodovar1 Conclusion: Assistance was multidisciplinary, but from a 1Hospital U y P "LA FE", Agencia Valenciana de Salud, Ribarroja nursing point of view, the staff had to improve their know- del Turia, Spain how and find new supportive psycological strategies in an emotionally fragile patient. One year after the transplant, the Introduction: Background: "It is generally agreed that patient is still alive and well. patient´s safety can be defined as freedom for a patient from Disclosure of Interest: None Declared. 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 NP012 require admission to paediatric intensive care. LONG-TERM SIBLING DONORS’ FEEDBACK AFTER GRAFT The average of HSCT children admitted in PICU varies between COLLECTION FOR ALLOTRANSPLANT IN ADULTS: A 10% and 20%, although peaks of 44% have been reported. The PROSPECTIVE EVALUATION AT THE CHU OF NANTES main causes were: Severe sepsis, fluid overload, and respira- D. Issarni*,1 and Ghislaine Francois, Melaine Leclercq, Rachel tory distress. Lebreton, Veronique Stocco, Pascale Dupuy, Thierry Guillaume, Paediatric Transplants Unit from Hospital Universitario y Jacques Delaunay, Pierre Peterlin, Philippe Moreau, Patrice Polite´cnico ‘‘La Fe’’ carries out an average of 25 HSCT a year Chevallier autologus, alogeneics (related and undreleated donors) and 1CHU, NANTES, France haplo.* and the average of patients who need to be transfer to PICU is similar to other Centers. Introduction: Evaluation is a key element of quality manage- Objectives: - To increase the transplanted patient´s safety ment. So far, few studies have considered the long-term during the transfer from the HSCT ward to the PICU, by

S515 systematizing information, developing a continuity of care between Zarzio vs. Neupogen group in respect to neutrophil report and following a checklist in order to increase the quality engraftment: the neutrophil count of 1,0x10e9/l was reached and effectiveness of information transfer. on median day 12 (9-14) vs. 12 (9-14) post-transplant. All - To avoid the mistakes in the information transfers getting an nurses (8/8) assessed Zarzio vs. Neupogen as being the same efficient communication among health care professionals. in respect to storage, administration and side effects in - Work team between both Units in order to assure the patients, however, in respect to manipulation 1/8 of nurses continuity of the care and, therefore, this team work is vital assessed Zarzio vs. Neupogen as being the same, 4/8 as being during all the transplant process. better, 3/8 as being much better. No nurse experienced any Method: METODOLOGY technical complication related to Zarzio administration. No - Bibliography review in order to know the scientific evidence significant side effects, but skeletal pains in granulopoesis about this topic. recovery, were observed both in approximately 10% of Zarzio - We have also valued our daily professional experience. and Neupogen treated patients. - Periodic meetings among nurses from both units have been Conclusion: Based on our observation we can conclude that established. Zarzio demonstrated similarity to the Neupogen in respect to - The Project aim is to elaborate a standardized operating neutrophils count recovery post-transplant and no significant procedure with the information required in order to guarantee side effects. Zarzio was assessed as better (safer, respectively) the patient´s safety during that process. It has been developed by nurses in respect to manipulation because of the innovative based in the Human Needs Model from Virginia Henderson automatic needle safety cover that passively locks for and the IDEAS techniques. protection against needle stick injury and for safer disposal. Conclusion: COMMENTS: Regarding the continuity of the Disclosure of Interest: None Declared. cares and the patient-safety periodically, we think that working parties among intensivists physicians and nurses, NP015 hemato-oncologist nurses and physicians as well as others SAFE DISCHARGE OF A NON-ENGLISH SPEAKING FAMILY health care professional, are of vital importance and should be FROM THE INTERNATIONAL PAEDIATRIC HSCT UNIT AT mandatory. GREAT ORMOND STREET HOSPITAL Jacie: F. Palk*,1 B2.1.1 The inpatient program shall have an intensive care unit or 1 equivalent coverage available. Bone Marrow Transplant, Great Ormond Street Hospital, B2.1.1.1 There shall be written guidelines for clear communica- London, United Kingdom tion and prompt transfer during and ongoing monitoring of the transfer of patients to an intensive care unit or equivalent Introduction: Discharge planning is routine following an coverage. admission to hospital but should be planned and individua- Checklist assessment should be made within a reasonable lised (Department of Health, DOH, 2004). Discharges can either period of time. be simple and nurse-led or complex, requiring a multi- Disclosure of Interest: None Declared. disciplinary 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 NP014 fully informed, educated and involved in the preparation for IS FILGRASTIM BIOSIMILAR ZARZIO SIMILAR TO being discharged (DOH, 2004). On the International Private FILGRASTIM ORIGINATOR NEUPOGEN? Patients’ Unit this becomes even more complex as the E. Bystricka*,1, R. Brandejsova1, S. Vokurka1, A. Jungova1, clientele is predominantly Arabic speaking and sponsored by P. Hlinkova1, J. Skardova1, P. Vodickova1 a funding body. Therefore the Unit relies on an interpreting 1Haemato-Oncology, UNIVERSITY HOSPITAL IN PILSEN, Plzen service to ensure the family’s information needs are met in (Pilsen), Czech Republic preparation for a safe and timely discharge (Nursing and Midwifery Council, 2008). Introduction: Filgrastim is a human granulocyte colony Method: OBJECTIVES: stimulating factor (G-CSF) and is widely used for chemother-  To teach parents in the safe administration of their child’s apy-induced neutropenia, hematopoietic stem cells mobiliza- medications in preparation for discharge tion and leucocytes recovery in hematopoietic stem cells  To ensure that the teaching requirements are met in a safe, transplantations. Neupogen (Amgen) is the original G-CSF effective and individualised manner prior to the discharge stimulating factor and Zarzio (Sandoz) is filgrastim biosimilar date approved in 2009 to have the same clinical effect. Daily  To educate parents about post-BMT cares and to recognise practice clinical data are further needed to verify the safety when their child is unwell and medical help needs to be and efficacy of biosimilar products. We decided to present our sought. experience focusing to nursing care predominantly.  To reduce re-admission to hospital Method: Pre-printed questionnaire was distributed to our METHOD: ward transplant nurses (n=8) to compare Zarzio and Neupo-  A discussion with the family is initiated at least two weeks gen in respect to nursing care issues: storage, administration, before agreed discharge date and a verbal agreement is manipulation, side effects and technical complications occur- sought from the parents to start practising administration of rence. The quality of variables were compared using a scale of medications with a qualified nurse 1–5 ( 1=much better; 2=better; 3=the same; 4=worse; 5=much  The use of a discharge checklist is initiated (pic) worse). Neutrophils recovery was observed in 148 autologous  A brief medical report is sent to the relevant funding body to transplantation patients treated with Zarzio and was com- inform of imminent discharge pared to historical control group of 148 patients treated with  A request is made for any medical equipment, specialised Neupogen. The Zarzio and Neupogen dose was 5 mg/kg/day teaching and medications for going home administered subcutaneously during neutropenia post-trans-  A medicine planner is completed, translated into Arabic or a plant till neutrophils recovery (&1,5x10e9/l). Zarzio and photographic book is done for parents who are illiterate – a Neupogen were used as original pre-filled syringes of 300 copy is given to parents (pic) and 480 micrograms (30 and 48 MiU).  Planned sessions with an interpreter for the discharge talks Results: No significant differences were observed between to be done Zarzio vs. Neupogen group in respect to: mediane age, gender Results: RESULTS: and chemotherapy protocols ( 62 vs. 60 years, 47% vs. 45%  Feed back questionnaires from nurses and parents on how females, BEAM 35% and HD-Melphalan 65% vs. BEAM 30% and they feel that the discharge planning is working - awaited HD-Melphalan 70%). No significant difference was observed  Re-admission to the unit within 72 hours is zero

S516 Conclusion: DISCUSSION: important. Ensuring this cooperation depends on the knowl- BENEFITS edge of informal caregivers about caregiving. There is not  Nursing staff is better informed about the medications, currently any study about knowledge and practice about which increases their confidence to teach the parents neutropenic patient care of informal caregivers of neutropenic  The use of the checklist ensures individualised needs are cancer inpatients. This study aims to specify knowledge and met practices on neutropenic patient care of informal caregivers of CHALLENGES neutropenic cancer inpatients.  Delay in authorisation of medication from funding body Method: This descriptive study was conducted at a University  Workload and time available for nursing staff to spend with Hospital in Ankara, Turkey on December 2012 and July 2013, the parents where research was conducted in twenty beds of the Medical  Lack of an in-patient Nurse Specialist on the unit to Oncology and Hematology clinic. This study includes inter- coordinate the discharge views with 100 informal caregivers of inpatients who become  Child not medically fit for discharge on agreed date neutropenic at least two days ago. Patients who had an Disclosure of Interest: None Declared. absolute neutrophil value under 2.000/mm3 were accepted as neutropenic. The SPSS software was used for statistical NP016 analysis. The descriptive statistics were presented by numbers COMPLEX CARE OF A PATIENT WITH MENTAL (n) and percentages (%), and by mean (standard deviation). RETARDATION UNDERGOING BONE MARROW Results: All informal caregivers indicated that they had TRANSPLANTATION FOR FANCONI ANEMIA knowledge of and practiced the following rules of patient care, including ‘washing hands’, ‘preservation of dirty objects F. Erdog˘an*,1, A. Duyan1, G. Koca1, S. Kaya1, K. Yalc¸ın1, 1 from clean ones’, ‘attention to personal cleaning of informal A. Ku¨pesiz caregivers’ and ‘following infection symptoms and controlling’. 1 ˙ ˙ ˙ AKDENIZ UNIVERSITY, ANTALYA, Turkey Besides, most of the informal caregivers (more than 80%) indicated that they have knowledge of and practiced the Introduction: Fanconi anemia (FA) is a rare, phenotypically following rules of patient care: ‘important matters about food’, heterogeneous, inherited disorder clinically characterized by ‘not keeping live plant in patient’s room’, ‘patient’s congenital abnormalities, progressive bone marrow failure mouthwash at least three times in day’, ‘putting on a mask’, (BMF), and a predisposition to develop malignancies. Hema- ‘preservation of catheter’, ‘not touching infected persons’, ‘not topoietic stem cell transplantation (HSCT) still represents the keeping too many objects in the room’ and ‘not accepting only curative option for FA. Results of unrelated donor HSCT visitors’. The least well-known and practiced rules by informal have been less encouraging because of many complications caregivers included ‘cleaning patient’s armpits and groin area but better results have recently been reported. In our centre two times in day’, ‘having bath every other day with we have performed 42 BMT for FA with success rate: 70% consideration of patient’s other blood rates’ and ‘not feeding survival and disease free survival. patient with slim crusted fruits, if given, they should be Method: The 15 year old boy was diagnosed with FA at 2 peeled.’ years ago. Treatment protocol with: Cy 200 mg/kg; Fludara Conclusion: In the current study, while all or most of the 150 mg/kg. GVHD prophylaxis was: CyA 2 mg/kg; ATG 90 mg/ informal caregivers were aware of and implemented some of kg; Metil-PND 2 mg/kg. Also as a novel procedure in our clinic, the rules associated with the care of neutropenic patients, it we used hyaluronic acid for hematuria prophylaxis. The donor was seen that some were known but implemented a lesser was the HLA-A mismatch unrelated. Chimerism reached 100% extent. It is recommended that standard education programs donor. In post BMT period, clinical complications were: be launched for caregivers, who play an important role in intestinal GVHD III; fever, skin GVHD III; hematemesis, patient care, and so should be provided with regular training. hematuria, diarrhoea and CMV re-activation. Furthermore, it is recommended that informal caregivers be Results: The socio-economic and educational degree of the observed when engaged in their routines, and any deficiencies family was very low. Beside this, patient had mental that are identified should be addressed under the supervision retardation. In such a complex condition, nursing manage- of nurses. ment was very hard. Also, many complications made it harder. Disclosure of Interest: None Declared. 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 NP018 management included: education of mother, skin protection AN INSIGHT INTO HURLERS (MPS1) TRANSPLANTATION AT during skin GvHD, intensive diarrhoe monitoring and rehydra- THE ROYAL MANCHESTER CHILDRENS HOSPITAL tion during skin GvHD, intensive blood/platelets transfusions, H. Webster1, H. Heartfield*,1 intensive pain control and infection control. At the end of the 1BMT unit, Royal Manchester Childrens Hospital, manchester, BMT hospital admission days both skin and intestinal GVHD United Kingdom were resolved. Conclusion: It was very difficult to ensure the care of a patient Introduction: The Royal Manchester Children’s Bone Marrow with mental retardation. By the intensive care and affection of Unit (BMTU) at the Central Manchester University Hospitals in nurses, best quality treatment was achieved. the United Kingdom (UK) are a leading centre of excellence, on Disclosure of Interest: None Declared. a national and international level, in transplantation of non malignant enzyme deficiency mucopolysaccharide disorders (MPS) Hurlers Syndrome. NP017 In 1980, UK doctors pioneered Bone Marrow Transplantation KNOWLEDGE AND PRACTICE OF NEUTROPENIC for MPS, with Manchester performing their first transplant in INPATIENT’S INFORMAL CAREGIVERS ON NEUTROPENIC 1985. PATIENT CARING Advances and success with MPS Bone Marrow Transplant G. Bagcivan*,1, B. Masatoglu1, Z. Topcu1 (BMT) at The Royal Manchester Hospital have developed over 1Gu¨lhane Military Medical Academy, School of Nursing, Ankara, the years to the present time. The collaboration of the Turkey centralised care within the hospital, working with a large multidisciplinary team, other centres and the establishment of Introduction: Neutropenic patient care is an important issue MPS stem cell research laboratory at Manchester have for preserving complications that are linked with neutropenia contributed to such developments. and shortening of neutropenia duration. Cooperation of Although there is no specific screening for MPS, there is informal caregivers on neutropenic patient care is very increased awareness and early detection is therefore

