Abstracts of the Nurses Group

EBMT 2006

and so decreases levels of anxiety and improves clinical Supportive care outcomes (Audit Commission 1993). Bone Marrow Transplantation (BMT) has been described as a procedure associated with isolation of the patient, prolonged N922 hospitalizations, rapid fluctuations in medical conditions, Nursing aspects in patient-information frequent and often life-threatening infections, and graft-versus- G. Rother, C. Weßler, N. Reebehn host disease (GvHD). UK-SH, Campus Kiel (Kiel,D) It is a complex process with immediate as well as long-term effects, which may permanently impair quality of life and can In addition to the information supplied by physicians there is affect morbidity and mortality. Achieving a level of also a need for explaining the nursing aspects to the patients. understanding of what is involved can be a bewildering Both sides are important to minimize fear, to create an proposition for many patients and their carers, and in itself can atmosphere of confidence and to help the patient complete present obstacles to informed consent and subsequent post- their treatment successfully. transplant expectations. A stay on the BMT-unit is not like any other time in hospital. The Seven Steps is a project which evolved through the need Lots of questions arise before admission and during the stay to meet our patients’ demand for accurate and clear written and patients often are left with a huge amount of uncertainty literature to support and compliment verbal description. The about what to do or not to do. During the preparations at the result is a book, which divides the bone marrow transplant outpatient clinic physicians inform their patients thoroughly journey into 7 clear steps, which provide a high level of detail about the medical side of the transplantation process but they yet with a strong patient focus. cannot give sufficient answers to questions concerning the The Seven Steps has been a multi-phase project nursing aspects of the upcoming admission and the weeks on incorporating a needs assessment, pilot and review of the first the ward. draft. The views, opinions and suggestions of patients, their Information patients get by hearsay or find in literature and carers, medical staff, nursing colleagues and members of the other media like the internet vary widely as concepts of multi-disciplinary team were incorporated at each stage. treatment and nursing still differ a lot from one transplantation Members of relevant professional bodies (EBMT Nurses’ centre to another. Group and RCN Haematology and BMT Nursing Forum) In order to avoid confusion and to enable patients to prepare reviewed the final draft. their stay on the BMT-unit properly some people of the The Seven Steps project is supported by the Leukaemia nursing team of our unit have started to develop a concept of Research Fund who publish and distribute the book. It can be patient-information from a nursing point of view. accessed by anyone seeking information on the subject since This concept consists of: it is free of charge to all users in hard copy, can be 1. Before admission a booklet is handed out to the patient downloaded from the Internet and has been translated into which basically explains the terms which are important during Spanish and Arabic. There is clearly scope for the Seven the stay and gives some general information about the course Steps to be translated into additional languages to facilitate of the day on the ward. more wide scale distribution beyond the United Kingdom. 2. Once a month an informative talk is offered for patients to The Seven Steps book has been widely used since be admitted to the unit within the next weeks. Relatives are publication 4 years ago and circulation is currently in the invited as well and there is a lot of time to answer specific region of 14,000 copies in the United Kingdom. The Seven questions, again about the nursing aspects of the treatment. Steps has filled a void for many patients and in response to 3. On the day of admission a nurse tells the patient the details patient demand; a follow-up book addressing post transplant about his everyday care, nutrition, communication facilities, complications and late effects is currently being developed. isolation procedures, visitor regulations and other things important to nurse and patient. Relatives are encouraged to be present at this conversation and the major content of the N924 talk is left at the patients bed in a written leaflet. Recognising indications for photopheresis in acute and Existing plans: chronic graft-versus-host disease patients 1. To design a brochure with advice and information for the H. Jordan-Graham (1), J. Wade (1), J. Rizzo (1), P. Hari (1), time after discharge. W. Drobyski (1), S. Miels (1), R. Gruling (1), S. Sorensen (2), 2. To continually improve the existing written information and A. Murtaugh (3) to keep it up to date. (1)Medical College of Wisconsin (Milwaukee, USA); (2)M D The poster will present the development and implementation Anderson (Houston, USA); (3)Seattle Cancer Care Alliance of our “Patient-information from a nurses point of view. (Seattle, USA)

Extra Corporal Photopheresis (ECP) is currently being used N923 as an effective treatment for patients with Acute (A) and The seven steps and beyond: developing accessible Chronic (C) Graft versus Host Disease (GvHD). Treatment information to meet the patients' needs before, during has been initiated as early as twenty-four hours after and after bone marrow transplantation confirming GvHD to be refractory to steriods. Although, there M. Kenyon is no standard treatment for CGvHD, ECP has been utilized Kings College Hospital (London, UK) as treatment with promising results. Method: Cumulative treatment records for patients with The benefits of good patient information are huge. It increases A/CGvHD that received ECP were retrospectively reviewed. the patient’s feeling of control (Gammon and Mulholland 1996) Indications, frequency and appropriateness of ECP were analyzed. Although, there were indications of improvement in

S258 patients with A/CGvHD while receiving ECP, it was difficult to quantify positive or negative changes in the patients' physical Crossing borders - a European assessment. It is important to recognize indications of GvHD approach in the allogeneic blood and marrow transplant population. Presented is a tool to facilitate recognition and follow-up of physical indicators in patients with A/CGvHD. This N926 assessment tool was developed following discussions with Experiences of the EBMT Swiss Nurses Group physicians and nurses in an effort to prospectively quantify the E. Aerts, J. Cvetanovic, C. Pino-Molina, M. Rigiani, C. Langer, response to therapeutic modalities. Additionally, it will assist V. Chapuis, N. Imboden, S. Van den Bosch, G. Kollbrunner on identifying time of response and benefit of ECP. The tool is behalf of the EBMT Swiss Nurses Group being validated prospectively on patients currently undergoing ECP. Once validated, it will be placed in routine use. The Introduction: Already in the early nineteen eighties,nurses met ultimate goal is to develop a tool to assist the clinical in and exchanged ideas with colleagues from different Swiss providing an initial and ongoing assessment both before and SCT-Units. during ECP. This tool, can assist in identifying improvements During the EBMT Congress in Montreux (CH)in 2002 senior or changes in the patient's A/CGvHD status. nurses from the transplant centers in Basel and Zurich Result: ECP can be an adjunctive therapeutic modality in the initiated a local organisation committee. treatment of A/CGvHD. The therapeutic effectiveness of the As the congress took place in Montreux, in the French treatment has been clinically evident. Most therapeutic speaking part of Switzerland, contact was made with the local responses recognized occurred with skin, fascia and muscle centers (Lausanne, Geneva), as well as centers from the GvHD. Providing documentable substantiation of therapeutic German and Italian speaking cantons of Switzerland. treatment is essential in providing effective care. Reporting Following the meeting, we started preparing the formation of a observable therapeutic effectiveness to treatment is also Swiss National Nurses Group. important in providing continuity of care. The Initial and Regular meetings and working liaisons have been established Ongoing physical assessment tool facilitates comprehensive by the teams of the Swiss centers. assessment for following patients with multisystem GvHD on The Swiss Nurses Group on Stem Cell Transplant Care was several immunosuppressive modalities. This tool provides a finally formed on May 11th, 2004. simple clinical document that facilitates characterization of Group meetings take part twice a year and consist on the GvHD at initation of ECP and tracking of response by disease following: manifestation/site. We hope this will provide better long term 1. Looking at the organisation of centers and the exchange of assessment of patients as a supplement to routine abstraction knowledge of clinic charts and dications. 2. A study session /workshop. First goals being exchange of knowledge, expertise and experience, the group was affiliated to the EBMT-NG at the N925 end of 2004. Retrosopective quantification of oral graft-versus-host While new goals were added, the team became more and disease symptoms by questionnaire more a professional working group. J. Gray, F. Clark The Swiss Nurses Group is currently involved in the JACIE Queen Elizabeth Hospital (Birmingham, UK) Accreditation process. The group recognises the importance of the project and is Oral complications after allogeneic stem cell transplantation planning an active cooperation with haematologists in the are increasingly recognised as a significant cause of last post- JACIE process. transplant morbidity. One of the most important causes is Method: chronic graft-versus-host disease and this has been The Swiss Nurses Group has been able to build up a national documented histologically in up to 45% of patients. In order to and international network. define the frequency of clinically significant oral symptoms in A SOFT analysis of our mutual work since the formation of the patients undergoing allogeneic stem cell transplant, we have group has been done. interviewed patients more than 100 days post transplant with Aim: To make recommendations based on the analysis and specific reference to oral pain, dryness and alteration of taste encourage other countries to form national groups as well. speech and swallowing. Conclusion: With our presentation we would like to show what 43 patients who had received an allogeneic stem cell it takes to implement a national group and why we think it is trnapslant at a single centre completed a questionnaire important to share expertise and experiences to further designed to identify the recall and time course of specific oral develop our field of SCT in Europe. symptoms. A review of patient hospital records then determined if oral GVHD had been contemporaneously noted and also to determine the relationship between oral symptoms N927 and documented evidence of GVHD of the liver, Gastro Happy nurses make happy patients. A comparative intestinal tract and skin. exploration of the support available to nursing staff in two 35% recalled either the onset of oral symptoms beyond 100 European stem cell transplantation units days or the continuity beyond 100 days of symptoms arising L. Knapen (1), M. Tiernan (2) earlier post-transplant. of all patients, the most frequent (1)UMC St. Radboud (Nijmegen, NL); (2)St. James's Hospital symptoms recalled in this time period were: altered or reduced (Dublin, IRL) taste 28%, xerostomia 21%, pain or burnign of the mucosa 21% and difficulty with speech or swallowing 14%. Background: The EBMT-NG set up an exchange program for We have demonstrated a high incidence of late oral nurses working in European Stem Cell Transplant (SCT) units complications after allogeneic SCT. These symptoms are by means of a grant. This exchange took place in September consistent with chronic oral GVHD, which is therefore still a and October 2005, between St. James’s Hospital Dublin and signifcant source of morbidity in todays transplant patients and UMC St. Radboud Nijmegen. The nurses worked alongside requires further analysis each other for five days in an effort to discover the similarities and differences between the two units. Nursing policies and protocols were reviewed, and there was opportunity for discussions with the nursing staff at both units. Aims: Although there were many variations in nursing care, one of the common aspects in both units was the

S259 psychosocial effect on nurses working with allogenic stem cell group members will be held there including invited transplant patients. representatives from Central and East European EBMT In Nijmegen the support systems in operation appeared to centres. A future cooperation, ideas, problems and comments facilitate the nursing staff in coping with the psychosocial on the group´s constitution will be discussed. For smaller effects of their job. In Dublin it seemed that a regular support countries with limited number of transplant centres, as we are, system needed to be established. any form of an international cooperation should always be Methods: In Nijmegen a survey was conducted on emotional considered and establishing a Central-European National stress of nurses working in the SCT unit. The questionnaire EBMT Nurses Group could be very helpful. used in this survey was employed as a framework for a questionnaire in Dublin, to determine what the nursing staff’s ideas are about the psychosocial effect of their role as a nurse N929 on the unit. Nursing research in the areas of stress, burn out Demographics, knowledge and expectation from Spanish and support systems were reviewed to support the relevance bone marrow transplant nurses of the subject. C. Gallego, N. Borràs, A. Ciurana, J. Güell, A. Hernando, C. Results and Discussion: From the results of the survey carried Laborda, D. López, M. Pallejà, A. Turró, M. Valverde EBMT out in Nijmegen it was clear that the nursing staff suffered high Spanish Nurses Group (Barcelona, E) levels of emotional stress. Therefore the support system on the SCT unit was reviewed and new methods of support for Background: The priority of the Spanish Nurses Group board nursing staff were introduced. Using the results of the is to offer a platform for nurse’s professional improvement. In questionnaire as a guide, a regular support system is going to order to adjust our initiatives to nurses’ priorities, we decided be established for nursing staff in Dublin. Results of the to launch a survey with the aim of discovering the questionnaire will be presented at the EBMT-NG Congress in characteristics, hopes and needs of the Spanish nurse Hamburg, March 2006. population. The aim of this presentation is to analyse the Conclusion: From both the results of the questionnaires and information that the questionnaire has provided. evidence from nursing literature it is clear that nurses who feel Material and Methods: We designed and validated a well supported and content in their work provide patients with questionnaire of 17 items, which was divided in three parts: optimum nursing care. Patients who recieve excellent nursing social and demographical data, valuation of one’s own care feel satisfied and content, therefore “Happy” nurses knowledge, and expectations and proposals’. 250 make “happy” patients. questionnaires were sent by post. Results: The number of questionnaires collected was 106 (42%) from 13 cities and 21 hospitals. 79 % of responses N928 were given by staff nurses. The median (range) age of nurses Czech and Slovak National EBMT Nurses Group – is 42 (25-56) years and 89% are women, with a median information, activities and proposals for an outreach (range) time working in the speciality of haematology of 9 (0- programme comprising an institution of a Middle 31) years. Knowledge: The average perception mark (scale 1- European National EBMT Nurses Group 5) given for their degree of knowledge of the speciality was 3, E. Bystricka (1), S. Vokurka (1), V. Pavlicova (2), J. Scudlova and for their level of English 2. 97% (103/106) responded that (3), M. Zitkova (4), M. Petlachova (4), M. Visokaiova (5), D. they had some kind of post-graduate training. 44% (47/106) of Valentova (6), I. Simkova (7), B. Machova (7) these had performed a Master and/or post-degree formation (1)University Hospital (Pilsen, CZ); (2)University Hospital but only 18% (19/106) had post-degree training in oncology (Hradec Kralove, CZ); (3)University Hospital (Olomouc, CZ); and/or haematology. Proposals: 16% of the nurses made (4)University Hospital (Brno, CZ); (5)University Hospital some type of proposals to the group. The most 2 highly valued (Kosice, SVK); (6)University Hospital (Bratislava, SVK); were the need of a more specific training and more (7)University Hospital (Martin, SVK) involvement in clinical research. Conclusions: Spanish nurses show evident signs of interest Introduction: The Czech and Slovak National EBMT Nurses for a European group. They recognise a medium level of group was launched in 11/2004 and several Czech and knowledge of the speciality and a low level in English. Slovak transplant centres are represented within the group. Therefore, the group will focus their immediate activities on Goals: 1) Specialised education for haemato-oncology nurses. educational aspects and on promotion of research. 2) Research in haemato-oncology nursing and presentations Translation of the information of the European Group of the results. 3) Standards of care and accreditations. 4) represents a special requirement for the present success of Patients and their families education. 5) Networking and an the group. international cooperation. Results: 1: three annual educational and scientifical meetings attended and participated (International haematology meeting in Olomouc, EDIPO and EBMT meetings), a text-book on nursing problems in haemato-oncology patients issued, TITAN Advanced nursing practice educational project attended. 2: two prospective randomised multicentre trials finished and presented on local and EBMT meetings and journals ( oral mucositis prophylactic care with N936 antimicrobial rinses and study on CVC dressing changes Nursing care during intermittent non-invasive ventilation frequency), two trials are ongoing ( QoL in transplanted in immunocompromised patients with acute respiratory patients and study on oral mucositis risk factors). 3: a national failure standard on nurse-staffing in transplant centres accepted and S. Soave, N. Orteca, D. De angelis, P. Cotugno, M. Amorese, presented to Czech Haematology Society and to other V. Molinari, S. Colella, A. Maruzzi, T. Canitano, C. Serra, A. relevant authorities to be legalised, the JACIE accreditation Frusone, F. Trenta, L. Acciari, M. Brunetti, C. Cirri, F. Conti, working group suggested to be launched. 4: a brochure on M. Mauroni transplantation and a diary available for transplanted patients. Policlinico Tor Vergata (Rome, I) 5: cooperation with Czech Society of Haematology, Czech Nurses Association and EBMT-NG ongoing, an exchange visit Avoiding intubation for acute respiratory failure is a major goal for nurses from transplant centres in Brno and Dublin initiated, in the management of immunocompromised patients (pts) with cooperation with neighbouring countries transplant centres haematological malignancies. Patients transferred to the (Poland, Croatia, Slovenia and Estonia) promoted. intensive care unit and undergoing to endotracheal intubation Challanges: In 2006, the 22nd Meeting of EBMT-NG is going and mechanical ventilation are at highest risk of death.The to be held in Hamburg, Germany. Regular meeting of our early use of intermittent non-invasive ventilation (NIV) during

S260 acute respiratory failure can help to avoid the need for fever and starting medication was improved by 13 minutes endotracheal intubation by improving patient outcomes.We from 57 minutes to 44 minutes. The proportion of patients that conducted a study of efficacy on intermittent NIV, in 18 had started therapy within the hour improved from 52% to haematological pts at an early stage of hypoxemic acute 89%. respiratory failure according to an approved protocol. In these Conclusions: Determination of bottlenecks in the procedure of 18 pts, immunosuppression associated or not with starting antibiotic for fever during neutropenia led to a change neutropenia, was related to intensive chemotherapy (n=7; in the policy of the ward. This in turn enabled nurses to help 39%), autologous (n=1) or allogeneic (n=5) HSCT preventing sepsis by instituting prompt empirical therapy. transplantation (n=6; 33%) or it was a result of intensive corticosteroid therapy (n=5; 28%). At the onset of the respiratory complication, the patients showed: pulmonary N938 infiltrates, fever, severe dyspnea at rest, a respiratory rate of Characteristics of oral mucositis in patients after more then 30 breaths per minute and a ratio PaO2: FiO2 of autologous stem cell transplantation and related risk less than 200. NIV was delivered to the pts trough a helmet. factors – a new study proposals The helmet was adjusted and connected to a “Venturimeter” E. Bystricka (1), M. Vrabcova (1), S. Vokurka (1), V. Koza (1), with a pressure support of oxygen. Positive end-expiratory J. Scudlova (2), J. Vitkova (2), D. Mjartanova (2), M. pressure (PEEP) was repeatedly increased by 2 cm of water Vodickova (2), V. Pavlicova (3), M. Visokaiova (4), J. Bockova up to a level 10 cm of water through a valve. The end point of (4) each procedure was to maintain the arterial oxygen saturation (1)University Hospital (Pilsen, CZ); (2)University Hospital above 90 percent. Period of non-invasive ventilation lasted at (Olomouc, CZ); (3)University Hospital (Hradec Kralove, CZ); least 60 minutes, alternated every 2 – 5 – 10 hours, according (4)University Hospital (Kosice, SVK) to the arterial oxygen saturation. The mean duration of NIV was 8 days (range 6-14). Introduction: Oral mucositis (OM) remains significant nursing These patients underwent an intensive nursing care for 141 problem in transplant settings. There has been defined only a days and 875 hours with continuous monitoring. few of explicit practical recommendations leading to a During NIV, major events (pulmonary oedema, pnx, reduction of occurrence of OM, so far. At the same time, there haemoptysis) occurred in 2 patients (11%) and according to has not yet been presented and generally accepted any the protocol NIV was stopped. confirmed OM risk factors definition (with the exception of high NIV was temporary discontinued for the occurrence of minor risk chemotherapy/radiotherapy protocols and their intensity). events (hypercapnia, hyperpyrexia, anxiety) in 11 cases (60 Results of various studies and observations on OM risk %). factors are mostly controversial or unproved. However, Fourteen pts (78 %) overcame the respiratory failure. Nine pts awareness of OM risk factors can be very usefull and could (50%) were discharged; 2 pts died for MOF and 3 pts died for help define patients indicated to a special, specific and progressive disease. probably also high-cost care and treatment in a future. To help In our study the intermittent use of NIV was possible without define and verify possible risk factors this study has been transferring the patients in intensive care unit and it permitted launched. to avoid endotracheal intubation, with encouraging results. Goals: to verify incidence and course of OM and risk factors. Methods: multicentre prospective observation with daily evaluation of OM characteristics, univariable and multivariable N937 statistical analysis of corelates. OM will be assessed by the Nurses play major role in sepsis prevention WHO scoring system. M. van Vliet, N.M.A. Blijlevens, J.P. Donnelly Patients: adults treated with high-dose chemotherapy BEAM UMC St Radboud Nijmegen (Nijmegen, NL) or HD-L-PAM (200mg/m²) followed by autologous peripheral blood stem cell transplantation, with healthy oral mucosa Introduction: Patients are often given high-dose chemotherapy baseline status. No radiotherapy of head, neck or total body in for treating haematological malignancies to prepare for a stem a history or for the conditioning. cell transplant. This treatment leads to suppression of the Discussion: the recruitment to the study started in 11/2005 bone marrow. One of the main consequences is that during 2- and several centres in Czech and Slovak Republic have 3 weeks the defences are down resulting in profound immune participated so far. Any other centers are welcommed to suppression. In addition, chemotherapy impairs the protective cooperate. barriers of the body such as skin and mucous membrane, The study protocols in Czech and English versions are which are also breached by invasive measures like infusions, available at: [email protected] and [email protected]. urinary catheters or central intravascular devices. Results of the study could further supplement the data gained Altogether this means that patients are extremely prone to by the POMA (EBMT/Amgen) trial. infections. Fever that occurs during neutropenia can herald serious problems such as sepsis and acute respiratory distress. Prompt administration of broad-spectrum antibiotics N939 is of vital importance to prevent these complications. Bone marrow transplant in Saudi Arabia: the challenge Our guideline states that the first dose of antibiotic should be A. Mohamad administered within an hour after observing an elevated King Faisal Specialist Hospital & RC (Riyadh,SA) temperature. The nurse also has to draw blood for culture beforehand and alert the duty physician to come and assess In 1984, the first Saudi patient was transplanted in Saudi the patient, contact the haematologist and prescribe the Arabia at King Faisal Specialist Hospital & Research Center. It correct medication. was a step into the unknown for the patients and their families. Method: Registration was done for 31 patients who developed But was a challenging step for the health team that has to face fever during neutropenia. old traditions, fixed beliefs and, at times, religion. Many Rather than wait for the duty physician to come during the patients declined from consenting on going through the evening and night and at weekends we initiated a protocol to procedure after being told about the potential complications of allow antibiotic prescription in advance, to obtain blood the transplant. Sterility was a big issue for the patients. In a cultures in a simpler fashion and educated the nurses so that society like the Saudis', Sterility is an important social issue they could detect early the signs of fever, sepsis and acute for a man. And as stated by one patient: "A man without respiratory distress. children, doesn't deserve to live". Follow-up registration was performed on 28 patients. This paper aims at exploring the challenges that faced, and to Results: Data of 31 patients at baseline and 28 patients for the some extent still facing, the bone marrow transplant program follow-up were evaluated. The mean time between assessing for both adult and pediatric. It will go through an introduction