S517 improving. There has been a significant increase in the different when comparing 0.6mls/min to 1.0 mls/min and did number of MPS transplants performed at Manchester over not affect the overall aim of achieving a transplantable dose of the past 20 years, averaging 8 transplants per year with a 2x10^6/Kg in the smallest volume possible. success rate of 90% engrafted survival. Conclusion: There was a reduction in collection efficiency in Once diagnosed the pathway to transplant at Manchester can the lower collect rates, but this drop in efficiency was smaller then be initiated. This involves; initial consultation with than might be expected especially when comparing the consultant, and support from Bone Marrow Coordinator, median CD34+ CE1% for 1.0ml/min and 0.6 ml/min collections intensive conditioning, resulting in potential side effects of which gave a net reduction of 21%. This is significantly less infection, Graft verses Host Disease and organ toxicity, and than the corresponding reduction in the median harvested finally post transplant long term care. Nursing management, product volumes of 1.0 ml (199 mL) and 0.6 ml (113 mL) care and support are paramount throughout this period and procedures which gives a net reduction of 43%. contribute hugely throughout the process of transplantation. Therefore, a collect rate of 0.6mls/min can be used when Conclusion: Advances in transplantation in MPS at the Royal harvesting cells using CMNC to attain a high concentration, Manchester Children’s Hospital are evident, therefore leading low product volume. However, this is at the risk of some loss of to greater knowledge and expertise within this nursing field. CD34+ cells due to the decreased extraction efficiency. Our goal is to improve therapies and with future develop- Disclosure of Interest: None Declared. ments 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 NP020 immediate past. AN INITIAL INTERNATIONAL CLASSIFICATION OF Disclosure of Interest: None Declared. FUNCTIONING, DISABILITY, AND HEALTH (ICF) CORE SET IN PATIENTS WITH STEM CELL TRANSPLANTATION BASED ON NURSING DOCUMENTATION NP019 *,1 2 2 1 A LOW VOLUME CD34+ RICH PRODUCT CAN BE ACHIEVED H. A. Stallinga , H. Wyma , S. J. Haan , P. F. Roodbol 1School of Nursing & Health, University of Groningen, University THROUGH COLLECT PUMP MANIPULATION WHEN USING 2 CMNC FOR AUTOLOGOUS STEM CELL HARVESTS Medical Center Groningen, Hematology, University Medical Center Groningen, Groningen, Netherlands H. Keane*,1 1 Apheresis, UCLH, London, United Kingdom Introduction: In patients with stem cell transplantation, biomedical oriented healthcare falls short in generating all Introduction: Product volume in autologous transplants can the information, required for determining healthcare provi- be a problem due to overall return volume and DMSO sion, to improve patients’ health status. A more holistic concentration for the patient as both can lead to adverse approach, by using the International Classification of Function- events during reinfusion. Additionally large product volume is ing, Disability and Health (ICF), focusing on patients status of a storage burden in cryopreservation laboratories which is a functioning, seems more appropriate, especially for nurses. resource issue for both cost and long term access to storage Objective: To develop an initial ICF core set for patients with space. stem cell transplantation based on nursing documentation. An With the recent introduction of the Continuous Mononuclear ICF core set is a short list of ICF categories relevant to a health Cell (CMNC) protocol on Spectra Optiat there is an condition. The core set can serve as a guide in assessing opportunity to directly influence final product volume by patients’ health status, relevant for clinical decision-making in direct control of collect pump flow rate. healthcare provision. The initial ICF core set is the first phase in Method: We methodically investigated the potential to reduce the development of a comprehensive core set, in which product volume by step-wise reduction in collect pump flow evidence from follow-up studies (a systematic review, an rate during individual procedures and the impact on overall expert survey, field testing) will be integrated. yield / dose and collection efficiency of targeted CD34+ cells. Method: Mixed methods; 1) through a peer-reviewed Results: 31 procedures have been performed to date with procedure, nurse documented patient information was linked patients being divided into 3 separate groups with the aim of to ICF categories using standardized linking rules established testing the effect on efficiency of using 3 different collect for the ICF: 2) absolute and relative frequencies of ICF pump flow rates; 1.0 ml/minute (default) against 0.8 ml/minute categories were reported. Included were 31 records of patients and 0.6 ml/minute. admitted for stem cell transplantation between March 2013 There was no significant difference between the patients in and September 2013 at the department of hematology in a each arm of the study and the median starting peripheral Dutch University Medical Centre. Two researchers, trained in blood CD34+/ul ranged from 42 in the 1.0mls/min to 31 and nursing care for patients with stem cell transplantation and in 34 respectively in the 0.8 ml and 0.6mls/min patient groups. As using the ICF, collected and analyzed the data. expected the smaller collect rate resulted in a significantly Results: 2372 meaningful concepts were identified of which smaller product volume with the median product volumes 2298 could be linked to 76 ICF categories of which 49 were being 199mls (1.0 ml/min), 160mls (0.8mls/min) and 120mls classified into body functions, 14 into anatomical structures, 8 (0.6 ml/min). into activities and participation and 5 into external factors. Sensation of pain (ICF code: b280), defecation functions (ICF CD34+ CE1% Collect pump flow rate (ml/minute) code b525), sensations associated with the digestive system (ICF code b535) and ingestion functions (ICF code b510) were 1 0.8 0.6 the most frequently reported categories. Eighty-three percent Number 13 8 9 of the documented information was related to body functions Min 43.0% 28.0% 29.5% and structures; ten percent was related to activities and Median 68.7% 55.0% 54.2% participation, and seven percent was related to environmental Max 101.9% 88.3% 69.9% factors. Conclusion: Almost all patient information, documented by nurses can be linked to ICF. However, the majority of nursing Despite a stepwise reduction in CD34+ CE1% when using documentation was related to the component of body lower collect flow rates from 68.7% at 1.0 ml/min to 55.0% at functions and structures, representing biomedical oriented 0.8 ml and 54.2% at 0.6 ml/min. This did not reach statistical healthcare provision. This may indicate that nurses are lacking significance until comparing the difference between 1.0 ml/ to document psychosocial information corresponding to the min against 0.6 ml/min (Po0.01). The drop in efficiency of the component of activities and participation and environmental overall CD34+ cell dose harvested/kg was not significantly factors. An ICF core set, which included all relevant biomedical

S518 and psychosocial aspects of patients with stem cell transplan- cancer (AAA). Last year a Nurse Board was created and we took tation, may be a useful tool for nurses representing their our first steps. Objectives: Investigate needs of nurses holistic approach to healthcare provision. attending adolescentes and young adults with cancer and at Disclosure of Interest: None Declared. the same time, needs that nurses may detect of these patients. Method: A survey was submitted for nurses from different NP021 hospitals in Spain. 46 hospitals answered the survey. 20 items SODIUM CITRATE (SODIUM CITRICUM 4%) AS CENTRAL were studied in the survey that were divided into 4 points: VENOUS CATHETER LOCK TO KEEP THE CATHETER LUMEN Training, information, resources and needs, our proper needs FROM OCCLUSSION IN PATIENTS AFTER ALLOGENEIC and the needs we think that adolescents and young adults STEM CELL TRANSPLANTATION have. *,1 1 1 1 1 Results: We received 46 surveys of responsibles of the units, J. Skardova , E. Bystricka , S. Vokurka , H. Petra , M. Karas , and 234 surveys of assistant nurses. 40% of the units were P. Vodickova1 1 pediatric units and 60% were adult units. Resources: adoles- Haemato-Oncology, University Hospital in Pilsen, Plzen (Pilsen), centes and young adults should be treated at pediatric units Czech Republic 60%, at adult units 46%. 88% of the facilities do not have an specific area for adolescents and young adults. Informa- Introduction: To protect CVC lumen from intraluminal tion:80% did not know where to acceed to information occlusion is one of the most imporant tasks in the CVC care. resources for adolescentes and youg adults, and information No data are available about the safety and efficacy of 4% resources to assist professionals. 100% considered that it sodium citrate locks administered into central venous catheter would be interesting to have a website or similar available to (CVCs) in patients after allogeneic stem cell transplantation guide and seek questions about these patients. Training: only (SCT). OBJECTIVE: To verify the reliability and safety of sodium 31% of nurses think they have enough training and knowl- citrate 4% locks. edge. 97% consider that specific training is important. 46% of Method: Prospective study, sodium citrate (sodium citricum the total of nurses feel unqualified. 93% consider that 4%, "Citra-Lock") was administered intraluminally for 24– adolescents and young adults with cancer need our attention, 72 hours into multi-lumen CVCs (Arrows) in patients after and 100% think that it is neccessary to develope specific care allogeneic SCT in cases where at least one lumen is no longer teams for adolescents and young adults. Needs: 60% of the needed for continuous administration of infusions. The citrate nurses do not know about their rights. 88% believe that volume corresponded to the volume of the CVC lumen. adolescents and young adults should receive all the informa- Results: 91 lumens in 43 CVCs in 43 patients were observed. tion of their disease and treatment and 96% consider that they The median number of days of observation of a single CVC must take decisions and participate with the team. lumen was 6 ( 2–32 ), and the number of locks administered Conclusion: Nurses need training, specific health education per lumen was 3 (1–13 ). The exchange interval between for professionals including treatment and care, physical, administering two locks was 24 hours in 49% of cases, 48 hours psychologycal and social development of this group and a in 19%, and 72 hours in 32%. At the end of the monitoring platform to guide professionals and patients. Nurse board of period, from 6 days out to a maximum of 32 days, and AAA is organizing a course for Spanish professionals that will including 3 or more lock applications (maximum 13 applica- be held on May 2015 and is participating at the AAA platform tions) in half the patients, patency was maintained in 58% of providing expert information. Efforts in Spain must continue, the lumens, was partial in 22% and was completely obstructed to create the adecuate environment, units for adolescents and in 20%. After converting the results per 10 applications of the young adults with specific care and listening to their greatest locks, complete obstruction of the lumen occurred in 6% of desire that is to "keep their life as normalized as possible". cases (6% complete obstructions per 10 administrations of the Disclosure of Interest: None Declared. 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). NP023 Blood cultures taken from the lumen prior to the first lock SETTING UP A TRIAGE AND ASSESSMENT (T&A) UNIT IN administration and at the end of monitoring were positive in CLINICAL HAEMATOLOGY – THE CHALLENGES OF MEETING 4% and 9% of cases (P=0.35), respectively. No complications THE COMPLEX NEEDS OF PATIENTS WITH MALIGNANT related to CVC lock application were observed. AND NON-MALIGNANT HAEMATOLOGICAL DISORDERS Conclusion: We can conclude that the use of a 4% sodium O. Brokka1, J. Garneau*,1, K. Bradley1 citrate lock every 24 to 72 hours in patients with multi-luminal 1Haematology Outpatient, IMPERIAL COLLEGE HEALTHCARE NHS CVCs is safe and the risk of obstruction of the lumen is TRUST, LONDON, United Kingdom relatively small - 6% and 7% per 10 applications or 10 days of using this method, respectively. Introduction: The haematology unit at Imperial College Disclosure of Interest: None Declared. 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 NP022 Haematology Day Care also incorporates a pain service for LOOKING FORWARD TO ADOLESCENTS AND YOUNG Haemoglobinopathy patients. It is planned that the full launch ADULTS SPECIFIC CARE IN SPAIN of Ambulatory Care will follow in February 2015 and will J. Ruiz*,1, P. Herreros1, S. Martı´n-Ventas1, R. Lorenzo1, V. Linde1, include Stem Cell Transplants.The T&A has 4 designated S. Aleza1, E. Trigoso2 treatment spaces and is staffed by experienced haematology 1Oncohematology and BMT Unit, Nin˜o Jesus Hospital Madrid, nurses who have been trained in the use of UKONS (UK Madrid, 2BMT Unit, La Fe Hospital, Valencia, Spain Oncology Nursing Society) Triage tool. Method: There are two dedicated helplines that provide rapid Introduction: In Spain the incidence of cancer in adolescents access to advice and initial assessment 24/7. This helpline is considering ages between 15 to 19 is around 450 cases. Then also used by GPs and other primary care agencies. All patients number of patients treated in our unit, Nin˜ o Jesu´s Hospital, are being assessed using UKONS assessment tool, except the Madrid, above 12 in 2013 was 28, which is around 30% of all Sickle Cell patients calling the pain service. They are assessed patients seen. Nurses detect needs that are different from using a modified and customised pain assessment tool. those of our smaller patients, we detect these different needs The patients are encouraged to seek advice via this service because we are beside patients 24 hours a day. Being rather than presenting unannounced on the unit, which concerned about this situation, we started working wiht the previously disrupted the day care service resulting in Spanish Asssociation of Adolescents and young adults with prolonged stays and poor patient experience.