S261 about the Saudi community. How people think and perceive explore areas of practice and search for improvement in child new introductions to their lives. What were the obstacles and care services and to bring these back to the Trust and initiate barriers? It will go through the changes and difference their implementation. between the patients in 1984 and today, twenty-one years Staff nurses visited two centres in the United States (US) from after the first Saudi patient was transplanted. the Bone Marrow Transplant (BMT) Unit at GOSH. The objectives were to collect anecdotal information on nursing practice in 4 key areas: N940 1. Management of Nutrition; Decision-makers and problem-solvers: the contribution of 2. Management of Nausea and Vomiting; nursing knowledge, skills and attitudes in the 3. Pain management and haematology setting 4. Provision of psychosocial support for families undergoing S. Clare, S. Rowley BMT. UCLH NHS Foundation Trust (London,UK) Upon return to the Trust there were many obstacles that impeded any further practice development in the areas Introduction: Nurse education over the past 15 years or so has explored. This resulted in no implementation of any changes. focused to a large extent on the quality of increasingly The reasons behind this will be explored in this presentation specialised training. With such emphasis on specialisation as an honest reflection into why these changes were what are the rewards for the profession and what advantages unsuccessful. can clients expect to see in clinical practice? This study The two centres visited were the Seattle Cancer Care Alliance attempts to identify and articulate how specialist knowledge and the Texas Children’s Hospital Houston. They both might impact the quality of clinical practice in a haematology provided a predominantly outpatient driven service with setting. optimal utilisation of community nursing teams and local Objectives: The survey attempts to identify opportunities for charity services. This paper presents potential challenges, decision making and problem solving that are enhanced by should GOSH move towards this type of service provision. the application of specialist skill sets, and highlight this often overlooked aspect of nursing practice. Nursing is still not fully acknowledged as a decision-making/problem-solving N942 profession and demonstrable examples are valuable building Evaluation of nutritional support in children undergoing blocks on the way to establishing a more robust professional SCT: a single-centre experience identity. M. Yilmaz, S. Aksoylar, A. Memis, H. Atay, A. Durdane, S. Methodology: A pilot narrative survey tool was designed to Kansoy record exampletory descriptions of nursing interventions or University of Agean (Izmir, TR) applications of specialist knowledge within Haematology Nursing Service (HNS) at University College Hospital (UCH), Children undergoing stem cell transplantation (SCT) have London. The tool was designed to be simple, user friendly and poor oral intake during the transplant period, caused mainly by time efficient. The narratives were analysed using an editing the intensive therapy used for their conditioning. Nutritional style of theme analysis that developed a categorisation support is needed and important. This study retrospectively scheme for more detailed analysis. Submissions to the survey analyses the experience with a nutritional support protocol in were made by colleagues who nominated staff to a monthly children undergoing SCT at the Ege University Pediatric SCT nursing award for excellence in the application of specialist Unit, Izmir, Turkey. haematology knowledge. Patients and Methods: Sixteen patients (7 female and 9 male, Results: Data will be presented on 52 submissions which were mean age 6.7 years, range 0-18 years) were transplanted analysed from a variety of nursing grades and working between 1 january 2004 and 31 september 2005; 9 children environments around HNS at UCH. Themes of acute received 11 allogeneic (9 from MSD, 2 from haploidantical observation and fast interventions are common, with nursing family donor) transplants and 7 were autologous. Indications staff observing seemingly minor changes to a patient’s included AML (3), CML (1), Thalassemia Major (2), condition and applying specialist knowledge and training to Osteopetrosis (2), Omenn syndrome (1), Fanconi’s anaemia identify risk factors and instigate, in many instances, life- (1), Neuroblastoma (3), rhabdomyosarcoma (2), NHL (1). The saving actions. conditioning therapy was heterogeneous. No total body Conclusions: This small sample of examples, detailing the irriadiation. Nasogastric (NG) tubes were inserted electively application of specialist haematology knowledge and training, either during conditioning or within the first week when highlights the need for periodic re-examination and more voluntary oral intake had decreased (weight loss >5 % of frequent analysis of our professions professional competence admission or poor oral intake of half estimated requirements). and expertise. Nurses are can be good decision-makers and NG tubes sited NG feeding. All pateints received ondansetron extremely effective problem-solvers; however, as a profession pretransplant to prevent nausea / vomiting. Platelet count was we can still sometimes lack the collective confidence in our reviewed risk of traumatic epistaxis. own abilities. Results: Twelve patients required enteral tube feeding with continious regime/ day time boluses. In 9 requiring NG initial feeding during conditioning. Median number day of NG feeding was 20 (range: 2-41) days. Six patients need parenteral support (TPN) for GIS intolerance and /or severe SCT and children infection. Those patients received TPN from day +1 until discharge. Median number days of TPN was 9.8 (range: 1-27 days). In 7 patients developed aGVHD and in 2 patients were N941 observed veno-occlusive disease (VOD). No significant weight Challenges in exploring and implementing new practice: a loss was observed in all children during transplantation In 4 reflection patients, mild weight loss (<5%) was observed. C.E. Gilmour In conclusion, nurses must learn to recognize patients at Great Ormond Street Hospital NHS Trust (London, UK) nutritional risk and intervene when necessary.The standart NG feeding strategy can prevent loss of weight, It is a safe, This paper reflects the use of a bursary scheme used to help easy and effective method of feeding in children undergoing implement changes in nursing practice. The Betty Barshard SCT. bursary is a nursing scholarship award available to nurses working at Great Ormond Street Hospital for Sick Children, London (GOSH). Its intention is to encourage nurses to