S519 The pain service is designed to reduce the need for in-patients setting. They were able to make more informed judgements admission by offering rapid access to pain relief in the event of when implementing nursing care. This seems to be beneficial a mild to moderate Sickle Cell Crisis. This has proved to reduce to nurses working in the department and is an idea going the number of emergency admissions and associated pro- forward to be introduced to newly appointed nurses coming longed hospitalisation. The patients that access this service into the department. have individualised treatment protocols which enables the Conclusion: Through professional development nurses are nurse to initiate treatment on arrival. able to enjoy autonomy and quality time with patients and For the malignant haematology group the service provides with continued practice the nurse can move from novice to rapid access to advice, assessment and medical review, which competent performer. may or may not necessitate direct hospital admission. Disclosure of Interest: None Declared. Depending on the result of the initial assessment based on the UKONS tool, some patients might be asked to attend the NP025 unit for further investigation and treatment. PLERIXAFOR AS A SINGLE AGENT FOR MOBILISATION OF On arrival the patient’s health records will be available for AUTOLOGOUS HAEMATOPOIETIC PROGENITOR CELLS AND reference and a nurse assessment will be undertaken that TWO DAY PERIPHERAL BLOOD STEM CELL COLLECTION includes recording of vital signs, blood tests and cannulation. FROM A 10 YEAR OLD BOY WITH T-CELL After the initial assessment the patient will be review by the ANGIOIMMUNOBLASTIC LYMPHOMA AND A HISTORY OF departmental physician who will decide on further treatment LIVER TRANSPLANTATION options. The Triage nurse will assist with investigations and K. R. Stephen*,1, M. Gabriel2, P. Shaw2, B. Ozgur2, V. Antonenas3 promptly administer prescribed treatments to comply with 1 2 3 national guidelines for the management of sepsis. BMT/Oncology, The Children’s Hospital Westmead, BMT Results: Since the T&A unit opened we have faced the Laboratory, Westmead Hospital, Westmead, Australia challenge of increasing numbers of patients accessing the service, which was further compounded by the closure of the Introduction: The successful collection of stem cells requires hospital’s EU department September 2014. adequate mobilisation of stem cells into the peripheral blood. Conclusion: Future plans include nurses being trained in Stem cell mobilisation can occur with using 1) cytokines, 2) advanced assessment, further development of patient group chemotherapy with cytokines, with the addition of Plerixafor directives and nurse prescribers. to either option. Plerixafor is a CXCR4 chemokine antagonist Disclosure of Interest: None Declared. 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 NP024 0.24 mgs/kg alone and the subsequent two day collection NOVICE TO EXPERT – IMPROVING NURSES KNOWLEDGE using the Optia Spectra MNC procedure of Autologous HSC’s BASE BY INTERNAL ROTATION from a 10 year old boy with a history of liver transplantation – O. Brokka1, K. Logan*,1 adult split graft. Following a complicated history he was 1Haematology Outpatient, IMPERIAL COLLEGE HEALTHCARE NHS diagnosed in December 2013 with malignant T-cell mono- TRUST, LONDON, United Kingdom morphic lymphoproliferative disorder. This was treated with Cyclophosphamide in March 2014. Introduction: Nursing today has grown very complex In September 2014 the patient was referred to the BMT/ especially in acute care settings. The need for more Apheresis team here at the CHW for Autologous PBSC experienced nurses in an outpatient setting has increased collection. Due to his history of chest infiltrates with due to acuity levels as well as decreased length of mediastinal lymphadenopathy as well as lung infiltrates with hospitalisation of patients. Increased complexity and needs effusions requiring chest drainage it was decided by the team of the patient requires highly skilled and competent nurses. to use Plerixafor alone. This decision was made to not provoke Being a novice nurse can leave you with feelings of further lung infiltrates and injury with the prolonged increased inadequacy and lack of knowledge in a specific speciality white cell count associated with the minimum of 4-5 days of such as haematology. Through guidance, support and educa- GCSF for mobilisation. tion it will enhance the knowledge and capabilities of the Conclusion: The peripheral CD34 count was monitored hourly nurse therefore improving standards of care. Clinical judge- throughout the procedure from 6 hours post Plerixafor dose ment is essential for every healthcare professional. Being able until the end of the procedure each day. The total harvested to assess, plan and implement necessary nursing interventions CD34+ cells collected was 2.9x10/6/kg with the thawed can only come through experience and training of the nurse. CD34+cells=1.7x10/6/kg. Method: Haematology services at Imperial College Health This case demonstrates that it is possible to mobilise complex Care NHS Trust (ICHNT) has developed and moved forward patients with plerixafor alone. with the opening of ambulatory care and triage and Disclosure of Interest: None Declared. 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 NP026 well as knowing the up to date treatment options available. To THE RAPID NURSING INITIATION OF FIRST LINE ensure the unit was staffed by experienced and knowledge- ANTIBIOTICS FOR NEUTROPENIC PATIENTS EXPERIENCING able nurses it was decided to send nurses to the inpatient PYREXIA AND / OR SUSPECTED SEPSIS: USING PATIENT ward on internal rotation to gain a better understanding of GROUP DIRECTION (PGD) IMPROVES PATIENT OUTCOME patient’s pathways. The rotation lasted for 3 months and AND EXPERIENCE included a stay on two transplant wards encompassing both S. D. Clare1, S. Rowley1, D. Comerford1, K. White*,1, G. Walters1, autologous and allogeneic transplants. By spending several S. Thomas1, J. Derbyshire1, S. Jordan1 weeks in the wards and working with more experienced 1Haematology, University College London Hospitals NHS Foun- nurses, it ensured that the nurses were able to follow several dation Trust (UCLH), London, United Kingdom transplant patients from admission to discharge. They experienced the patients various complex treatment protocols Introduction: For every hours delay in septic patients and how the side effects of these regimes and the impact it receiving intravenous antibiotics the chances of survival had on the patient and patient state of mind. reduce by 7.6% (Kumar et al 2006). This is likely to be even Results: The nurses that took part in the internal rotation greater in the neutropenic population. A review of the time it reported increased confidence and abilities when dealing with took haematology/HSCT patients to receive first line anti- patients coming from the inpatient setting to the outpatient biotics at UCLH in London (’Spike to needle time’) for

S520 suspected neutropenic sepsis identified significant delays over relaxation of the body:n=31 (35%), well-being: n=29 (33%), and above the recommended 60 minute maximum. Delays decrease of stress:n=16 (18%), learning how to breathe: n=9 were mainly as a result of the wait for busy doctors to attend (10%), other: n=4 (4%); 95% of the P were satisfied by the the patient. While these delays often occurred at night, sessions and 81% wished to pursue them. surprisingly, delays also occurred in daytime hours. To reduce Conclusion: In a hematology department,which performs this critical period, the service developed and introduced a highly technical procedures such as allotransplantation,so- Patient Group Direction (PGD) in order for haematology nurses phrology had to be integrated progressively,as part of a global to initiate and administer the first line antibiotic of Tazobac- multi-profession cohesive project. The goal is to develop non- tum or Ceftazadine. drug-related means for a quality care,and to help the P retain Method: A pre and post intervention clinical audit of first line their well-being during a physically and mentally taxing antibiotic delivery was conducted across haematology in- therapeutic procedure. patient units. Haematology/HSCT staff were surveyed regard- Disclosure of Interest: None Declared. ing the use of PGD and their level of competency. A competency based training resource was developed and the NP028 antibiotic-PGD was mandated across the service. THE EFFICIENCY OF SINGLE-NEEDLE VERSUS DOUBLE- Results: Pre-PGD, first line antibiotics were appropriately NEEDLE DELIVERY OF EXTRACORPOREAL PHOTOPHERESIS delivered 46% of the time. (ECP) TREATMENT TO ADULT PATIENTS WITH GRAFT The nursing survey reported 80% non-PGD givers would like to VERSUS HOST DISEASE (GVHD. be trained, 85% would like to see more PGD prescribers and L. Robertson*,1, M. Foster1, T. Maher1, R. Goodgrove1, C. Swift1, 70% wanted more PGD education. One year on the average 1 1 1 1 1 st C. Rushton , J. Mayo , H. Denney , A. Alfred , P. Taylor time to 1 line antibiotic delivery has dropped to 26 minutes, 1 based on a revised target time of 30 minutes (n=200). ’Spike to Rotherham Photopheresis Unit, The Rotherham NHS Foundation Needle’ times reduced significantly and have been maintained Trust, Rotherham, United Kingdom with 100% nursing administration. Conclusion: These improvements only served to highlight Introduction: As demand for ECP increases, together with a continued delays in the delivery of 2nd line antibiotic broader eligibility, it is important to establish the most efficient (Gentimycin or Ciprofloxacin). A second PGD has subsequently method to deliver effective ECP treatment to patients with been developed for 2nd line antibiotics. To address concerns GvHD. Patient’s presenting for ECP with GvHD repeatedly of nurse prescribing of nephrotoxic antibiotics the latest PGD present a challenge to the ECP team due to poor venous includes an electronic algorithm that nurses can use to safely access resulting from previous therapies and skin changes. determine dosage. This may often result in multiple cannulation attempts on a Disclosure of Interest: None Declared. regular basis, leading to bruising, haematoma, transient pain and syncope. The insertion of a tunnelled Hickman line catheter presents alternative problems, with increased inci- NP027 dence of infective episodes and blocked catheter lumens EVALUATION OF SOPHROLOGY AS SUPPORTIVE CARE BY often resulting in the deferral of treatment. In both situations PATIENTS DURING AN HEMATOPOIETIC STEM CELL treatment delivery may be adversely affected with multiple ALLOTRANSPLANTATION alarms and extended treatment times. M. Zygar1, L. Tardieu*,1, C. Philippon1, M. Otmane Cherif1, Method: To ascertain the most efficient method of delivery of M. P. Gourin1, J. Abraham1, S. Girault1, P. Turlure1, ECP treatment, we performed a retrospective analysis of both D. Bordessoule1 single and double needle mode treatment delivery via either a 1hospital, chu limoges, Limoges, France 16G peripheral IV cannula or a tunnelled Hickman line catheter. This will consequently enable us to ensure we are Introduction: Hematopoietic stem cell(HSC) allotransplanta- fully optimising the efficiency of the Rotherham Photopheresis tion can improve the prognosis in many cases of severe Service. The retrospective study analysed 317 Photopheresis malignant hemopathy, but generally at the cost of long treatment procedures which were completed at The Rother- hospitalizations, a difficult experience for patients(P), both ham NHS Foundation Trust on adult patients with GvHD, physically and mentally. Sophrology(S) is a relaxation method during a 3 month period between 1st July 2014 and 30th that could prove interesting for those P’ care. S’s objective is to September 2014. All procedures were completed using improve the P’s well-being by focusing their attention on the Therakos Cellex Photopheresis System (Version 4.1), sensations to reinforce physical and mental comfort. Beyond allowing for both single and double-needle treatments to be any preconceived idea, the aim of our work is to have P compared. evaluate the benefits brought by S during their stay at the Results: Of 317 treatments, 250 (78.9%) procedures were hospital for an allotransplantation. completed using cannulation compared to 67 (21.1%) Method: Prospective, descriptive and analytical study of the recorded Hickman Line procedures. Median treatment times impact of S on the experience of transplanted P who have were 2hr15min in single-needle cannula (n=217, 68.4% of all benefited from a S session. Surveys (Q) elaborated by a treatments), 2hr30min in single-needle Hickman (n=45, steering committee were distributed to all consecutive P taken 13.8%), 1hr50min in double-needle cannula (n=34, 10.4%) in S, with anonymized gathering of demographic data and and 1hr55min double-needle Hickman line (n=24, 7.2%) anxiety evaluation10-points scales measured before and after treatments. The overall median treatment duration for patients care. Statistical analysis were done with Excel. treated over the 3 months was 2hr15mins. Results: Between 11/2011 and 09/2013,45 P were allotrans- Conclusion: The data collected is in agreement with the data planted with at least one S session,37/45 Q(82%) have been from Therakos, the manufacturer of the photopheresis device, completed and analyzed. Population: sex ratio 0.68,median that double needle treatment may decrease treatment time in age 56[18–68],for myeloid(76%) and lymphoid(24%) patholo- comparison to single needle treatment by approximately gies. Characteristics of allograft were geno(30%)/ pheno(70%) 30 minutes. However, out of 317 treatments, only 17.6% were donors;myeloablative(38%),non-myeloablative(62%);periph- completed in double needle mode due to problems with eral HSC graft(76%), bone marrow(14%),umbilical cord(11%). peripheral vascular access and Hickman line patency. Patient Acute GVH disease was present in 41% of the P. P knew S preference also played a role in treatment mode selection. before their disease in 43% of the cases. Duration of a S Therefore, in order to fully optimise the ECP service at The session on average:30 min in 76% of the cases with inclusion Rotherham NHS Foundation Trust, each patient should of music in 81%. Anxiety on a scale of 0 to 10 (maximum continue to be individually and holistically assessed at each anxiety) falls from 5/10 to 2/10 before and after the S session. visit to ensure optimal treatment and patient satisfaction. The benefits of S listed by the P (n=89) are,divided into Disclosure of Interest: None Declared.