S262 N943 child with cancer (9 treated with stem cell transplant), and 52 Psychological screening of children and their parents mothers of a healthy child. before haematopoietic stem cell transplantation: results Instruments: Relation with the child was evaluated by the and implications for clinical practice instrument of Rubin (2003). C.M.J. Vrijmoet-Wiersma, H.M. Koopman Results: A significant difference was found in maternal-child LUMC (Leiden, NL) relations before and after cancer diagnosis, in parameters such as, the child as central resource for emotional support to Hematopoietic stem cell transplantation (HSCT) is his mother (p<0.001). Mean of this support was found to be acknowledged as one of the most stressful treatments in higher (M=4.061, SD=1.344) than before the diagnosis of modern cancer care. The psychological impact of HSCT has cancer (M=3.16, SD=1.312). A significant difference was been widely reported both in children and their families, which found between bereaved mothers and mothers of healthy may extend beyond the treatment phase and result in long- children, in their perception of relation with the child (p<0.001). term morbidity. The mean relation with the child in his life was found higher We chose to initiate a program of individually directed support among bereaved mothers (M=4.38, SD=0.44) than mothers of by exploring pre-existent psycho-social traits in children and healthy children (M=3.87, SD=0.61). The relation with the their families scheduled for HSCT in the Department of deceased child for bereaved mothers includes longing for the Pediatrics, Leiden University Medical Center, in the child a few times a day (66%), persistent thoughts about the Netherlands. dead child (78%), remembrance of the child a few times a day At a minimal of two weeks prior to admission for HSCT, all (78%), and feeling of pain while thinking of the child (80%). patients aged over 8 years old and their parents were Conclusions: Maternal-child relations change and get stronger requested to complete an extensive questionnaire battery through the course of the child’s disease. These relations regarding coping style, state-trait anxiety, HQoL and parental receive different meaning after the child’s death, but they stress. continue and never end. Based on the results of these questionnaires, a psychosocial profile was formulated for each individual patient. These results were used to inform care-givers (both medical and N945 auxiliary staff) about the way patients and parents deal with Haemopoietic stem cell transplantation for idiopathic difficult situations. This was augmented by a psychosocial juvenile arthritis (Still's disease) plan, stating the competencies of this family and what R. Davies interventions were needed. Royal Liverpool University Hospital (Liverpool, UK) Twenty patients and families were included in the study and were followed for a median of 6 months (range: 1-12 months) Introduction: Autologous haemopoetic stem-cell after HSCT. transplantation is essentially becoming a treatment option for The same questionnaires were used to detect any changes. A patients with stills disease where convention treatment has semi-structured interview was held with patients older than 8 failed, largely non steroidal anti inflammatory (NSAID), anti years and their mothers. TNF AND ANTI INTERLEUKIN 6 (IL6), however it is still under From the results of pre- and post SCT assessments we researched resulting in little evidence to support long term concluded that in most children and their parents, HQol had prognosis. deteriorated, especially parent-reported 'home functioning' The following abstract will focus on one case, A female with a and 'role restriction'. Most stress was experienced during the twelve year history of active stills disease, transplanted in first few months following hospital discharge. early 2005 Cychophosphamide was used for the mobilisation Long-term problems included difficulties returning to school of pbsc ands BEAM was used for the conditioning followed by and social life, fatigue and living with the fear of a possible GCSF on day +7. relapse. Still’s disease is a recognized systemic inflammatory disorder In conclusion, psychological screening before HSCT allows for of unknown aetiology and pathogenesis. Characteristic better counseling during admission and results in manifestations include quotian fever, evanescent rash, sore improvement in psychological adjustment after HSCT. throat, arthritis, polyserositis, leukocytosis and seronegativity. This study highlights the need for more intensive Its clinical course is marked by systemic exacerbation and /or psychological counseling for patients and their families after chronic arthritis. (Cush, J c2005) discharge from the HSCT unit. Complications: initial treatment was well tolerated; reported side effects include sepsis, Mucositis and diarrhoea. Joint pain and fevers did occur pre, peri and post transplant however this N944 has since subsided. The main complication was haemolytic Bereaved mothers of children who died of cancer: anaemia of unknown aetiology resulting in black urine and relation with the child in his life and after his death falling haemoglobin despite regular transfusion, these were A. Peles Bortz (1), T. Krulik (2), R. Malkinson (2), I. Yaniv (1) stopped due to continued adverse reactions resulting in a very (1)Schneider Childrens Medical Center (Petach Tikva, IL); gradual increase in haemoglobin. (2)Tel Aviv University (Tel Aviv, IL) Conclusion: haemopoetic stem cell transplantation for diseases other than haematological malignancies is still At the time of child’s diagnosis with cancer, his parents begin investigational. The current research that is available is to experience various losses and changes. One of those promising, however in-depth clinical studies will be the changes includes changing maternal relations with the child principal factor that will determine the long-term endurance of due to accompanying the child intensively in various this treatment. treatments, including life threatening procedures such as stem cell transplant. Research objectives: 1. Finding the changes in relation with the child before he was diagnosed with cancer, and after his diagnosis. 2. Revealing the difference in maternal perception of the relation with the child (in his life), between bereaved mothers and mothers of healthy children. 3. Exploring the characteristics of the relation with the deceased child among bereaved mothers. Method: 150 mothers of children aged 6-18 years participated. Fifty bereaved mothers of children who died of cancer, in the last 1-10 years (23 had stem cell transplant), 50 mothers of a

S263 that PICCs had to be removed prematurely because of local Preventing infections signs of infection and/or thrombosis such as swelling, pain and erythema but this was not reflected in their Catheter- Related Bloodstream Infection (CRBSI) rates. CRBSI rates N946 varied according to device (per 1000 catheter days): 3.9 in Problems with isolation: observations during stem cell tunnelled catheters; 2.69 in PICCs; 10.5 in short-term transplantation versus perceptions of children and their catheters and 18.2 in Vascaths (Femoral). The PICC average parents lifespan was 21.3 days compared with skin-tunnelled S. Voerman, H.M.C. van der Weijden-Dijkers, F. van Iperen, catheters, which lasted 83.5 days. In addition,thrombosis rate L.M. Ball was particularly high in PICCs at 12%. In summary, tunnelled Leiden University Medical Centre (LUMC) (Leiden,NL) devices remain the CVAD of choice when examining a risk/benefit ratio in this population because of the catheter In the past years various aspects of the management of lifespan advantage, moderate infection rates and low patients in protective isolation during stem cell transplantation thrombosis rate. Catheter lifespan is important in this (SCT) changed, i.e. the period of isolation was shortened and population because the longer a catheter can remain in situ, the isolation rules were made less rigorous. Proper studies the less need there is for multiple re-catheterisations and vein addressing these issues are lacking; in particular problems integrity is preserved. children and parents encounter, nursing observations and The benefits and risks of the use of each type of CVAD in the diagnoses in relation to the episode in isolation during SCT. haemato-oncology setting will be presented, using case study Aim: The aim of this study was to better harmonise the examples. Suggestions will be made regarding appropriate nursing care in isolation with the specific needs and wishes of device selection and nursing care based on the current transplant children and parents. available evidence, for example the “epic guidelines”, which Methods: In this retrospective study we enrolled 15 children have been formulated from a systematic review of the who underwent an allogenic SCT in the Leiden University literature on catheter-related infection. This has a direct Medical Centre (LUMC): 4 female and 11 male patients, age impact on nursing care, as nurses may be involved in device range 11 to 17 year. Twelve were transplanted for a malignant selection and insertion procedures, but primarily because and 3 for a non-malignant haematologic disease. Five were nurses are responsible for the care and management of such nursed in a HEPA filtered laminar air flow isolator and 10 in a devices. The highest standards should be maintained to positive pressure isolation room (Ultra Clean Room). minimise catheter-related infection and thereby reduce Children and parents both received a scoring list addressing morbidity and mortality. different nursing diagnoses, and they were asked about their ideas for improvement in order to facilitate the isolation period. Additionally, the same nursing diagnoses were obtained from N948 the day-to-day reports and from the notes of the multi- Once-a-week versus twice-a-week frequency of central disciplinary meetings. These were added and compared to venous catheter dressing changes in patients treated with those from the children and parents. intensive chemotherapy – randomised study results Results: From the various remarks of the children and parents E. Bystricka (1), I. Chvojkova (1), J. Suvova (1), N. Mullerova it was noted that indeed problems were encountered during (1), S. Vokurka (1), V. Koza (1), J. Scudlova (2), J. Vitkova (2), the isolation episode. Among those problems were the size of D. Mjartanova (2), M. Vodickova (2), M. Visokaiova (3), J. the room, the food, the lack of privacy and the difficulties with Bockova (3) communication to the outside world. The observations of the (1)University Hospital (Pilsen, CZ); (2)University Hospital nursing staff differed in several facets from those of the (Olomouc, CZ); (3)University Hospital (Kosice, SVK) children or parents. Nursing staff scored some of these problems higher than the children and parents. Introduction: Usually, as a standard, CVC occlusive dressings Conclusion: We believe the results of this survey will lead to are changed twice-a-week. We set this study to verify if better harmonisation of the needs of children and parents in prolonging this interval will be safe and of any benefit for our isolation during SCT. The implementation of nursing patients in respect to less damaged skin without more related diagnoses in our patient management is facilitated by these infections. results. In addition, specific ideas from children and parents Objectives: To compare CVC insertion area skin damage and could further improve the patient care. CVC related infections in patients with once-a-week vs. twice- a-week frequency of CVC dressing changes. Methods: Prospective, randomised and multicentre trial. N947 Patients: adults with AML, treated with induction or An audit of catheter-related bloodstream infections and consolidation chemotherapy. CVC non-tunneled, polyurethan, catheter lifespan of 282 central venous access devices inserted into v.subclavia and the site covered by polyurethan with recommendations for their care and management in semipermeable occlusive dressing (Bioclusive). the haemato-oncology setting Characteristics: 83 AML patients were enrolled in 8/2003- L. Bishop (1), G. Munoz-Mozas (2), U. Riley (2) 8/2005 and randomised into a „A“ twice-a-week or „B“ once- (1)Guy's Hospital (London, UK); (2)Royal Marsden Hospital a-week group. The both groups were well balanced in respect (Sutton,UK) to number of patients, gender and Ara-C dose. They differed in age (49 vs. 41y., p=0,01). Several types of central venous access devices (CVADs) are Results A vs. B: maximum skin toxicity: erythema 26% vs. currently available, including skin-tunnelled catheters and 15% (n.s.), erythema with itching or dry desquamation 11% Peripherally Inserted Central Catheters (PICCs). The choice vs. 17% (n.s.), moist desquamation 2% vs. 0% (n.s.). The skin of device depends on diagnosis and length and type of changes were temporary with spontaneous regression in 40% therapy, patient preference, clinical status, availability of of the patients in each group. The CVC insertion site clinical patent veins, operator experience and previous CVAD history. inflammation: 55% vs. 25% (p=0,008) with the median With each insertion of any type of CVAD the potential risks diameter of 5(3-30)mm - including the CVC. Positive CVC and benefits should be considered. This prospective audit was blood cultures: 30% vs. 33% (n.s.) of patients. Ratio of undertaken because of the perception of high rates of dressing changes done per protocol: 80% vs. 58% (p=0,001). infection. Data was collected on every insertion and removal, Reasons for unplanned changes: soiled or loose dressing (7% blood cultures and catheter tip culture. vs. 18%), bleeding or inflammation or skin irritation (13% vs. PICCs are frequently used as an intermediate type of venous 24%). Mean change interval: 3,8 vs. 5,4 days. access because they are seen to be safe, economical and can Discussion: No significant difference between the groups was be easily placed at the bedside. However, this audit revealed observed in respect to skin toxicity and positive blood cultures.