S521 NP029 prevalence of medication non-adherence and to identify TRANSFUSION SURVEILLANCE OF STEM CELL potential risk factors for medication non-adherence in TRANSPLANTATION: TRACKING OF HPC INFUSION hematological-oncological patients in their home situation. L. Russo*,1, G. Cusumano1, N. Meliambro1, T. Gangemi1, Method: This is an exploratory cross sectional study, carried M. Scirto`1, M. Monorchio1, R. Avenoso1, I. Repaci1 out between February and April 2014. 472 patients were sent 1Azienda Ospedaliera Bianchi Melacrino Morelli, CTMO, Reggio questionnaires containing questions on patients’ character- Calabria, Italy istics, medication adherence, beliefs about medication, anxi- ety, depression, coping, and Quality of Life. Finally, 259 Introduction: As part of an approach aimed at risk manage- questionnaires were useful for analysis. We performed a ment in the CTMO of Reggio Calabria has been adopted and univariable analysis, followed by a multivariable analysis to implemented a quality management system that has mapped predict medication non-adherence. the diagnostic and care pathways to improve patient manage- Results: In the univariable analysis, 9 variables were found ment, catering to identify the critical issues and activities significantly related (P=o0,20) to medication non-adherence. involving more to adopt measurable indicators for monitoring In the multivariable analysis we found lower age, living alone of key processes. and insufficient social support to be significantly related One of the activities of major significance in the context of a (P=o0,10) to medication non-adherence. These three vari- ables explain 7,9% of the variance in non-adherence bone marrow transplant center is the infusion of stem cells 2 (Hemopoietic Progenitor Cell-HPC) autologous or allogeneic (R =0,079). collected after apheresis or bone marrow withdrawal. Conclusion: With this study we achieved to gain more Method: The infusion is divided into two phases with precise knowledge about the prevalence of non-adherence in responsibilities of the medical and nursing staff: nurse follows hematological-oncological patients in their home situation. the procedure, providing for the detection of vital signs pre- Despite these results it remains difficult to predict non- infusion, staging principals of emergency, the recognition of adherence. the generality of the patient and the characteristics of the Disclosure of Interest: None Declared. product to be infused. In order to share with the laboratory and handling with Transfusion Servicer (SIT) traceability of NP031 adverse events or reactions related to the infusion of HPC, was ASSESSMENT OF FATIGUE IN HEMATOPOIETIC created and shared a record called "feedback transfusion AUTOLOGOUS STEM CELL TRANSPLANT PATIENTS reaction." This form is completed by the physician in charge of L. Pomper*,1 the infusion and subsequently validated by the nurse after 24- 1 48 hours; recordings are stored by the LAB-MC CTMO, at the Clinical Hospital Merkur, Zagreb, Croatia end of the year and the report of the cellular products infusions, is transmitted to the SIT that participates in outcome Introduction: Fatigue is expected problem in hematopoietic of such assessments. autologous stem cell transplant (ASCT) patients (pts) and can Results: From 2013 to today were made 160 of autologous last for longer period after SCT. Fatigue is subjective and infusions and 76 of allogeneic cellular products. Complications individual expression that adversely affects multidimensional in relation to autologous transplants occurred in only 4 aspects of quality of life (QoL) like physical, cognitive and patients, while in the allogeneic transplants occurred in 5 emotional fatigue. Aim: to determine severity, frequency, patients. The reactions were managed with medical therapy duration and impact of fatigue on quality of life in alone and consisted of febrile reactions; in only one case was hematopoietic autologous stem cell transplant patients before, found a hypertensive episode and probably a reaction to the during and after SCT. DMSO solved with medical treatment and temporary suspen- Method: We evaluated fatigue of pts during and after ASCT sion of the infusion. with a standardized questionnaire of self-assessment (yFati- Conclusion: The implementation of a program of clinical gue symptom Inventory‘‘). The questionnaire consisted of 14 governance within the transplant route has proven to be an questions about the severity and impact of fatigue on QoL indispensable tool for the correct classification of risk manage- (min. 0 to max. 10), related to weekly (0 to7 days), daily fatigue ment. Although not currently institutionalized a phase of frequency (min.0 do max.10), and the pattern of fatigue monitoring structures related to the infusion of HPC, the frequency during the day. On level 0-10, fatigue 1-3 was adoption of a recording adapted to detect the occurrence of graduated as minor, 4-6 as middle and 7-10 severe. We’ve adverse events, was a great tool for validation of security, analyzed reports of 10 consecutive hospitalized autologous traceability and efficiency transfusion in the context of cell- SCT pts from September to November 2014. (7 MM, 2 NHL, 1 based therapies. MH). Median years was 54.5 (41-69); F:M ratio was 5:5. Disclosure of Interest: None Declared. Conditioning protocols were: HD-melphalan (7) and BEAM (3). Control group were employees of the Hematology Department. We’ve analyzed all data individually and NP030 as group. MEDICATION NON-ADHERENCE IN HEMATOLOGICAL- Results: The highest degree of fatigue and the biggest impact ONCOLOGICAL PATIENTS IN THEIR HOME SITUATION on QoL was during the hospitalization (4 and 3), as well as L. Bouwman*,1, C. M. Eeltink1, O. Visser1, J. M. Maaskant2,3 during the first 7 days after discharge (3,5 and 2,75). One 1Hematology, VU University Hospital Amsterdam, 2Department month after the discharge the level of fatigue returned closely of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical to the pre-transplant level (2) for most of the pts. Seven of ten Faculty, Academic Medical Center and University of Amsterdam, pts complained on severe fatigue during the SCT, while 3Emma Children’s Hospital, Academic Medical Center, Amster- moderate fatigue experienced one pts. During the 7 days after dam, Netherlands discharge 3 of 9 pts complained on severe fatigue, while 4 of 9 pts reported moderate fatigue. One month after discharge, Introduction: Medication non-adherence is associated with moderate fatigue experienced 3 of 6 pts. Fatigue was most poor health outcomes, and increased health care costs caused present in the first week after discharge (6 of 7 days), while by more frequent visits to doctors and frequent and longer one month after discharge was present in 5 of 7 days. The stays in hospitals. Adherence in cancer patients ranges biggest impact of fatigue on QoL was in general level of between 16% and 100%, which illustrates a serious problem. activity and normal work activity (both 5,5), one week after Although there is a lot of knowledge about medication non- discharge, but also a month after discharge (4 and 5). Level of adherence and risk factors of medication non-adherence, this fatigue was significant in all control groups except nurses issue has not been investigated in hematological-oncological employed less than a year. That fatigue was shorter and didn’t patients in their home situation. This study aims to explore the have significant impact on QoL.

S522 Conclusion: These data have shown that the fatigue is NP033 present even a month after the discharge for most of the TRANSITION TO A TOTALLY NURSE-LED BMAT SERVICE transplant pts and has negative impact on multidimensional FOR OUT PATIENTS INCREASING EFFICIENCY – IMPROVING presentation of QoL. Nurses should be aware how to recognize PATIENT EXPERIENCE the fatigue and the risk factors. The assessment should M. Glover*,1, D. Collier1 be individualized and multidimensional. Patient who is 1UCLH McMillan Cancer Centre, UCLH, London, United Kingdom informed about the fatigue, it’s impact on QoL, and education how to handle with it, has less worry and better control over Introduction: In 2010 nurses started performing some bone everyday life. We will continue prospective research with marrow aspirate and trephines (BMAT) at UCLH. Now in 2014 more pts. the nurses run a bi weekly clinic & perform most of the BMATs, Disclosure of Interest: None Declared. excluding those with sedation using Midazolam. In 2014 the Royal College of Anaesthetists updated their guidance on NP032 sedation with Midazolam requiring increased monitoring and A RETROSPECTIVE OBSERVATIONAL STUDY TO EVALUATE training so that it would not be possible to use Midazolam in THE INFECTION MANAGEMENT IN THE TRANSPLANT the nurse-led paradigm. At the same time increasing demand CENTER for the nurse-led BMAT service & pressures on bed usage meant 50% oxygen/50% nitrous oxide gas (Entonox) was L. Cappucciati*,1 on behalf of Hematology, R. Scopelliti1,D. 1 1 1 1 1 1 proposed as the alternative. We used the Donabedian (2) Petrucci , G. Pattini , C. Gozzo , S. Fava , S. Sbizzirro , R. Patras , model to help us assess the quality of our clinical care and S. Gandolfi1, L. Cavanna1, D. Vallisa1 1 identify areas for improvement under these drivers of change. Hematology, H. G. da Saliceto, Piacenza, Italy Method: Using a survey we gathered information on ‘out- comes’ to establish a baseline before changing to Entonox: 1. If Introduction: BACKGROUND The management of hospital patients receive information from the hospital prior to coming infections in the Transplant Centers has become over the years for the test. 2. How patient reported levels of pain associated more and more relevant. The involvement of the nurses as a with having a BMAT in our clinic compared with other major player in the collection of cultural tests, allows to define reported surveys. 3. If the patients overall experience was strategic choices both at diagnostic as well as at therapeutic better or worse than they expected. level. Results: 1. Most of the patients surveyed did receive PURPOSE OF REVIEW The first goal that we set as a team of information from the hospital prior to their BMAT ‘‘U.O. Ematologia e Centro Trapianti ’’ was to analyze infections 2. We looked at patients reported pain scores for everyone data of patients undergoing transplant procedures from 2012 that was surveyed 46 respondents fell into the LA only group, to 2013. The retrospective observational study is aimed at nearly 2/3rds of this group reported a pain score between 0-5 identifying the correlation between surveillance swabs and (65%). In the LA+Entonox group none of the respondents possible infection developing during the transplant reported a pain score greater than 6 procedures. 3. overall the reported pain scores from our clinic were better Method: All patients, who underwent autologous or allo- than those reported in an online poll 3.In general, most geneic transplants, upon admission were subjectedt to respondents said that the experience of attending the clinic surveillance Swabs (nasal, perianal, coproculture, skin swab was better than they had expected site central venous catheter if any). In case of Tempera- & 1 Conclusion: Conclusions The survey was useful to get a ture4=38 C, we proceeds with peripheral blood cultures ‘snapshot’ of some aspects of our BMAT service. &We did not equal to 3 samples at a distance of 30 minutes from each seek a direct comparison of pain scores between LA only and other. If the patient is a carrier of Cvc/Picc, the first blood LA+ Entonox in this instance but have obtained a base line for cultures are performed in duplicate, one sample from doing so when the new practice is embedded. &There are peripheral blood and one sample from the catheter. Coloniza- many factors other than the actual procedure that can affect a tion status is established by a positive surveillance swab. 1 patient’s perception of pain (reference); previous experiences, Infection is defined according during to T4=38 C twice. pre-procedure preparation, anxiety levels. &Most people find During the course of infection, we always run blood culture, the procedure acceptable with LA only. &In general patient while culturing of feces, urine and sputum only in case of feed back is positive and procedure associated pain is in line symptomatic patients with other reported pain scores. Results: From 2012 to 2013, 72 patients underwent transplant Disclosure of Interest: None Declared. procedures: - 24 allogenic transplants and 48 autologous ones - 11 patients among allogenic tranplantations (46%) presented NP034 colonization while 14 ones in the setting of autotransplant THE IMPACT OF EARLY DOSING OF PLERIXAFOR ON BED (29%) OCCUPANCY AND APHERESIS SLOTS - Fever with or without isolates (i.e. infection) developed in 19 M. Farrell*,1 allotransplants (80%), in 22 autotranspalnts (46%) 1BartshealthNHS Trust, London, United Kingdom - In allotransplant setting colonization predicts a risk of infection of 90% while in auto of 50% Introduction: Plerixafor is approved for stem cell mobilization - three patients had infection correlated with the isolated in patients who have Multiple Myeloma and Non Hodgkin’s swabs surveillance Lymphoma. However the administration of Plerixafor can Conclusion: In our patients, who underwent transplant prove problematic for the patient and clinicians. procedures, the evaluation of a possible colonization at the The recommended administration protocol, that is, adminis- beginning of the procedure may predict the risk of an infective tration at midnight before the scheduled harvest the following complication afterwards, although the last one may be morning necessitated admission to the inpatient ward for supported by different bacteria from the previous ones.Our surveillance of side effects. data suggest that this observation is particularly true in the This proved to be difficult in terms of the frequency of bed setting of the allo-transplants. Also the mortality appears to be shortages. A solution was required in order for Plerixafor to related to colonization status at the beginning. remain an option. However, according to our policy, when fever appears in a What we discovered was that our experience was not transplanted neutropenic patient, empirical therapy takes into uncommon and that a solution was already being practiced account the results of the previous swabs until new isolates successfully. By bringing the administration time forward from grow up. midnight to 17.00 hours, these groups reported having over- Disclosure of Interest: None Declared. come the practical barriers associated with the pharmaceutical

S523 company’s recommended dosing schedule without negative potential complexity of our patients and aids forward impact upon the harvest yield. planning. At this time, we were not aware of any other UK centre using We are also validating our acuity scoring system by asking the an altered schedule such as this but felt the evidence reported nurses to review the staffing level and asking them to propose was worthy of trial. We were able to make use of our Day unit the number of staff they feel would be adequate to deliver to administer the Plerixafor at 7pm and to observe the patient safe nursing care. Using the expert opinion of our own nurses for an hour post for any reactions. Patients could opt to go to suggest safe nursing levels is an empowering way to home or stay in the ambulatory care hostel for the night to involve nurses in the development of our service. return for Apheresis at 9am the following morning. Conclusion: This project is helping us to understand patient Method: A total no of 45 patients with Myeloma and acuity in an ambulatory care setting and we are developing an Lymphoma received the early administration of the Plerixafor evidence base to ensure nursing levels are matched to the from April 2011 to April 2013. There was an equal distribution needs of patients to ensure safe care. of male and female patients within both disease groups, Disclosure of Interest: None Declared. although patients with Lymphoma were amongst the young- est in the audit the median age remained the same for both NP036 group of patients. HOSPITALITY AS A LEAD FOR IMPROVING CARE OF Data was sourced retrospectively from patients clinical notes, PAEDIATRIC SCT PATIENTS chemotherapay diary, Apheresis diary, laboratory results, stem *,1 1 1 1 cell laboratory and admission dairy. M. Koster , H. Verweij-Baars, , H. Mekelenkamp , L. Ball ,M.de Taeye-Veldhuijzen1, W. Kollen1, A. Lankester1 This data was then collated in treatment prior to mobilisation, 1 mobilisation strategy, apheresis sessions and stem cell yeild. Paediatric Stem Cell Transplantation Unit, Leiden University Results: The study showed that 55 days of bed occupancy was Medical Centre, Leiden, Netherlands saved alomg with 49 Apheresis sessions. Two patients were admitted however due to vascular access Introduction: Hospitality is an ‘‘emotion’’ of hospital ‘‘guests’’, and the need for subsequent harvest the next day. based on experiences, some lasting only seconds. The Incidental findings also showed no difference in stem cell yeild experiences in question are of two types, namely hosting compared to standard dosing. and guest orientation. As an organisation, an ‘‘hospitable’’ Conclusion: The main reason for conducting the study was to hospital should be experienced as a warm and welcoming assess the actual impact of early administration of Plerixafor environment. Patients and their families, health care profes- on bed occupancy and Apheresis slots. sionals and all other visitors, should be treated as individuals The study showed that bed occupancy was virtually by employees using a cohesive, collaborative approach. eliminated and Apheresis slots were managed more efficiently Paediatric Stem Cell Transplantation (SCT) requires lengthy resulting in patients proceeding directly to transpant without periods of intensive treatment. The experience of hospitality is delay. There was a positive impact on the patient experience. an integral part of the care provided to children and their Disclosure of Interest: None Declared. 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 NP035 staff. IMPLEMENTING PATIENT ACUITY SCORING IN Method: As part of a general healthcare innovation plan, AMBULATORY CARE hospitality training was provided to selected staff of the T. Marler-Hausen1, M. Encinas*,1, R. Blackwood1, N. Lewin1 children’s hospital. Training was provided to managers, 1Ambulatory Care, University College Hospital London, London, physicians, nurses, secretaries, nutrition assistants and others United Kingdom who have patient contact. They were trained to be ‘‘ambassa- dors of hospitality’’ in order to motivate and inspire remaining Introduction: In our Ambulatory Care Unit we treat patients colleagues by their exemplary behaviour. Each ambassador having allogeneic and autologous transplants alongside high received 6 days of training and 3 individual coaching sessions. dose chemotherapy. Increasing numbers of patients are now Each identified ‘‘buddies’’, with whom they shared the identified as being suitable for ambulatory care and with our information and insights gained. Parents experience of service growing we decided to look closer at the acuity of our hospitality was measured before and after this staff training patients and to identify staffing levels that match the total by use of a standard questionnaire. acuity score rather than the number of patients being treated. Results: Twenty-eight parents of patients in our children’s Nationally there has been a focus to implement the Safer Care hospital completed the questionnaire before hospitality Nursing Tool (SNCT) to help wards understand the acuity training. They rated hospitality at 8.6 out of 10 and quality and dependency of their patients. However this tool has not of care provided at 8.5. Sixty-eight percent of respondents been validated in an ambulatory care setting and so we reported their expectations of hospitality had been surpassed. have adapted an acuity scoring system that was developed at Respect, helpfulness and commitment scored highest while the Cleveland Clinic Cancer Centre. This model fits closely punctuality scored lowest. Re-assessment, post training is with the nursing interventions carried out in our Ambulatory being undertaken. An increase in self-perception of staff as not Care Unit. only providing medical care but functioning as ‘‘hosts’’ to Method: We have scored our nursing interventions between patients and parents, resulting from the ambassador function level 1-4, with 1 being the lowest level, i.e. a simple IV infusion was recorded. Similarly, children’s experience of hospitality and level 4 being the highest level, i.e. a stem cell return. By was for example improved by providing them with a ‘‘teddy- calculating the total score the shift coordinator can then bear ambulance’’ allowing ‘‘acting-out’’ in play physical measure the total unit acuity against the levels of nursing. The examination and medical procedures. prospective scoring of each patient appointment allows the Conclusion: A hospitable organisation is effective in hosting nurse coordinator to anticipate potential days when the unit as well as guest orientated. Specific hospitality training of all will require more nurses; conversely it can also identify days hospital employees, independent of background, is an that are less busy and adjust staffing accordingly. Under- effective method to achieving this goal. Creating ‘‘ambassa- standing the acuity of the unit will also give us a better idea of dors’’ able to inspire and motivate colleagues facilitates rapid what our patient capacity is, and should allow us to schedule dissemination of a cultural and attitude change, intended to patients appropriately. improve the experience of patients and families. An ongoing Scoring patients both prospectively and at the end of the shift awareness of the guest’s needs and experiences is needed to allows us to identify differences and trends in our planned increase and sustain quality of care. acuity and actual acuity. This gives us further insight into the Disclosure of Interest: None Declared.

S524 NP037 tumors and relapse. An appropiate an adapted monitorization COMPARATIVE STUDY OF THE COLLECTION EFFICIENCY OF check list is necessary which will help the nurse to identify all CONTINUOUS MONONUCLEAR CELL COLLECTION (C-MNC) arising events. Finally the nurse should be able to educate SPECTRA OPTIA APHERESIS SYSTEM DEVICE VERSUS patients after the transplant in order to diagnose complica- AMICUS CELL SEPARATOR DEVICE IN MONONUCLEAR CELL tions as soon as posible as well as to contribute to COLLECTION (A-MNC) improvement quality care in administering treatments by M. GUMOGDA*,1, H. KEANE1, A. JUMAH1 following standard operating protocols. 1Haematology, University College London Hospital NHS Method: In order to select variables to be analyzed a Foundation Trust, LONDON, United Kingdom literatura review: PubMed, CINAHL, LILACS, CUIDEN. In this project the NANDA, NIC and NOC taxonomy were used as Introduction: AIM: The aim of the study is to determine the well as, the the Standard Operating Procedures Manual collection efficiency of Continuous Mononuclear Cell Collec- of our transplant Unit and and the quality standards set by tion (C-MNC) Spectra Optia Apheresis System versus Amicus JACIE. Cell Separator Device in Mononuclear Cell Collection (MNC) in Results: This nurse plan is been aplied to our out patient clinic. the Autologous patient population at the University College In our Unit we performed on 2013 131 transplants (70 London Hospital (UCLH). allogeneic, related and unrelated and 61 autologous). Median Method: METHODS: Apheresis harvest records and stem cell number of allogeneic patients at the out patient clinic per day laboratory data were analysed retrospectively from 20 is 17.5. Patients are followed always after transplant at the randomly selected autologous patients on C-MNC and 20 Unit. autologous patients undergoing Amicus MNC Collection. The Conclusion: In conclusion nurse has a crucial role in the two cohorts were matched in terms of diagnosis, and the Pre outpatient care after a hematopoietic stem cell transplanta- and post peripheral white blood cell count, duration of MNC tion. Standardizing the nurse activity through a protocolized procedure and CD34% yield/blood volume processed were work plan, helps in reaching effective and quality cares. The compared and analysed. training of nurses in this activity and the characteristics of Results: RESULTS: these complex patients allows it to quickly identify problems There were a total of 40 patients reviewed with 20 patients in and to coordinate a multidisciplinary team in the early each arm, they had a median age of 57 years (range of diagnosis and the treatment. In turn this helps decreasing 25-71yrs) with 14 Non-Hodgkin Lymphoma (NHL) and 26 the time from when symptoms occur until they are overcome, Myeloma patients in total. The priming regimens were varied including an improvent in the quality of care and the patients across the different patient subsets however this is reflected in life quality. both patient populations. All patients underwent a 2.5 total Disclosure of Interest: None Declared. blood volume stem cell harvest. NP039 THE COMBINED TRANSPLANT COORDINATOR AND CASE CD34 CE2 MANAGER MODEL IN HEMATOPOIETIC STEM CELL TRANSPLANTATION Optia CMNC Amicus M. Baydoun*,1, R. Nehme 1, S. Okaily 1, A. Ali1, R. Kawas1, All (n=20) All (n=20) A. Bazarbachi 1 Median 49.88 35.35 1American University of Beirut Medical Center, Beirut, Lebanon Min / Max 33.71/79.58 15.8/72.7 Mean±SD 50.19±11.22 37.04±14.8 Introduction: The modern healthcare recognizes comprehen- T-Test2 P=0.003771 sive care management as a crucial approach for excellence. Considering the complexity of care required for Hematopoietic Stem Cell Transplantation (HSCT) patients, we believe multiple By conventional criteria, this difference is considered to be resources should be placed to meet patients’ needs through- statistically significant. T-Test2=one sample t test comparing out the transplant phases. The transplant coordinator at our CD34% yield / blood volumes processed on 2.5 TBV MNC center has been responsible for preparing patients for harvest on OPTIA CMNC or Amicus cell separators. admission and follow-up after discharge. However, we noticed Conclusion: CONCLUSION: Both the Amicus MNC and OPTIA that extra resources are needed to meet patients’ needs. Thus, CMNC programme are safe and effective devices in harvesting we aimed to adopt a staffing model to manage patients’ care mononuclear cells. However, the data indicates that the throughout the transplant phases. Amicus was not as efficient as the OPTIA MNC programme for Method: To achieve our objective, a staffing model composed CD34+ collections. of Combined Transplant Coordinator and Case Manager Disclosure of Interest: None Declared. (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 NP038 comprehensive care management and meet patients’ needs. NURSING PROCEDURES IN THE OUTPATIENT UNIT AFTER To assess the impact of the model, in September 2014, a HEMATOPOIETIC STEM CELL TRANSPLANTATION survey was distributed to 11 out of 13 nurses working in the M. Garcia*,1, M. Salinero Peral2, B. Rodriguez1, D. Caballero HSCT unit; two nurses were excluded because they were newly Barrigon1, 3, L. Vazquez1,E.Pe´rez Lopez1, O. Lopez Godino1, hired. The survey included five open-ended questions to L. Lo´pez Corral1, C. Can˜izo*1, M. Gonzalez Dı´az1 explore nurses’ perceptions regarding the effect of the model 1Stem cell transplantation unit, Hospital Clı´nico de Salamanca, on nurses’ satisfaction and patients’ outcomes. 2Stem cell transplantation unit, Hospital Clinico de Salamanca, Results: Five nurses returned back the questionnaire. The 3Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain other 6 nurses did not respond due to either time inconvenience or being on leave. The most three recurrent Introduction: Hematopoyetic stem cell transplant outpatient answers were as follows: care requires a nurse activity adapted to the unique - All nurses expressed satisfaction with the model and characteristics of these patients. The nurse priority consulting considered it as an effective strategy to meet patients’ needs. receiving ambulatory patients should have a training and a For example, a nurse mentioned that the model made them work plan developed in order to permit the nursing process. more comfortable in solving clinical problems. Another nurse This program will be able to detect early GVHD, infections, said that the model covers patients’ needs throughout the other acute, chronic, long term complications, secondary transplant phases.

S525 - Four nurses expressed that the model enhanced a better NP041 patient education process, and made the discharge planning OUT OF HOURS OPEN ACESS TO CARE DURING more comprehensive and standardized. HAEMATOPOIETIC STEM CELL TRANSPLANT RECOVERY - A common perception among all participants is that the M. Rowe*,1, S. Dodd1 model has improved operational efficiency and reflected 1NHS, Newcastle upon-Tyne, United Kingdom positively on patients’ outcomes. A nurse said that both the transplant coordinator and case manager roles complement Introduction: Children are referred to Newcastle for HSCT each other to improve patients’ outcomes. Another nurse from a wide geographical area within the UK and overseas. mentioned that the coordinator and case manager assist This distance can delay discharge home due to the ability of nurses through facilitating clinical activities and speeding work non specialist teams to manage transplant related concerns. processes. Our service uses a number of local Trust rented properties to Conclusion: The CTCCM model at the HSCT unit was accommodate the child and family allowing the child to leave successfully implemented, which reflected positively on hospital and enabling the parents to regain confidence and nurses’ satisfaction and patients’ care. The model has offered control of their child’s care. Appointments for review on our a comprehensive care delivery for HSCT patients throughout day unit are given for daily or twice weekly visits. the transplant process as follows: preparing for admission, During the ongoing process of recovery, patients commonly patient education, discharge planning, and periodic follow-up self refer to our inpatient unit after the day unit closes with after discharge. HSCT centers should always consider revising acute pyrexia, naso-gastric tube re-insertion, acute illness or staffing resources to meet the complex needs of HSCT parental anxiety. This increases the workload on the inpatient population throughout the continuum of care. service and the child and family may be required to wait to Disclosure of Interest: None Declared. have assessment and intervention. Staff have voiced concerns that they do not have the NP040 resources to adequately respond to children who may arrive PATIENT EDUCATION IN HAEMATOPOIETIC STEM CELL with little warning in a vulnerable condition. TRANSPLANTATION Method: A new system of Open Access has been introduced M. Baydoun*,1, A. Ali 1, S. Okaily1, R. Nehme1, R. Kawas1, in partnership with the Accident and Emergency Department. A. Bazarbachi1 The families are given a clear pathway and a passport 1American University of Beirut Medical Center, Beirut, Lebanon document which outlines active medical issues and identifies the child’s key workers. Introduction: Patient education is a critical part of the process Families are assured that the child will have direct access to a of Hematopoietic Stem Cell Transplantation (HSCT). The HSCT cubicle and that medical and nursing staff have been informed team at the American University of Beirut Medical Center of the child’s needs. (AUBMC) is a multidisciplinary group of professionals devoted Early feedback and outcomes suggest that the Open Access to providing excellence in patient care. At our center, it was Passport system has had a positive outcome for patients and noticed that the patient education process is often fragmen- families. The treatment pathway is prompt and the families ted, unstandardized and unregulated among providers. Thus, know exactly what to do if they require any hospital care. The we aimed to achieve a patient education process that is inpatient staff are now able to focus on delivering high standardized, comprehensive, and addresses patients’ needs standards of care to their inpatients without the additional within a multidisciplinary approach. responsibility of out of hours patient attendance. Method: A task team was formed from the HSCT multi- Conclusion: This presentation will highlight pressures on the disciplinary team to identify gaps in the current patient service and how this system has streamlined the pathway of education process and recommend improvements care. We will present our documentation and describe patient accordingly. experiences since the introduction of this service. Results: The group met five times and conducted an Disclosure of Interest: None Declared. evaluation of the status quo. The group broke down the problems to two important factors. First, the absence of NP042 standardized patient education materials, which leads to UNDERSTANDING AND MANAGEMENT OF DISEASE SPECIFIC inaccurate or discrepant information provided to HSCT COMPLICATIONS BY HSCT NURSES IN MALIGNANT patients. Second, the current process does not take into INFANTILE OSTEOPETROSIS DURING THE COURSE OF HSCT consideration all the transplant aspects that HSCT patients N. Cetin*,1, F. Kırac1,E.Ku¨cu¨kyavuz1, B. Tavil1, F. V. Okur1, experience, including preparation for the transplant, the B. Kus¸konmaz1, D. Uckan-Çetinkaya1 admission process, the delivery of health care services, 1Pediatric Hematology- BMT Unit, Hacettepe University Faculty of environmental precautions, discharge planning and follow- Medicine, Ankara, Turkey up. Therefore, to optimize the patient education process, the multidisciplinary team devised a new patient education Introduction: Malignant infantile osteopetrosis (MIOP) is a rare material that incorporates all the transplant phases and inherited disease caused by a defect in osteoclast differentiation provides prospective HSCT recipients with standardized, and function which results in defective bone resorption. It might reliable, and comprehensive information. show rapid progression and be lethal if left untreated in early Conclusion: The current project suggests that HSCT centers infancy. HSCT is the only curative treatment option which should continuously revise work processes to meet the maintains donor derived osteoclast function. These children complex needs of HSCT recipients. Moreover, addressing usually have a complicated course of transplantation. Engraft- patients’ problems in a multidisciplinary approach is always ment failure, VOD, pulmonary hypertension, respiratory pro- the key for providing high quality care to patients. At our blems and hypercalcemia are the most important complications center, we were successfully able to modify the patient seen in patients with MIOP. Nursing care and management of education process through our commitment to excellence in disease specific complications are of critical importance for these patients care and multidisciplinary collaboration. From our children suffering from multiple fractures, agitation, mucositis view, this will enhance better patients’ outcomes and quality and malnutrition. Supporting parents and helping them to of care. understand the disease and teach them how to deal with its Disclosure of Interest: None Declared. 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.