S264 Highly significant incidence of insertion site inflammation was length of CMV viremia, antiviral drug use, hospital inpatient observed in a standard twice-a-week group with more stays and hospital outpatient visits. frequent changes. Prolonging the interval of dressing changes Inclusion criteria: CMV viremia in recipients of a low intensity has not harmed our patients, helped to spare the nursing time allogeneic transplant with a CMV seropositive donor. and could be recommended in that cohort of patients, as far Results: The 10 CTL patients had a total of 39.9 weeks of as high quality CVC nursing and occlusive dressings are treatment (range, 1.1-8.6 weeks) compared with 64.7 weeks provided. As not every patients will keep the dressing (range, 2.6-16.7 weeks) in those that received standard attached for 7 days due to various reasons, such as local therapy. This represented a 38% decrease for patients who bleeding, inflammation or loose dressing, the change may be received CTL. needed to be done sooner. All patients required antiviral therapy, however, there was a 55% reduction in ganciclovir use in CTL patients. This could be due to 10% fewer CTL patients receiving the drug coupled N949 with a reduction in treatment length. Fewer CTL patients Accurate detection of parainfluenza 3: a change in received foscarnet and those that did required it for 35% fewer practice doses. C. Cockburn More CTL patients had ganciclovir via a Cadd pump, however, The Royal Marsden Hospital (Sutton, UK) non CTL patients required this for, on average, 37% longer. CTL patients spent 38% fewer nights in hospital, averaging 11 Introduction:- Parainfluenza virus type 3 (PIV3) is associated nights fewer per patient. with a high mortality rate in BMT recipients with lower Discussion: respiratory tract infections (Hohethal et al 2005). These results highlight that patients who receive CTLs require Twenty three patients in one year acquired parainfluenza type less antiviral treatment resulting in fewer inpatient stays and 3 within our Unit at the Royal Marsden Hospital. Of these 23, outpatient visits. 4 patients died. Due to insufficient data, there is still no This has implications for both the patient and the hospital recommendation on how to treat these patients, therefore service. Fewer hospital stays/visits can have a positive effect there must be a strict policy to ensure early detection in order on patients mental health 4 and reduced drug related toxicities to prevent a spread. assists their physical recovery 5 Nasopharyngeal sampling:- Nurses within the unit have In this study, a £22.8K saving was made on pharmacy costs always used a specific practice to take a nasopharyngeal alone and the reduction in hospital inpatient stays saved in sample. It was noted that of the 23 samples taken. 13 cases excess of £38K. In addition, there were cost savings in patient of PIV3 was diagnosed through immunofluorescence within 6 transport and daycare nursing costs. hours of the sample being taken. However 10 samples had to In summary, patients who received CMV-specific CTL had be cultured due to insufficient cells. The results taking up to 10 fewer treatment episodes and side effects. These patient days. benefits were associated with lower healthcare costs. Early detection:- Because 10 of these patients with PIV3 were not diagnosed early, it is recognised that they themselves were at risk as they were not being treated. While other immunocompromised patients were being put at risk in the outpatients department. Addressing quality of life Risk Management: The possible risk of spread of parainfluenza was brought to attention at the Bone Marrow Transplant Risk Management Meeting. On speaking to the N951 microbiologist who received the samples, it was felt that he An audit of communication practices in the Do Not should come and teach us to use a different product for Resuscitate (DNR) process within haematology nursing sampling. I have now begun to audit the new samples while service at a university college hospital, London holding regular teaching sessions on the new method of S. Rowley, S. Clare nasopharyngeal aspirates. So far all the samples have been UCLH NHS Foundation Trust (London,UK) sufficient. I would like to present this method of new sampling at EBMT Introduction: End of life issues remain among the most with the results of the current audit, to share whether a controversial and challenging for healthcare professionals; change in practice could reduce the risk of requiring PIV3 for and few issues are more challenging or cause more anxiety many immunocompromised patients. than the decisions surrounding resuscitation. Tensions exist within the communications between medical staff, nurses, patients, and their families. Family units are particularly N950 vulnerable at this trying time and are easily confused. Impact of CMV-specific immunotherapy on duration and Misunderstanding and poor communication can lead to cost of anti-viral therapy dissatisfaction with care and mistrust of healthcare providers. J. Moran (1), S. Verfuerth (2), K. Peggs (2), S. Mackinnon (2) Objectives: Haematology Nursing Service (HNS) at UCH (1)University College London Hospital (London, UK); (2)Royal wanted to establish a baseline understanding of the types and Free and University College Medical School (London, UK) quality of communication patients and their families received prior to, and during, the process of making a decision Cytomegalovirus (CMV) can be a serious infectious concerning resuscitation. complication for recipients of allogeneic transplants 1. Current Methods: A prospective longitudinal clinical audit of Do Not treatment includes antiviral drugs which can have toxic side Resuscitate (DNR) communication issues was initiated. A tool effects 2. This has led to the development of novel was developed to collect qualitative data about DNR approaches to prevent and treat CMV whereby patients are practices. Haematology inpatient units recorded data on given donor derived CMV specific T cells (CTL). The safety patients who were assigned a DNR status. Data was collected and efficacy of these approaches have been scientifically and coded using a coding matrix developed by the HNS proven 3 and this study aims to evaluate the effects of this research team. The data collection tool also formed part of the approach on the patient experience and hospital service. template for analysis of qualitative data. Method: 20 patients were evaluated, 10 who received CMV- Results: Data will be presented from 10 examples, 5 men and specific CTL post transplant and 10 who received standard 5 women, of the DNR process recorded over 12 months. antiviral therapy. Antiviral drugs were given as an outpatient Problems with the recording of data resulted in a high via Cadd pumps whenever possible. The study reviewed the proportion of incomplete records being discounted from the audit; however, the resulting cases provide a representative

S265 insight into DNR communication practices at a single centre. Important components of ‘normalisation', such as, taking a Emerging themes surrounding ‘truth-telling’ and ethical holiday can be complex and costly without the security of considerations highlighted a variety of phenomena including adequate and appropriate travel insurance. As a result of evasiveness, inconsistency, and misunderstanding. Medical patient experience, we report on a database of insurance and nursing staff appear to have quite different perceptions of companies willing to provide holiday cover for BMT recipients. the DNR process, and these perceptions are in-turn Objectives: To identify criteria and premiums applied by travel sometimes at odds with the understanding of patients and insurance companies when considering requests from BMT their families. recipients for a 2 week holiday in Europe. Conclusions: The results reinforce data from previous studies Methods: A list of travel insurance companies was assembled that support the notation of a sometime problematic from 2 sources: a) commercial Internet search engine, b) from relationship within the triangulation of interested parties. More the patient database. investigation is needed across a variety of centres in order to A telephone survey was conducted to determine companies assess these phenomena within a European context. that would provide cover for BMT recipients. For those companies willing to provide a quotation, a hypothetical patient scenario was applied. N952 Results: 26 companies were contacted. 17 were unable to Nursing staff perception towards religious practice provide cover for patients who had undergone a BMT. 4 among Jewish children undergoing bone marrow companies stated that they would provide cover, but could not transplantation provide a quote, and quotes based upon the hypothetical J. Limor, I. Akav, J. Stein, I. Yaniv patient scenario were provided by 5 of those companies Schneiders' Medical Center (Petah-Tikva, IL) contacted. From the patient database of 12 companies, 10 were Cultural, ethnic, and religious background strongly impact contacted successfully, 2 could not provide cover and 3 would individuals’, families’, and communities’ adjustment to illness, provide cover, but could not quote. Of the quotes obtained, all crisis and death. Religion provides an important source of 5 came from the patient database. emotional strength at such times. Strictly observant Jews The mean premium was £186.42 (£23.85-340) and 1 seem to limit their personal autonomy by choosing, through company volunteered a range of quotes that were destination assistance and advice of their rabbis, to follow God's law as dependent (e.g. Spain = £510, Italy = £143). The mean defined by their faith. This framework may provide religious excess required was £450 (range £50-1000). children with better coping in stressful situations. Religious Conclusions: Provision of travel insurance for BMT recipients patients and their families continue to perform Jewish ritual is difficult to access. Each company applies its own laws during hospitalization in the BMT unit, such as praying assessment of risk to each individual applying for cover, and three times a day, laying phylacteries, washing hands, and as such, there is no standard tariff. Companies that are ‘tried studying religious texts. Adherence to ritual enables the child and tested’ by patients more consistently provide cover than and his family to organize their day and continue with their randomly selected companies. However, even within the religious routine as they had done before admission to the database discussed here, there was wide variation in the cost BMT unit. We sought to evaluate the perception of the nursing of premiums and criteria applied to the hypothetical scenario. staff towards the effects of patients’ ritual observance on the We would suggest that such varied results highlight the need nursing care of the child during the transplant, using an open- for improved education of the industry to better provide a more ended questionnaire and an interview. Eight nurses were equitable service to BMT recipients. interviewed for their perceptions. 3/8 nurses identified themselves as religiously observant (1 Moslem, 2 Jewish). Ten observant Jewish families were the focus of this project. N954 Staff members perceived a positive influence of religious The 'Open Window' project: a novel art intervention in the observance on the part of the patient and/or his family on treatment of patients undergoing stem cell recuperation after transplant. The nurses thought that there transplantation for haematological malignancies was more compliance to BMT unit routine among religious C. McCabe (1), D. Roche (2), F. Hegarty (3), C. Begley (1), S. families, as compared with non-religious families. All nurses Collier (3), S. McCann (3) reported enabling the child and his parents to fulfill their (1)Trinity College (Dublin, IRL); (2)National College of Art and religious practices. Religious children we seen as coping Design (Dublin, IRL); (3)St. James's Hospital (Dublin, IRL) better with difficulties and difficult times as compared with other children. Nurses felt that belief in God endowed patients Many health care environments could be criticised for being and their families with added strength, and enabled them not so clinical in design that they are experienced as cold, despair in difficult times. Nurses felt that observant patients unwelcoming and somewhat intimidating by patients. Over the had more extensive support from their communities past 25years, art and design have become recognized as key (synagogues and seminaries). Nurses cited the need to make ingredients in the planning and development of patient- minor accommodations to meet the special requirements of centered health care environments. observant patients, but that treatments were not compromised A great deal of research exists that demonstrates the in any significant way. importance of patient-centered design in health care Conclusions: There seems to be a need to enrich nurses’ environments. There is also an abundance of literature that knowledge regarding cultural, ethnic, and spiritual needs of supports the role of art in health care environments, however religious patients. We plan to develop an assessment it is generally anecdotal, descriptive and rarely critical. Some instrument for the religious and spiritual needs of our patients evidence exists in relation to the positive impact of art in the and their families. health care environment but the findings from these studies are questionable due to control and sample size issues. The value of art in health care stems from its ability to comfort, N953 console and sustain and it is thought to reduce stress and Travel insurance for recipients of bone marrow anxiety levels, and promote well-being and a positive mood. transplants: patients make sense of the system Although closely related concepts, art and design are quite M. Kenyon distinct and the presence of art, in particular, appears to have Kings College Hospital (London, UK) the potential to help patients in a more individual way. ‘Open Window’ (‘OW’) is a novel art intervention in the With reduced toxicity and improving survival, bone marrow treatment of patients with haematological malignancies that transplant (BMT) recipients are able and eager to restore has been available for the past year at the ‘National Stem Cell normal life. Transplant (SCT) Unit’ at St. James’s Hospital, Dublin Ireland.

S266 The aims of this intervention are to help patients who have had a SCT deal with being in a restricted protective Standardising care environment for 4-6 weeks and provide a sense of connection with the outside world in a relaxing and soothing environment. A research study is now being conducted using a randomised N956 control trial design. The purpose of this study is to measure Preparations for JACIE accreditation: what changes do the effect of ‘OW’ on patients’ psychological well-being and we need to make to haematopoietic stem cell donor explore their perceptions of how it influenced their experience assessment? of having a SCT. Patients undergoing autologus or allogeneic J. Sinclair, M. McGarvey, A. McPhelim, S. Taylor, K.W. SCT’s are randomized separately to either a control or Douglas intervention group. Using interviews, The Hospital Anxiety and S.N.B.T.S. Clinical Apheresis Unit (Glasgow, UK) Depression Scale (HADS) (Zigmond & Snaith 1983), The Distress Thermometer (DT) (NCCN 2003) and a single-item Accreditation by JACIE (Joint Accreditation Committee of questionnaire the primary outcomes being measured are ISCT and EBMT) is desirable, and will soon become patient-reported levels of distress, anxiety, depression and mandatory, for all European transplant centres. Our Unit is expectations/perceptions of their experience. Art practice and responsible for pre-donation counselling & medical theory relating to the project is also being studied concurrently assessment of autologous and allogeneic BM and PBSC with the National College of Art and Design. donors, as well as for actual PBSC collection. JACIE has issued detailed guidelines both for pre-donation counselling and assessment, and for stem cell collection. In preparation N955 for future accreditation, we have examined deviations from Identification of nursing indications in BMT these recommendations in the past, and how these can be emergencies/critical situations changed. G.M. Deiana, E. Cervetto, S. Calza, M. Cotrozzi, B.M. Autologous Donors: JACIE guidelines state that any stem cell Francesia, E. Ghibaudo, M. Matarese, T. Pastorino, R. Pau, collections must be processed through a quality-controlled IT A. Toscano, G. Zinfollino, G. Bisaccia system. To address this, all of our stem cell collections will be G.Gaslini Institute (Genoa, I) processed as blood products through the Blood Transfusion Service’s IT system. This requires all donors to have a blood Our study group has been formed to respond to the need of grouping sample processed through the BTS system at least facing effectively nursing emergencies and critical situations in 24 hours before 1st PBSC/BM harvest. We have taken transplanted children. advantage of the need for a pre-collection visit to introduce a We initially identified the following situations that can occur in system of mandatory donor assessment and counselling the ward: 1) emergency: immediate life threatening situation; several days before first harvest, and generally prior to 2) critical situation: possible worsening of clinical conditions; mobilising chemotherapy. This has been enormously useful in 3) latent critical situation: preventive nursing intervention identifying potential problems which might arise with the (patient monitoring) in the absence of immediate worsening of donation process (e.g. donors on long-term anticoagulant clinical conditions. therapy, or donors with carer responsibilities). We also find We subsequently identified the most frequent situations: 1) that are donors are better informed and consequently less shock: septic, hypovolemic, cardiogenic; 2) bleeding: internal, anxious when they are seen for the actual PBSC collection, external; 3) acute respiratory failure; 4) seizures: febrile, and have had positive feedback both from donors and from toxicologic, organic. referring clinicians. On the basis of symptoms, we identified for each situation in Allogeneic Donors: When a donor is selected who does not the different health care plans: 1) who should intervene; 2) meet the normal donor selection protocol of the local what instruments should be used; 3) which modalities should institution, JACIE recommends “documentation of the be chosen. rationale [for donor selection] and of informed consent of Doctors and nurses contributed to support and validate health donor and of recipient". Our Unit already has a detailed S.O.P. care plans based on this classification. on donor selection. Internal audit showed that 11% of The correct application of health care plans requires the transplants over the preceding 3 years had used donors falling following: outwith our own selection criteria. We have now developed a - adoption of periodical check lists of resources and materials detailed counselling and consent process to be used in such required; cases, including documentation of the written consent of both - adoption and maintenance of a psychological approach donor and recipient in the full knowledge of the circumstances. tailored to the characteristics of the child and his family even Conclusions: Preparation for JACIE accreditation involves a in emergency/critical situations, the child being conscious or substantial workload, but can also lead to real (and sometimes unconscious, in case of need of transfer to the intensive care unexpected) benefits in donor care. unit. Objectives: improvement of nursing care in emergency/critical situations with more rapid and effective interventions; N957 improvement of skills of new personnel or with less JACIE accreditation process and Czech and Slovak experience in emergency/critical situations. National EBMT Nurses Group E. Bystricka, S. Vokurka University Hospital (Pilsen, CZ)

Introduction: the JACIE accreditation represents a process with standards focused to promote quality of practise in haematopoietic progenitor cell collection, processing and transplantation within the EBMT centres. All the requirements and guidance to become JACIE-accredited are provided in JACIE Standards book and Manual. Alongside with the „Quality management“ the accreditation process comprises three main issues: 1) clinical transplantation, 2) stem cells management and donorship, 3) progenitor cell processing. The clinical transplantation section and standards B3.700- B3.800 deals with minimum requirements on nurses and other staff. Any centre applicating for JACIE must be able to prove

S267 and document to have: 1) staff (nurses) trained and to all ward managers and junior sisters for dissemination to experienced in management of transplant, resp. haemato- nursing staff. oncological patients, 2) established specialised training and education that provides competencies for the staff, 3) written nursing procedures, 4) other staff available to support the N959 centre – transplant coordinator for both patients and donors, A collaborative approach to mobilising autologous stem dietary, pharmacy, social service, physical therapy and data cells: regimes, outcomes and clinical issues management staff. Compliance with JACIE´s requirements is T. Rintala (1), L. Ritchie (2), S. Goodwin (3), D. Kennedy (3), a marker of quality of the accredited centre. O. Keane (4) Objectives: 1) to provide and document regular attendance to (1)St Bartholomew's Hospital (London, UK); (2)The Royal courses, conferences, on-the-job-trainings, etc., that are Free Hospital (London, UK); (3)King's College Hospital focused to our cohort of patients and to related treatment, (London, UK); (4)Guys and St Thomas' NHS Foundation Trust nursing and problems. 2) to document existence and use of (London, UK) written policies for nursing procedures - SOP. 3) to document an established system of quality management - audits, Background: National and international directives such as the inspections, errors detection. 4) to have other necessary staff Medicines and Health Care Products Regulatory Agency available at the centre and to document their relevant (MHRA) and the Joint Accreditation Committee for Ishage and competencies. EBMT (JACIE) put forward that quality management; Suggestions: a working group has been proposed to be standardisation and evidence-based practice are essential for established within our national nurses group to start all UK bone marrow transplant (BMT) programmes. These evaluating current status at each individual cooperating centre accreditation processes address not only the clinical and in respect to the goals mentioned above. In case of any laboratory components of the BMT programme, but also the insufficient situation at any of the centres, the group will help collection facilities. Recent developments regarding service to find solution and provide relevant supplements and know- provision in London have seen a number of facilities merge. how. This has further enforced the need to standardise clinical practice. Methodology: The London Apheresis Working Party (AWP), N958 initiated in 2004 to provide a collaborative forum to address An audit to assess staff knowledge regarding blood apheresis practice issues, audited consecutive peripheral transfusion administration within haemato-oncology blood stem cell collections (PBSC) undertaken in four London J. Gray, D. Palmer transplant centres between January 2004 and December University Hospital Birmingham (Birmingham, UK) 2005. This was a retrospective audit reviewing autologous mobilisation regimes and outcomes. A questionnaire was sent to 118 nursing staff of all grades and Results: The most commonly used protocols included G-CSF looked at training, consent, and labelling, patient information, alone and Cyclophosphamide in combination with G-CSF for checking procedures, administration procedures, patients with multiple myeloma. It was noted that there were observations, complications, signs and symptoms, disposal differences in dosing and timing of the G-CSF. The regimes procedures and documentation / reporting of adverse used for mobilising stem cells from patients with lymphomas reactions. There was a 28% response rate. were even more diverse. These included IVE, ESHAP, Ara-C Only 61% of nurses had received training regarding any and VP16-Ara-C. A further issue raised was the use of aspect of blood transfusion. Written consent is not required, pegfilgrastim. 88% of staff correctly answered this. The majority of nurses Conclusion: This review highlighted the differences in (88%) felt it was responsibility of the person taking the blood preferred regimens and the challenges of reaching consensus sample to ensure the tube was correctly labelled; this should in standardising protocols. These included the challenge of have been 100%. overcoming clinicians’ preference and adapting generic 84% of nurses did not mention giving the Blood Transfusion protocols for site-specific use. Despite the differences in Service leaflet, about blood transfusions, to patients when clinical practice, a collaborative approach has allowed for providing information. Similarly 88% did not identify informing apheresis nurses to address the practical application of patients about side effects they could experience. mobilisation regimes. If a number of different regimes have Identification of appropriate checks was unsatisfactory, with comparable outcomes, it is an opportunity for nurses to only 84% of nurses correctly identifying name, date of birth advocate regimes that are ‘patient-friendly’ in terms of logistics and registration number as patient identity checks. Only 3% and utilising an ambulatory care approach to mobilisation. correctly identified additional blood bag checks of Blood This has implications for nursing time, bed occupancy, cost group, Expiry date, Donation number, Cytomegalovirus (CMV) and ultimately patient satisfaction. status and Rhesus factor. Two charts were included for completion. The first a Blood Group compatibility, the second a Rhesus factor compatibility. N960 63% and 53% respectively completed these correctly. CML as "novis" patients: an intervention approach for There was a wide variation in frequency of blood observations enhancing adaptation to the transplant process although all practices were safe. Identification of complications E. Rom, H. Schimmel / signs and symptoms was generally poor with only 59% Sourasky Medical Center (Tel Aviv, IL) identifying anaphylaxis as a complication. The documenting of adverse reactions was deficient. There The patient, a 27 years old athletic, law student, arrived in the was clear confusion between intensity of adverse effects and emergency room suffering from severe headaches and serious adverse effects, including which required reporting to leukocytosis (blood count 100,000). A later bone marrow Serious Hazards of Transfusion (SHOT). aspiration showed CML in its chronic phase. The results raised concerns regarding theoretical knowledge This bad news was a turning point in the patient’s life. of blood transfusion administration and prompted a number of After 4 years of intensive follow up in the outpatient clinic, actions. Training days have been set up under direction of the treated by Blood Transfusion Nurse Practitioner with annual updates for IFN, Hydrea and later on Glivec, the disease indicated a all nursing staff. Blood group and Rhesus factor compatibility transformation to the accelerated phase. During this period an charts have been issued to all wards for display in treatment unrelated donor was found for the patient. rooms. Flow sheets identifying clear guidelines for reporting It is important to emphasize that throughout this time, the and documentation of adverse reactions have been circulated patient lived a notably productive life. He graduated from law school, began a new business, married and became a father.