S526 [NP042] Results:

Problem No. of patients Management

Fractures/bone 9/16 Immobilization and pain management Prophylactic measures deformity for handling patients and especially during invasive procedures Upper airway 12/16 Mucositis care and prevention and mucosal edema and nasal obstruction, other 7/16 care respiratory problems Careful monitarization of fluid balance, avoidance of fluid Pulmonary hypertension retention/overload, medical treatment (ilioprost, sildenafil,y) Growth retardation 12/16 Nutritional support, long term follow up Nutritional problems 11/16 Prevention of aspiration during feeding NG/OG feeding tube placement or TPN support Loss of vision 14/16 (unresponsive VEP testing) Early HSCT Family support, education, specific discharge instructions Hypercalcemia 3/16 (only the ones needed Close follow up of serum calcium levels after engraftment therapeutic intervention) Hydration, diuretics, steroids, calcitonin, biphosphanates Neurological findings 15/16(hypocalcemic convulsions, Symptom-specific treatment hydrocephaly, cranial nerve deficits,y) Bone marrow failure 11/16 General measures for management of cytopenias Venoocclusive disease 9/16 Avoidance of fluid overload, diuretics, defibrotide as prophylaxis or management,

Conclusion: In HSCT practice most of the guidelines involve NP043 general measures and there is a need for development of NURSE TRAINING PROGRAM ADJUSTED FOR PEDIATRIC disease-specific, patient-oriented approaches for pediatric HSCT FOCUSING ON SPECIAL ISSUES IN INHERITED DISEASES BMT, particularly for inherited diseases. Training pediatric N. Cetin*,1, F. Kırac1,F.O¨ zenc1, F. V. Okur1, B. Kus¸konmaz1, nurses for disease-related specific problems carries great D. Uckan-Cetinkaya1 importance for optimal treatment of these patients and also 1Pediatric Hematology/BMT Unit, Hacettepe University Faculty of for family support. Medicine, Ankara, Turkey Disclosure of Interest: None Declared. Introduction: Nursing management in pediatric HSCT neces- sitates acquisition and maintenance of current knowledge and competency in infant and child care. Based on the hetero- geneity 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 RECOMMENDATION/EVALUATION

CHILDHOOD Infections Introduction of isolation rules (VRE) SPECIFIC Assessment of growth and Growth charts, follow-up by endocrinologist endocrinopathies Lansky score Performance scale in children Spesific scales for children Pain assessment and control Encouragement of oral intake by behavioral methods, enteral/parenteral Evaluation of nutrional status feeding), spesific diets Assessment and management Spesific measures for oral care of mucositis Close follow up for fluid overload HSC infusion Size, stabilization, dislocation Central venous catheter Family education, school attendance, isolation problems Social Ethical issues and specific procedures, long term effects of G-CSF, Pediatric donors absence of carier state and/or disease DISEASESPECIFIC Thalassemia Prior cheletion therapy, ferritin level, tissue/organ damage due to iron Fanconi anemia overload, high risk for VOD Severe immune deficiency Multiple congenital anomalies, increased risk for toxic effects of disorders conditioning regimen, higher malignacy risk Neurological (leukodystrophy) Some patients transplanted without conditioning regimen MIOP 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

S527 Method: Here, nursing training program used at Hacettepe ages undergoing stem cell transplants. Protocols and treat- University Pediatric BMT Unit are summarized. The details are ments administered during and after transplantation and in listed in table I. the treatment of complications may cause disturbances in Conclusion: HSCT practice guidelines mostly involve general glucose levels. transplantation measures for adults. Establishment of disease- Malglycemia, which refers to blood-sugar disorders ranging specific, patient-oriented approaches in pediatric BMT practice from hyperglycemia to hypoglycemia, may disrupt the is needed. Considering critical role of nurses in HSCT team, transplantation process and cause an increase in the incidents improving their knowledge regarding childhood specific of cardiologic and nephrologic disorders. Several clinical topics and their acqusition of practical skills will increase the conditions related to transplants can contribute to malglyce- success and improve the quality of life of children undergone mia including infection, sepsis, neutropenia, mucositis, graft- HSCT. The practical points listed here are intended to versus-host disease, high-dose steroid therapy and feeding contribute to training of pediatric HSCT nurses and optimiza- with TPN. tion of practices. At Sheba we work under institutional protocols in order to Disclosure of Interest: None Declared. control diabetes. While they are standardized for all depart- ments, our department requires unique protocols that adapt NP044 to the transplant process. CARE CHALLENGE AND PSYCHO-SOCIAL SUPPORT IN A As a result, it became necessary to increase the awareness REFUGEE CHILD UNDERGOING BONE MARROW among the staff, study the subject in depth, consider TRANSPLANTATION appropriate treatment alternatives for transplant patients, adopt the selected treatment methods and prepare an N. Gu¨ltekin Bag˘la*,1,A.Gu¨zel1,H.O¨ zer1, S. Kaya1, K. Yalc¸ın1, 1 appropriate treatment protocol. A. Ku¨pesiz Aim: To achieve improvement in the short and long term 1 ˙ ˙ ˙ AKDENIZ UNIVERSITY, ANTALYA, Turkey outcomes of treatment via mapping and monitoring diabetic patients, improving patient and staff training and developing Introduction: Turkey is facing a major increase in the number treatment protocols appropriate for the combination of of Syrian people seeking asylum, of whom approximately a diabetes and bone marrow transplant. quarter are children.The available literature shows consistently Method: Patients with diabetes, on TPN and/or receiving increased levels of psychological morbidity among refugee steroid treatment were identified and mapped by a nurse children, especially post-traumatic stress disorder, depression, specializing in diabetes, who followed them and conducted and anxiety disorders. We report a refugee child undergoing checkups based on a set of specified parameters. bone marrow transplantation and his care complexity. Results: In 2014, 48 patients with diabetes were treated at The Method: We describe here a 15 year AML refugee boy from Bone Marrow Transplantation Department, which accounted Syria, diagnosed one years ago. He could not complete his for 22% of all transplant recipients that year. The percentage treatment because of the war in Syria. He came to Turkey with of glucose measurements above 200 mg/dL after these his family. He recieved induction therapy in a border city, interventions were introduced decreased from 57% in the S¸anlıurfa. Then he was refered to our hospital for BMT. The first quarter to 16% in the third quarter. The documentation of clinical protocol was: Busulfan and Cyclophosphamide. GVHD glucose measurement increased from 83% in the first quarter prophylaxis: CyA and MTX. Donor was matched HLA related to 100% in the third quarter. The percentage of patients sibling. Engraftment was 100% donor’s 20 days after BMT. Nurses educated on a low-sugar diet increased from 90% to 98% and provided patient with direct care, monitoring and hospitalization. the percentage of tests performed on diabetic feet increased Results: Three days after BMT he started to present from 88% to 100%. complications, such as fever, hematuria, hematemesis, diar- Conclusion: A team that is managed by a nurse with clinical rhoea, cardiac tamponade, renal failure. I would like to say that knowledge of diabetes performing closer monitoring, training the treatment got more complex with the complications and checkups of glucose levels according to a suitable related to be a refugee. As a refugee, he and his mother try to protocol contributes to the improvement of the treatment cope with complications of BMT, post-traumatic stress disorder results among transplant patients. related to war and communication problems in a new country. Disclosure of Interest: None Declared. 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. NP046 Sleep disorders, eating disorder, suicide ideation were the NURSING STUDIES ABOUT CENTRAL VENOUS CATHETER psychological complications we bring up against. To cope with CARE: A LITERATURE REVIEW AND RECOMMENDATIONS this complications, we made a great teamwork with pediatric FOR CLINICAL PRACTICE psychiatry and nutritionists. N. Kalender*,1, N. Tosun1 Conclusion: In our case, the patient had several BMT- 1School of Nursing, Gulhane Military Medical academy, Kec¸io¨ren, complications and psychological problems that only experi- Turkey enced professionals can handle. Refugee children have several problems and a complex treatment like HSCT makes them Introduction: In 2003, The American society of Clinical harder but we try to do best for him. Oncology, and in 2004, The Oncology Nursing Society Disclosure of Interest: None Declared. published guidelines for nurses who are the primary responsibles for central venous catheter (CVC) care and contunity. These guidelines present all the relevant evidence NP045 on issues such as catheter dressing, maintenance of catheter UNIQUE PROTOCOLS AND A TEAM LED BY A SPECIALIZED flow, obtaining blood samples, management of complications, NURSE TO IMPROVE and prevention of catheter-associated thrombus. Evidence- TREATMENT OUTCOMES AMONG BONE MARROW TRANSPLANT based studies performed by nurses on CVC care are limited in PATIENTS WITH DIABETES: A NEW APPROACH *,1 1 1 number. The aim of this study was to systematically evaluate N. Atar , S. Torati , I. Sabah the literature data about nurses’ responsibilities on each step

1 of the care of CVC. The study also aimed at determining the The Bone Marrow Transplantation Department, Sheba gaps in the relevant data or issues to be re-evaluated, which Medical Center, Ramat Gan, Israel could be helpful in future studies. Method: Primary research evidence published in English Introduction: Diabetes is a medical problem that may cause between 2007-2012 obtained using pre-defined search criteria morbidity and mortality in over 18% of cancer patients of all in electronic databases MEDLINE, PubMed and SCIENCE

S528 DIRECT. All of the clinical environment such as oncology, pain relief. Also, PCA effectiveness was enhanced by haematology or Intensive Care Unit and patients were psychological factor of the patient being able to control the included in the study. Pediatric patients and patients who pain. have port catheter were excluded. Papers on CVC and nursing Conclusion: Tramadol is effective and safe analgesic for care that were in the English language were included in the children and teenagers with OM stage 2-3 after PCT and study. The Randomized Controlled Trials (RCTs) the Non- hematopoietic stem cell transplantation. PCA with tramadol randomized Controlled Trials (non-RCTs) and the Quasi has several advantages such as customized dosage optimiza- Experimental Studies (SES) comprised the systematically tion, sleep improvement, anxiety relief, that improves quality studied material. Nine articles met the inclusion criteria. of life. Results: Three prominent themes were identified in the Disclosure of Interest: None Declared. literature related to: (1) Measures to Prevent Infection (2) Infection Control of central venous catheter, Results, and Other NP048 Findings (3) Applications to Sustain Catheter Flow. USE OF PERIPHERALLY INSERTED CENTRAL CATHETERS Conclusion: According to the results of this study, nursing (PICC LINES) FOR THE HOME CARE AFTER ALLOGENEIC studies on the some subjects are either absent or inadequate HEMATOPOIETIC STEM CELLS TRANSPLANTATION such as the type of dressings used in catheter-dressing and 1 *,1 1 1 the frequency of dressing change, the type of lock solution M. Gire , P. MARTINEZ , C. TRANCHAND , E. TAVERNIER , D. GUYOTAT1, J. CORNILLON1 used. In view of these facts, nurses are required to carry out 1 high-quality evidence-based Randomised Controlled Trials. Institut de cancerologie Lucien Neuwirth, st Priest en Jarez, Disclosure of Interest: None Declared. France Introduction: Long-term venous access devices are often NP047 used for outpatient care after allogeneic hematopoietic stem TRAMADOL AS PAIN RELIEVER IN CHILDREN AND cells transplantation (HSCT). Tunneled catheters are generally TEENAGERS WITH ORAL MUCOSITIS AFTER used in this setting. However, infections and thrombosis are HEMATOPOIETIC STEM CELL TRANSPLANTATION recurrent complications. Currently, there is little data in the O. Ivanova*,1, E. Marina1, G. Julia1, G. Ekaterina1, P. Ivan1, literature on the use of PICC lines after transplantation, M. Bogomolny1, L. Zubarovskaya1, B. Afanasyev1 particularly in terms of safety. We have implemented in our 1First Pavlov State Medical University of St. Petersburg, unit a systematic use of PICC lines for home care after HSCT. Saint-Petersburg, Russian Federation We present here preliminary results of this procedure. Method: This is a prospective single-center study including all Introduction: Oral mucositis (OM) is one of the most frequent patients (N=33) who had an allogeneic HSCT between January complications after polychemotherapy (PCT). It manifests with and September 2014. A subclavian (SC) non-tunneled central pain that varies in intensity. In our hospital a common practice venous catheter was installed during their initial period of is to indicate tramadol which mechanism of action is hospitalization in the protected area in 31 patients. 2 patients characterized by the presence of opioid and nonopioid were already equipped with a PICC line because of previous components.According to guidelines of World Institute of treatments. 22 patients had a single lumen PICC line inserted Pain (FIPP WIP, USA), European Pain Federation (EFIC), in our at discharge from our unit and after neutrophil recovery. The study we used Patient Controlled Analgesia (PCA) which installation was performed under ultrasound guidance. The represents an effective alternative to other methods of catheter care was performed through a private home service anesthesia. Nowadays PCA with tramadol in children and with prior training of nurses. 9 patients had no PICC line teenagers needs thorough investigation. inserted because a Portacaths device was already in place Method: Sixty-eight patients (5-18 years old, median 10) with (N=6), early death (1), multiple thrombosis (1) or lack of stage 2-3 OM in the early posttransplantation period were indication (1). These patients were excluded from the study. divided in two groups. Group 1 comprised of 36 patients with Donors were unrelated for 54% of transplants. Conditioning continuous intravenous tramadol infusion at the rate of 4- was reduced in 67%. Data were collected daily between the 8 mg/kg/day. Group 2 comprised of 32 patients with PCA first day of conditioning and the date of PICC line removal. parameters consisting of basis 0.1 mg/kg/h, bolus 0.125 mg/kg Results: For 20 patients, the SC line was removed at the end of and 30 minutes lockout. Study methods included visual the first period of hospitalization. Only 2 patients had their line analogue scale (VAS), questionary for nurses that helped removed prematurely during hospitalization. The cause was indicate the most appropriate approach for analgesia, that inflammatory exit site for one and broken tip for the second. In optimize nurse care. 4 of 24 patients, the PICC line was only used for weekly blood Results: Experimental data analysis showed that in both controls. In 20 patients, the PICC line was used at home, for groups pain intensity according to VAS varied from 5 to 10 hydration (14 patients), antibiotic administration (5), human scores (median 7) prior to initiation of pain relief therapy. The immunoglobulin infusion (3), transfusions (5), extracorporeal number of night awakenings varied from 0 to 5 with median photophoresis (1). Hydration at home was performed for an number of 2. In group 1 pain intensity decreased to 2-5 VAS average of 29 days. PICC lines were also used in 5 patients scores in 28 patients (77.8). The number of night awakenings after readmission. The catheter was removed from 16 patients associated with pain decreased to 0-3. Average duration of after an average of 71 days. The reasons for removal were lack tramadol course was 14 days and average tramadol dosage of utility (N=6), patient’s wish (3), suspicion of infection (3), was 7 mg/kg/day. Adequate pain relief was not achieved in 8 bleeding at puncture site (1), accidental removal (1) and death (22.2%) patients and morphine was indicated as a next step of (2). The 8 remaining patients still had their catheter at the time WHO analgesic ladder. Adverse events were not registered in of evaluation. During this period of study, no infection or this group. In group 2 pain intensity decreased to 1-4 VAS thrombosis was finally described. scores in 29 patients (90.6%). The number of night awakenings Conclusion: These preliminary results suggest that the associated with pain decreased to 0-1. Two patients (6.3%) systematic use of PICC line as long-term venous access for could not achieve adequate pain relief and morphine was home care does not cause significant infectious or thrombotic used as further therapy. One patient experienced visual events despite frequent and often prolonged use. However, hallucinations (3,1%). Other adverse events were not regis- more patients are needed to confirm these first impressions. tered in this group. Average duration of tramadol course was Disclosure of Interest: None Declared. 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 asso- ciated with analgesia-free period reduction, stable and rapid