S268 During the preparation period for the transplant and required follows the child during several weeks together with the BMT isolation, several difficulties emerged that illustrated significant team. differences relevant for patient preparation for the transplant A combined role of clinical nurse specialist and coordinator process. certainly is optimizing continuity of care in an autologous and The care team identified major differences between patients allogenic bone marrow transplant program. awaiting transplantation: - CML patients are usually "de novo" in terms of adaptation to the disease and its relatively "easy" treatment during the N962 chronic phase, unlike other patients. Autologous and low intensity BMTs based within the - Lack of hospitalization experience or intensive chemotherapy ambulatory setting; audit results of an ongoing pilot treatment and its side effects prior to the transplant leads study many CML patients to be unaware of the potential P. Statham, C. Demosthenous ramifications of such situations. University London College Hospitals (London, UK) - The CML patients’ perception of being " healthy" (fully functioning, positive body image and high quality of life) can Background: The intensive nature of autologous and low affect compliance during the required stage of tests, as such intensity allogeneic bone marrow transplants (BMT) has patients frequently express difficulties in psychologically historically dictated the need for inpatient monitoring and associating themselves with the sick role. These differences support. Various clinical drivers, including increases in patient led the care team to acknowledge the necessity of developing activity and advances in supportive care, now exist to a specific preparation program for CML patients prior to the enhance the transfer of such treatments to the ambulatory Allogeneic transplant. The specific program relates to their setting. An audit has been undertaken reviewing ambulatory unique needs in order to achieve adequate preparation for the practice, with a particular focus on BMTs, within the long and complicated transplant process. Haematology Day Care Unit at University College London The model will be presented in congress. Hospitals (UCLH). Within the pilot, treatments that are traditionally administered in the inpatient setting are delivered to patients in the ambulatory environment. Eligible patients attend the Ambulatory Care (AC) Unit daily for treatment and assessment, and while well enough, reside in a hotel 100 Innovations in care metres away form the hospital. Aim: The primary aim of the audit is to identify factors which maximise the use of AC in terms of BMT regimens and N961 hospital re-admissions. The unique role of the nurse coordinator in paediatric Objectives: bone marrow transplant unit • To define socio-demographic and clinical characteristics of I. Porat, R. Ofir, M. Ben Arush, R. Elhasid patients Meyer Children's Hospital (Haifa, IL) • To define patterns of usage of AC slots in order to optimise hotel occupancy Bone marrow transplant patients pose challenges to achieve • To determine potential transplant treatment days that continuity of care, as they have complex needs, care is patients may be hospitalised in relation to specific transplant chronic, and patients cross numerous health care settings. protocols Traditionally, bone marrow transplant centres have attempted Sample: So far, a total of 51 patients have been audited; 14 to meet patient needs by separating needs into preadmission, (27%) were female, 37 (73%) male. All patients fulfilled the AC inpatient, and outpatient period and by hiring two to three eligibility criteria and of the sample, 21 (42%) received a nurses to work within each of those time periods. BEAM autograft, 13 (25%) a melphalan autograft and 17 The unique role of nurse coordinator in pediatric BMT unit (33%) a low intensity allogeneic transplant. designed to meet the needs of patients along the entire illness Results: Preliminary audit results reveal that the median continuum. length of stay in AC for patients treated with a BEAM autograft The Nurse Coordinator accompanies the child and his/her was nine days. The median length of stay for patients who family from the time bone marrow transplantation decision is received a melphalan autograft was seven days. Of the low made. intensity BMT group, the median length of stay in AC was 11 1. The initial meeting includes meeting the child and his/her days. family and giving them an initial explanation regarding the Conclusion: To date, the pilot audit results illustrate that expected procedure treatments, including BEAM, melphalan and low intensity 2. Meets the donor and the cell collection team, and explains allogeneic BMTs may be delivered safely to eligible patients the cell collection procedure (including sensations and side based within AC. It is anticipated that ongoing audit data will effects of growth factors. enable practitioners to identify potential hospitalisation days in 3. Prepares the multidisciplinary team to receive the child in relation to specific BMT protocols. the Bone Marrow Transplantation Unit, composed of teachers, music therapists, national service girls, etc., who are responsible for educational and occupational activities during N963 the patient's stay Interpretation of leukaemic patients' experiences during 4. Instructs the child and his/her family regarding the isolation condition for BMT transplantation process, including the drug protocol, feelings G. Shodja e razavi, M. Rashidi, Z. Shahriary, A. Zaree and sensations during the preparation treatment and the Shariati Hospital (Tehran, IR) transplantation procedure, and side effects of chemotherapy 5. Instructs the family on how to keep the child busy during the Study is the outcome of interview with admitted patients about long stay – bringing toys, videos, various creative arts, isolation through phenomenology method as a qualitative maintaining contact with friends via the internet, drawing, research individuality at the BMT ward in Shariati Hospital. writing letters, etc SCT is a major treatment for selected hematologic 6. The Nurse Coordinator visits the child every day and is malignancies and solid tumors. Human stem cells are available to answer questions from the child and his/her family collected for transplant from circulating peripheral blood 7. As the time for discharge approaches, the Nurse (PBSC), umbilical cord blood or bone marrow. Although stem Coordinator contacts the community nursing team, to discuss cell sources vary, the common goal is cure. After a patient is preparations for required equipment and medications, and admitted in the ward for HSCT, the focus shifts to safety and survival. Most patients are admitted about 9 days before