S529 NP049 help in many clinical situations, particularly where commu- THE DEVELOPMENT OF AN IN HOUSE TRANSPLANT STUDY nication is difficult due to illness, injury or disability. Patients DAY receiving hematopoietic stem cell transplantation can experi- R. Clout*,1, A. Leather1, R. Angelica1, J. Tomlins1, J. Murray 1, ence increased distress related to both the treatment intensity D. Kaye1, D. Sweeney1 and isolation in protected environment. If not addressed, this 1Haemato Oncology, THE CHRISTIE HOSPITAL, Manchester, emotional distress can lead to anxiety, depression, and post- United Kingdom traumatic stress disorder. The purpose of this study is to analyze the efficacy of music therapy in promoting patients’ Introduction: The Christie Transplantation Study Day was psychological adjustment during hospitalization towards both developed to offer a standardised curriculum of education and a quantitative and qualitative analysis. practice within the field of haematopoietic transplant patient Method: From September 2013 to September 2014 8 care. The day contributes to assurance of adequate nurse patients undergoing hematopoietic stem cell transplantation training required for JACIE accreditation. Nurses also need to were offered music therapy as part of the supportive work to the standards set out by the NMC, including care. During their hospitalization all patients received music continued professional development. The aim is to develop therapy treatment once a week for one month. Before and and maintain nurses’ skills and aid in professional develop- after this treatment patients were administered standardized ment to ensure that nursing staff receive appropriate questionnaires to investigate their level of distress [Psycholo- induction and training. This will contribute to fulfilling their gical Distress Inventory PDI (Morasso, 1996)], anxiety and role to in caring for this diverse and complex patient group. depression [Hospital Anxiety and Depression Scale HADS Method: This day has been repeated on five occasions to (Zigmond & Snaith 1983)]. Themes reported by all patients ensure a good attendance of staff. Attendance is open to after listening to the music during all the 4 sessions were also inpatient haematology and transplant, day unit haematology registered. and transplant, MAU, Critical Care and The Critical Outreach Results: While quantitative data reported no statistically staff. The agenda covered all the key training requirements set relevant effects (Po0.05) on the reduction of anxiety, out in the JACIE standards. All the subjects were covered by depression and distress, qualitative data referred to the key personnel utilising the transplant team Clinical Nurse themes reported by the patients showed a better psycholo- Specialists, Nurse Clinicians, Haematology Pharmacist, Dieti- gical adjustment: while at the beginning of the music therapy cian, Stem Cell Laboratory Manager, Quality Manager and intervention patients described images referred to nature and Clinical Practice Facilitator. memories of the past where they were alone or played passive Results: Total number overall attendance - 60. The numbers of role, then they reported images of themselves prone to share staff attending ranged from 8-17. Inpatient haematology and their disease experience. transplant staff 34/47 (72%). Private patient inpatient haema- Conclusion: This positive result encourages further research in tology and transplant staff- 8/10 (88%). Rest of the trust - 18. the application of music therapy in onco-hematological Staff were asked two simple questions How did you find the settings. The analysis of patients’ themes, emerged during relevance of the sessions arranged? How did you find the level the sessions, suggests that music therapy treatment promotes of teaching? Comments for each session were asked. The an elaboration process and reflection about the illness feedback was positive overall, examples of comments were: condition and represents a safe space suitable for sharing very interesting and educational, previous knowledge and their experiences. skills updated and discussions enjoyble, overall a good study Disclosure of Interest: None Declared. day, sessions were engaging and thought provoking, best study day in ages, really good refresher, mini workshops fun NP051 and useful, very informative, enjoyed the day, a lot more Abstract Withdrawn 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 NP052 there are people with not much haematology experience. THE IMPACT OF THE CHILDREN’S AND YOUNG PEOPLE Conclusion: Overall the attendance of the days has been AUDIT POLICY TOOL (CYPAPT) ON CHILD AND FAMILY good. The feedback has also been positive and the day has CENTRED CARE (CFCC) IN THE PAEDIATRIC STEM CELL been well received by members if the nursing team.The plan TRANSPLANT UNIT (SCT) AT THE GIANNINA GASLINI for next year is run the day twice to cover any staff that INSTITUTE (IT) haven’t been able to attend this year, including new staff. The *,1,2 2 3 3 day will also be encouraged with outlying wards with a focus S. Calza , A. Bagnasco , P. Petralia , M. L. Sperlinga , L. Fornoni3, S. Del Buono3, U. Rosati3, G. Aleo2, L. Sasso2 on critical care and the outreach team. The clinical skills rooms 1 have also been booked to set up additional days. These will Paediatric Haematology and Oncology, Giannina Gaslini Institute, 2Department of Health Science, University of Genoa, focus on practical skill sessions some of which require regular 3 updates such as stem cell thawing, antiobiotics PGDs. These Giannina Gaslini Institute, Genoa, Italy days will follow a similar format to the existing training, ensuring a standarised approach to nurse education. Introduction: The ‘‘Children’s and Young People Audit Policy Disclosure of Interest: None Declared. 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 NP050 cultural validation, the Italian version of this tool was used to MUSIC THERAPY IN THE MANAGEMENT OF PATIENTS measure and improve the quality of Child and Family Centred UNDERGOING TO HEMATOPOIETIC STEM CELL Care (CFCC) at the Giannina Gaslini Institute in Genoa. TRANSPLANTATION: A PILOT STUDY The aim of the study is to investigate the perception health S. Giuliani*,1, C. Facchini2, M. Bernardi2, C. Matteo2, L. Sarno1, professionals have of CFCC, change and evaluate the quality of F. Ciceri2 care using the Children’s and Young People Audit Policy Tool 1Health Clinical Psychology Unit, 2Hematology and Bone marrow in the SCT Unit in Gaslini Institute in Genoa (IT). transplantation unit, IRCCS San Raffaele Scientific Institute, Method: A descriptive, monocentric study with a mixed- Milan, Italy method design, including multi-professional Focus groups and semi-structured interviews Introduction: Music therapy is an established clinical dis- Results: Through the Audit Tool, health professionals reported cipline which is widely used to help people whose lives have several differences with the local system, such as the type of been affected by injury, illness or disability. Music therapy can facilities, the organization, types of hospital staff, and

S530 legislation. SCT staff perceived an improvement in child and related blood stream infection (CRBSI) and no cases of family engagement, the engagement of adolescents, pain thrombosis or occlusion were found. This low rate of management, infection control, communication negotiation of complications also found in other recent studies seems to care, higher level trust and respect especially for nurses. Of be related to the improvements in the insertion technique and particular interest, the positive impact on therapeutic educa- in the development and strict observance of catheter care and tion in the Unit. maintenance protocols.Yet, the need to remove the PICC in Conclusion: CFCC can profoundly change and improve the order to insert a central venous access with more lumens is a current way of providing care to children, and in particular fact we can’t ignore because it means a 20% of our sample. paediatric nurses are in the key position to assess compliance The kind of treatment, its duration and the patient character- with CFCC using the Children’s and Young People Audit Policy istics should be carefully considered before choosing a central Tool. Education sessions for health professionals will facilitate venous access in order to avoid unnecessary insertions. compliance with CFCC. In the light of our experience, we Disclosure of Interest: None Declared. envisage to spread CFCC also to other SCT Units in Italy, both to improve benchmarking and encourage further research in NP054 this field. THE RETURN HOME AFTER A CHILDS’ HEMATOPOETIC References STEM CELL TRANSPLANTATION. THE EXPERIENCES AND 1. Coles L, Glasper EA, Battrick C, Brown S. (2010) Assessing COMMITMENTS PARENTS FACE, THE INFLUENCING NHS trust’s compliance with child health policy standard. FACTORS AND THEIR RESULTING NEEDS British Journal of Nursing 19; 1218-1225 *,1 2 1 3 1. Franck LS et al. (2012) Parental involvement in Neonatal V. Van de Velde , F. Mussche , C. Dhooge , M. Grypdonck 1Pediatric Hemato-Oncology and HSCT, 2Specialized Pediatric pain Management: An empirical and conceptual update. 3 Journal of Nursing Scholarship 44:1; 45-54. Unit, University Hospital Ghent, Department of Public Health, 1. Mikkelsen G, Frederiksen K. (2011) Family centred care of University Ghent, Ghent, Belgium children in hospital - a concept analysis. Journal of Advanced Nursing 67(5); 1152–1162. Introduction: Hematopoetic stem cell transplantation (HSCT) Disclosure of Interest: None Declared. 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 NP053 after the intensive inpatient period. SUITABILITY OF THE PERIPHERALLY INSERTED CENTRAL The objective of this study is to understand how parents CATHETER IN THE MANAGEMENT OF THE experience the post transplant period of their child, to get an HEMATOLOGICAL PATIENT AFTER AN ALLOGENEIC STEM insight into their commitments and to describe the influen- CELL TRANSPLANT cing factors and needs they experience in order to improve S. Navarro Mediavilla*,1, A. Estraviz Chiarelli1, the overall support that parents are given during post E. Go´mez Rodriguez1, A. Graells-Pique1, E. Machado Lo´pez1, transplant hospital visits. A. Llaurado1, S. Puig Darde1 Method: A descriptive qualitative study was conducted in 1Onco-Heamatology, HOSPITAL CLINIC, BARCELONA, Spain which semi structured interviews were held with 15 parents whose child had undergone an HSCT. During a two year Introduction: The aim of our study is to determine the period at least one parent of all HSCT patients participated. suitability of the PICC use in hospitalised or out-patients that The interviews were transcribed and coded (NVivo7). Constant need a central venous access to get intravenous therapy after comparison was used to analyse the data. having undergone an allogeneic hematopoietic stem cell Results: Experiences and commitments: Once home, parents transplant (HSCT), as few studies have evaluated the PICC use face complete responsibility of care for their child. The exclusively in this population continuous monitoring of their child implies a great burden Method: An observational retrospective study was conducted and it requires a great effort to integrate the regimen received from January 2013 to July 2014. All patients that had already from the professionals into their daily routine. The parents received an allogeneic HSCT and needed the insertion of a experience feelings of insecurity not only about their child’s PICC to get treatment were enrolled in the study. All PICCs medical evolution, but also about their quality of life. Most were inserted by a specialised vascular access nursing team mothers have to interrupt their professional life. Parents long under ultrasound guide. A specific CVC care and maintenance for a ‘‘normal’’ life. protocol was strictly followed. We collected sociodemographic Influencing factors: data, haematological diagnosis, type of HSCT, reason for the Factors which can influence the experiences to a greater or PICC insertion, catheter characteristics, insertion success, lesser extent are: the disease progression, the duration of the duration, removal reason and need for another central venous post transplant period, the relationship with the partner, the access. family situation, social environment, personal background, Results: 30 PICCs were inserted in 26 patients (15 men, 11 personal factors, practical and financial situation,y women; mean age 44’37 years, range 17-68) for a total of 1283 The needs: days (mean 44’2, range 0-198). 11 patients (42’3%) had Parents adjust their lifestyle to take care of their child, undergone a related allogeneic HSCT, 15 (57’7%) an unrelated prioritizing it over their own needs. Depending on these allogeneic HSCT. The insertion was successful in the 96’6% of influencing factors, parents have different needs. the cases. The reasons for catheter removal were end of What is clear is that a trustful relationship is needed with the treatment 16 (53’3%), need for another central venous access professionals. Above all parents have a need for information. 6 (20%), death 3 (10’%), suspected infection 3 (10’%), tip They also need psychosocial and practical support, particularly malposition 1 (3’3%) and catheter pulled out by the patient 1 when making decisions. Parents also appreciate help educat- (3’3%). From the three PICCs removed for suspected infection ing the siblings. Some of them need a professional life and all the cultures were negative whereas two of the PICCs time for themselves. removed for end of treatment resulted in a positive culture Conclusion: Parents face an immense, very complex and (6’66%). extensive commitment when they return home with their Conclusion: Our results suggest that the use of a PICC is a child after HSCT. suitable alternative to conventional central venous catheters The experiences and challenges they face are strongly even in patients particularly prone to infective and hemor- intertwined with each other and are influenced by different rhagic complications such as patients who have received an factors. Parental needs can be fulfilled by friends or allogeneic HSCT; only 6’66% of the cases developed a catheter neighbours and professionals.

S531 The results of this study create an awareness in professionals subclavian vein. No difference detected in fever and redness and are a first step towards improved post transplant of the insert site. Dressings were categorized as 2 day gauze consultations. (25/50 patients) vs 7 day transparent (25/50 patients). Disclosure of Interest: None Declared. Catheters, dressing types, durations and complication ratios are described in table 1. NP055 Conclusion: It has been suggested that the higher coloniza- WHICH TYPE OF THE DRESSING AT THE INSERTION SITE tion rate with transparent dressings may be partly offset by MAY AFFECT THE RATE OF CATHETER INFECTION: GAUZE earlier detection of local signs of inflammation.In this study OR TRANSPARENT SEMIPERMEABLE DRESSING? although insert site redness was higher in seven day dressing,there was no statistical difference between the blood N. Ozturk1, Y. Eraslan Karadag*,1, Z. Gol1, T. Sen1, D. Gultay1, 1 1 1 1 1 2 stream infection rate and fever. Although seven day dressing O. Kilic , M. Okay , G. Bolat Sever , F. Akal , H. Cinar , E. Atilla , seems not cost effective than two day dressing, it may reduce P. Ataca2, S. Civriz Bozdag2, S. K. Toprak2, P. Topcuoglu2, 2 2 the daily work load of the nurses. M. Kurt Yuksel , G. Gurman Disclosure of Interest: None Declared. 1ANKARA UNIVERSITY DEPARTMENT OF NURSERY, 2ANKARA UNIVERSITY DEPARTMENT OF HEMATOLOGY, ANKARA, Turkey NP056 Introduction: Central Venous catheters are the devices most BODY IMAGE AND QUALITY OF LIFE IN LEUKEMIA frequently used for vascular access in Hematopoetic Stem Cell PATIENTS AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL Transplantation (HSCT). Although CVC are indispensable in TRANSPLANTATION HSCT, they also represent a significant source of complications Y.-C. Huang*,1, Y.-T. Dai2, C.-F. Chang1, J.-L. Tang1 most important of these are bloodstream infections. Our aim is 1Tai Cheng Stem Cell Therapy Center, 2Department of Nursing, to compare the incidence of Catheter related blood stream National Taiwan University, Taipei, Taiwan, Province of China infection (CRBSI) with two different dressing two days gauze and seven days sterile transparent dressing. Introduction: After receiving stem cell transplantation, Method: Full aseptic techniques were used before CVC patients went through high-dose chemotherapy, polyphar- insertion. The catheter site was covered by sterile gauze or a macy, and graft-versus-host-disease (GVHD). These changes sterile, transparent semi-permeable dressings. Gauze dressings may affect their body image and quality of life (QOL).The were replaced at least every two days and transparent purpose was to investigate the relationships among demo- dressings every seven days. If patients had tenderness at the graphic characteristics of stem cell transplantation, condition- insertion site or fever without obvious source, the dressing ing protocol, complications and symptoms after stem cell was removed for through examination. transplantation, body image, and QOL. Results: Fifty patients whom underwent allogeneic stem cell Method: This research was a descriptive, cross-sectional study transplantation were included in this retrospective study. with structured questionnaire; Multidimensional Body-self Diagnosis of the patients were as follows: Aplastic anemia(AA) Relations Questionnaire-Appearance Scale (MBSRQ-AS), the n=4(8%), AA/Myelodysplastic syndrome (MDS) n=1 (2%), Acute traditional Chinese version of The Functional Assessment of Lymphoblastic Leukemia (ALL) n=7 (14%), Acute Myeloblatic Cancer Therapy- Bone Marrow Transplant version 4 (FACT- Leukemia n=28 (56%), Chronic myeloid leukemia (CML) n=2 BMT), and demographic questionnaire. The study recruit 84 (4%), MDS n=2 (4%), Primary myelofibrosis n=1(2%), Mycosis leukemia patients who have done allogeneic stem cell Fungoides n=3 (6%), Non Hodgkin Lymphoma(NHL) n=1(2%), transplantation from post-transplantation and hematology Peripheral T cell Lymphoma (PTCL)n=1 (2%). 18 patients (36%) outpatient clinics in a stem cell transplantation medical center had noncuffed central venous catheters (nCCVC) placed into in northern Taiwan. external juguler vein and 32 patients (64%) had cuffed Results: The major findings of this study were as follow: An tunneled central venous catheters (CCVC) placed into 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 Table 1. Catheters and dressing types, durations, mean of patients’ QOL were between middle level and upper complication ratios level. The essential predictors of FACT-BMT include MBSRQ-AS total score, age, changes of hair, and months after transplan- Catheter type Cuffed Noncuffed P tation. As a result, the total amount of (R2) could explain to tunneled CVC CVC (n=18) value 46.2%. Body image change is a predictor of QOL for leukemia (n=32) patients who have received allogeneic stem cell transplantation. Conclusion: Healthcare providers could provide holistic care Duration during 42 days (12- 39 days 0.195 before patient discharge, and give long-term follow-up on hospitalization 104) (26-96) their body image changes in order to help patients acknowl- period edge their body image changes. Hope we can help patients Removal because of 1(3.1%) 5 (27%) 0.399 adapt to and promote the QOL after transplantation. infection Disclosure of Interest: None Declared. Bacteremia 14(43.25%) 5(27.7%) 0.264 Dressing type 7 day 2 day P value Duration (days) 42 (24-91) 39(12-104) 0.289 NP057 EVALUATION OF FOLLOW-UP BY SPECIALIZED STEM CELL Bacteremia 9(36%) 10 (40%) 0.77 TRANSPLANT (HSCT) NURSES AFTER PAEDIATRIC HSCT Fever 24((96%) 24(96%) 1 Y. Jostemyr*,1, A. Klaesson-Hjelt 1, M. Sundin1 Reasons for catheter 1Karolinska Huddinge, Pediatric hematology, Stockholm, Sweden removal Infection 1(4%) 5 (20%) 0.19 Introduction: At Karolinska University Hospital about 25 Death 2(8%) 2(8%) children per year are undergoing hematopoetic stem cell Spontenously 1 (4%) 1 (4%) transplantation (HSCT). Pre- and post transplant care is offered Thrombosis 2(8%) 0 at the Dept of Paediatrics while the transplant procedure is No need more 12(48%) 16(64%) performed at the Dept of Transplantation with isolation Redness of the site 10(40%) 1(4%) 0.005 facilities. After discharge the follow up is continued at the paediatric day care unit. Until recently children had an

S532 appointment with the paediatrician at every visit and often stressful environment of the BMT unit but have rarely had to see a nurse for blood-sampling or other procedures. experienced the fruits of their labor. These appointments with nurses were not ‘‘organized’’, but Method: During the past five years, our nurses have had the there was an obvious need for both children and parents to opportunity to visit some of these patients in their homes get more support and time for personal questions. Appoint- several years following their transplants and experience the ments were time consuming both for doctors and nurses and impact it has had on the families and their communities. information given was sometimes duplicated or conflicting. Results: The nurses obtained the following information by Method: Follow-up by specialized stem cell transplant social interaction with the families of several patients in their (HSCT) nurses: To improve the care a new routine was homes: introduced in 2012. Children now meet the paediatrician only Parents who have had to travel long distances over desert once a week and the other visit is scheduled to a specialized roads and stay in the hospital for substantial periods of time, nurse. Two paediatric nurses have been trained to become now have been able go back to work and spend time with the nurse practitioners (HSCT-nurses). An advantage is that the other children in the family. visits mostly are directed to the same nurse and the time for A group of adolescents waiting for one of their friends to the visit has been expanded. The visit to the HSCT-nurse has return from hospital now have a member of their football been developed and standardized together with the paedia- team who can score goals, an empty Eid celebration last year tricians to complement the other weekly appointment to the is now full of meaning with the presence of their child who has doctor. The first follow up is scheduled already at discharge been cured of hemophagocytocytic lymphohistiocytosis. from the transplant unit. An individual rehabilitation plan is A first born child with interferon gamma receptor deficiency made aiming at normalizing life as soon as possible. Each who has spent a year battling tuberculosis is now reunited patient fills in a questionnaire describing all the different with her family after a successful transplant. problems that can occur after HSCT. At the weekly visits the Patient education and awareness via HSCT has also resulted in HSCT nurse does the regular blood-sampling but also requests by a few families for premarital genetic testing – a performs GVHD assessment and Lansky/Karnofsky score. positive step in the direction towards control of these fatal and During weekdays HSCT nurses keep contact with parents by economically devastating diseases. phone or e-mail regarding test results and when needed Conclusion: The joy and happiness that our transplant nurses change prescribed medicine dosage in cooperation with the have experienced to see their patients cured and integrated in paediatrician. society has given them a new perspective to their roles as Results: Evaluation of the follow-up with HSCT nurses was healthcare providers. Such real-life experiences help to performed with the help of standardized patient question- continually motivate and sustain the high standard of nursing naire. Preliminary results show the value of continuity. The care that is required in this very demanding field. patients don’t always meet the same paediatrician at every Disclosure of Interest: None Declared. 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 NP059 extra time for the nurses to answer personal questions, explain THE APPLICATION OF MOIST WOUND HEALING THEORY IN and support the families in this often very arduous time when THE SKIN CARE OF A SEVERE GVHD PATIENT focus is changing from ‘‘only to survive’’ to reorganize and Z. Yang*,1 ‘‘continue to live’’. 1Peking University Institute of Hemotology, Beijing, China Conclusion: Standardized follow-up appointments with spe- cialized stem cell transplant (HSCT) nurses have improved the Introduction: Severe GVHD is one of the most common cause level of care after HSCT of children. A weekly visit to both of mortality of hematopoietic stem cell transplantation. paediatricians and nurses has improved our ability to support Without cautious nursing care, the skin ruptures and ulcera- the family on an individual basis this conveys a feeling of tions can easily cause severe infection and lead to adverse assurance and safeness. outcome. In this case, the skin care for this kind of patients is Disclosure of Interest: None Declared. 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 1Nursing 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

S533 We applied skin care based on the moist wound healing When a child has a bone marrow transplant (BMT), mothers theory on a 19 years old, male patient with IV degree skin are exposed to new stresses. Stress responses of emotional or acute graft-versus-host-disease(GVHD) after the haploid hema- physical reactions occur when demands are greater than the topoietic stem cell transplantation. At +23 day after the individual’s resources. Social support is an important resource transplantation, the patient got skin peeling and rupture on for individuals who are experiencing stress. The purpose of this his face, neck and chest, accompany with severe pain. We prospective study was to determine the impact of a child’s made an individualized care plan for the patinet, using the BMT on mothers’ stress reactions and to examine effects of moist wound healing treatment. social support on maternal responses over time. Method: The dressing changing method is as follows: Method: Six self-report questionnaires were used to measure 1. To clean the wounds and the surrounding skin with 0.9% mothers’ responses: depressive symptomatology using Centre saline. of Epidemiological Studies Depression Scale, anxiety using 2. To cover the wounds with Vaseline gauzes soaked with 0.5% State Trait Anxiety Inventory, somatic complaints and sleep iodophor. behaviour using Health Assessment Scale, social support using 3. To dress 3 times a day. Stress Support Scale, severity using Perception of Severity The vaseline gauze has a good balance on permeability and Scale, and worry using Worry Scale. Hundred mothers leakproofness, which can create a moist environment to completed questionnaires on their child’s admission day (T1), promote the growth of granulation tissue. The healing time on the 2nd (T2), and on 10th (T3) day’s after bone marrow was consequently shortened. On the other hand, the gauzes infusion or post conventional chemotherapy for non BMT. were easy enough to remove from the wounds while dressing, Results:.A majority of mothers had depression scores indicat- which significantly reduced the pain of the patient. ing that they were at risk of developing clinical depression. Results: After 2 weeks, the wounds healed and the rupture The depression mean scores increased over time. Also a turned into escharosis. majority of mothers had moderately high anxiety scores all The moist healing environment can speed up the migration of three times. Few somatic complaints and sleep disturbances epithelial cells, promote the growth of fibroblasts and were reported. The somatic complaint mean scores increased endothelial cells, increase cutin cells proliferation, and significantly over time. Only anxiety mean scores differed stimulates the production of capillaries. significantly by level of social support. Anxiety mean scores for Conclusion: Vaseline gauzes soaked with 0.5% iodophor is an mothers with a moderate level of support increased at T2 but attempt of moist healing treatment, which might be a good declined at T3 while anxiety mean scores for mothers with low choice for severe skin GVHD patients. or high levels of support increased at T2, and T3. The findings Disclosure of Interest: None Declared. indicate a child’s BMT is stressful for mothers. Conclusion: Additionally, health care professionals need to NP060 provide psychosocial support to assist the mothers cope with EFFECTS OF SOCIAL SUPPORT ON MOTHERS’ EMOTIONAL stress during the child’s BMT.Nurses cannot eliminate the AND PHYSICAL RESPONSES DURING THE CHILD’S BMT stress, but they can help Disclosure of Interest: None Declared. Z. A. Ibrahim*,1 1Pedaitroc 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

S534