S269 transplant for conditioning. Patients stay in isolation condition good counselling, discharge is medically safe and patients are in a special private BMT room, with a bed, TV, VCR, phone satisfied with this possibility. and private bath room. It is a special room in which provides a In 2005 we started a new research for satisfaction in patients. positive pressure environment to protect the patient from With this new research we aim to improve the quality of care infectious agent and to minimize complication associated with for these patients. transplant process and to test the feasibility of psychotherapy as a supportive intervention for BMT patients in isolation. Discussion: isolation condition is started with admission of N965 patient in the ward. Patients are faced with physicians and Using ultrasound guided techniques in central venous nurses who have worn gown, mask and gloves in the private catheterisation to improve safety in the presence of room without any direct contact. For infection control all deranged clotting and/or low platelets caregivers must wash their hands before entering and leaving L. Bishop (1), L. Dougherty (2) the room.The way that patients could connected out is (1)Guy's Hospital (London, UK); (2)The Royal Marsden telephone and visit their family through the windows by I- Hospital (Sutton, UK) phone through visit hallway. The door of rooms are kept closed at all times for maintaining positive pressure In the UK, ultrasound guided insertion is now recommended environment and minimizing the risk of developing infection for central venous catheterisation by the National Institute of during transplant. At this situation some patients believe that Clinical Excellence (NICE 2002). It can also be used to insert isolation means progress to wellness in spite of limitation for Peripherally Inserted Central Catheters, particularly when a them. It depends on cultural level of patients.At this time proximal, or upper arm, approach is used. Ultrasound not only nurses should pay close attention to shifts of need or behavior has the advantage of allowing the operator to check for vein and patients emotional needs. The patients may show patency but also allows the operator to visualise the vein depression, anxiety and panic attacks. during cannulation thereby increasing the likelihood of an Conclusion: Data supports the need for good hand-washing atraumatic, “first pass” procedure. There has been reluctance, for all caregivers as a means of control infections and this is a by experienced operators, to use ultrasound guidance in basic step of isolation and by elimination of gowns and masks preference to landmark techniques because new skills have to in care of patients undergoing BMT will save nursing time and be learned, in spite of the fact that anatomical surface hospital resources as well as eliminate one isolation barrier markings can be unreliable. The use of ultrasound in experienced by patients. Due to hygienic issues, isolation is haemato-oncology may be of even greater importance necessary but not to destroy psychologic condition or life style because central venous catheterisation is often performed in of patient. The most important goal of treatment is keeping the the presence of deranged clotting and/or low platelets in those balance between good psychology and physical condition of patients where avoidance of platelet transfusions are clinically the patient in isolation. indicated, for example those with Thrombotic Thrombocytopenic Purpura or those who are refractory to platelets. N964 The use of ultrasound guided central venous catheterisation Discharge of haematological patients in the neutropenic by two nurse operators was audited. Platelet count and INR phase were recorded at the time of catheterisation. The number of C.A. Weerman passes, volume of anaesthetic and any mechanical St. Antonius Ziekenhuis (Nieuwegein, NL) complications, e.g. arterial puncture, were recorded. Over 100 procedures revealed only one arterial puncture and all Introduction: Until recently, patients with an expected catheterisations were successful. In three cases no internal neutropenic phase longer than one week (after autologous jugular vein was visible either due to previous thrombosis, stem cell transplantation and after induction chemotherapy in lymphadenopathy or anatomical anomaly. If ultrasound leukaemia), usually stayed in the hospital during their visualisation had not been used, “blind” techniques may have neutropenic phase. In recent literature it appeared to be an resulted in traumatic procedures, as there was no vein to advantage to discharge these patients from the hospital, catheterise. In addition, studies of the neck anatomy reveal provided that there will be taken care of the following the internal jugular lying laterally to the carotid artery in only conditions; for the patient: good condition, psychologically 66-70% of cases, also increasing the likelihood of arterial stable, support at home from the caregiver, hygiene; for the puncture during landmark guided insertion techniques. hospital: within reach, possibilities for later admission. This audit confirms the NICE guidance to use ultrasound for Subject: During multidisciplinary meetings conditions were central venous catheterisation. The two operators were developed, necessary to be fulfilled both by the hospital and inexperienced in use of ultrasound but found it very easy to the patient, to make a discharge from the hospital possible. In learn the new techniques. Further study is recommended to 2003 we started the discharge of neutropenic patients fulfilling investigate if ultrasound guided central venous catheterisation these conditions. Counselling is given to the patients step by reduces infection rates. This seems likely if atraumatic, first- step by the different disciplines (haematologist, nurse, pass catheterisation rates are higher when ultrasound is used dietician). The patient receives a reference book with all the compared to landmark-guided techniques. given information. The patient visits the hospital three times a week at the short stay unit for a check up and if necessary blood transfusion. Results: From January 2003 until December 2004 25% of the patients included were discharged of the hospital. Medical Oral mucositis chart analysis demonstrated that the discharged group did not develop more complications than the admitted group of patients. From interviews with a selection of the discharged N966 patients we learned that they feel comfortable and safe at Improving oral care in transplantation: quality control of home, and the given information contributed to that. It is no oral mucositis assessment in the EBMT Prospective Oral problem to come to the hospital three times a week for a Mucositis Audit (POMA) check up. R. Stone, B. Quinn, S. McCann, N. Blijlevens on behalf of the Conclusion: In patients with leukemia who are treated with EBMT Mucositis Advisory Group autologous stem cell transplantation it is possible to discharge the patient from the hospital in their neutropenic phase in 25% Introduction: The multidisciplinary EBMT Mucositis Advisory of the patients. When taken care of certain conditions and Group is conducting a prospective oral mucositis audit (POMA) to evaluate the incidence and management of OM in

S270 30 European Stem Cell Transplant (SCT) centres. In the of vomiting and diarrhea episodes, total days of absence of universal, standardized OM assessment hospitalization, days of TPN administration, and need for guidelines, POMA assessors undergo on-site multi-media systemic analgesics were also documented. The study was training before study initiation to achieve consistent quality of approved by the local Helsinki committee. OM assessment using the WHO Oral Toxicity scale. Results: Statistical analysis using t-test, proved that carob Education around the key drivers for each WHO grade decreases significantly the mucositis level in the mouth space (erythema, pain, ulceration and alimentation) is provided. To (p = 0.0). T test proved that carob decreases significantly the ensure that the training provided has been successful and that amount of vomiting (p < 0.05). There was no influence on OM assessment data is being recorded correctly and amount of diarrhea or on the number of hospitalization days. consistently, a Quality Control (QC) evaluation of written data Regarding days of TPN administration and need for sheets was conducted. analgesics, no statistical significance was documented due to Methods: QC was performed by an analyst after OM confounder variables. assessment data sheets were available in 20 patients. Conclusions: Carob is an effective preparation for the Worksheets were selected from days where OM was likely to prevention and treatment of mucositis of oro-pharyngeal area. be present, e.g. day 5, 7, 9 and 12. The analyst used the key Since carob is a natural substance, it can be safely used drivers of OM grade provided on the data sheets to record during chemotherapy and radiation treatment in children their estimation of WHO score. The site score recorded was undergoing HSCT. compared to the analyst score. Results: Data from 5 POMA centers from across Europe were reviewed. In total, 21 patients with 3 or 4 worksheets each N968 were analyzed for a total of 82 individual data sheets. Results Oral cryotherapy to prevent total parenteral nutrition for revealed that 74% (61/82) of the reported WHO grades patients undergoing bone marrow transplantation correctly matched the QC grade, while 26% (21/82) were A. Svanberg (1), K Öhrn (2), G. Birgegård (1) incorrect. Of the incorrect assessments, 76% (16/21) differed (1)Akademiska University Hospital (Uppsala, S); (2)Dalarna by 1 OM severity grade and 24% (5/21) by 2 grades. The University (Uppsala, S) most common errors were related to incorrect recognition of the importance of pain, oral alimentation, or ulceration to Introduction: Mucositis is a major complication in intensive WHO grade. chemotherapy, which often necessitates total parenteral Conclusions: Oral assessment has not always been nutrition (TPN). While the side effects of the conditioning consistently and accurately assessed, therefore mucositis regimes vary with regard to degree of severity among may be underreported and undertreated. These QC findings individual’s and between transplant types, the gastrointestinal reveal that OM assessment training is largely successful, with (GI) toxicities have an immense impact on the short-term the majority (74%) of assessments recorded correctly. nutritional status of the transplant patients. Additionally, Measures will be taken to inform sites of the most commonly patients who have undergone allogeneic transplant (related or reported errors. An additional QC check is planned. POMA unrelated) are uniquely susceptible to graft versus host training demonstrates that appropriate education can help the disease (GvHD), which has both short and long-term SCT team achieve consistent OM assessment. The nutritional consequences. TPN imply an increased risk for multidisciplinary nursing, physician, and dentist Mucositis infections. There is a lack of knowledge concerning the effect Advisory Group plan to extend OM training to centres not of oral cryotherapy on nutrition for patients treated with involved in POMA in an effort to standardize OM assessment superintensive chemotherapy before bone marrow throughout Europe, thereby leading to improved patient care. transplantation. Objectiv: The objective with the present study was to evaluate if oral cryotherapy during chemotherapy may reduce number N967 of days with TPN due to less intensity of oral pain from Evaluation of carob efficiency for prevention and mucositis. treatment of oro-pharyngeal mucositis in children during Material and metod: All patients 18 years and older, who were bone marrow transplantation scheduled for bone marrow transplantation were included A. Levinzon, R. Ofir, M. Ben Arush, R. Elhasid consecutively and randomised to oral cryotherapy or routine Meyer Children's Hospital (Haifa, IL) oral care. A stratified randomisation was used with regard to type of transplantation. The number of days of total parenteral Oro-pharyngeal as well as gastro-intestinal mucositis remains nutrition was collected from the patient’s medical and nursing a significant clinical complication in children undergoing record. hematopoietic stem cell transplantation (HSCT) with or without Result: The result showed that fewer patients in the total body irradiation. Over the past decade, despite significant experimental group (41%) than in the control group (51%) advances in supportive care for patients undergoing HSCT, received TPN (n = 16 vs 20). There was a tendency to fewer management of mucositis remains marginally effective. Carob days with TPN in the experimental group (4.2 ± 3.9) compared is an evergreen tree with dark-brown flattened pods filled with to the control group (6.6 ± 4.8) among patients with soft pulp. Arab families treated in our department reported that autologous transplantation even though it did not reach a in their culture carob is known for its healing properties in significant level. The kreatinin level was significantly lower in severe oro-pharyngeal mucosal damage. In order to the experimental group at day 3-5, 9 and 9-21. document it scientifically, we decided to conduct a randomized Conclusion: Oral cryotherapy indicates that fewer patients are prospective clinical trial to evaluate carob efficiency for in the need of total parenteral nutrition (TPN) and that the prevention and treatment of oro-pharyngeal and gastro- number of days with TPN is reduced for patients treated with intestinal mucositis in children undergoing HSCT. superintensive chemotherapy before autologous bone marrow Methods: Between years 2000-2004, 54 patients (2-23 years) transplantation. were evaluated. There were 28 boys and 26 girls. Thirty eight patients (pts) underwent allogeneic HSCT and 16 autologous HSCT. The control group included 25 pts (average age: 9.8 y) N969 receiving the usual mouth-wash with Chlorhexidine and An effective approach in the management of oral Nistatin (15 pts underwent allogeneic HSCT and 10 mucositis autologous HSCT). The study group included 29 patients H.M. Vrehen, L.F. Verdonck, S. Kerkkamp, S. Teunissen (average age:7.4 y) receiving in addition carob ( 23 underwent University Medical Center Utrecht (Utrecht, NL) allogeneic HSCT and 6 autologous HSCT). Mucositis score was evaluated daily by treating nurses who used special Introduction: Oral mucositis is a nearly universal and often research instrument based on WHO staging system. Number severe complication following stem cell transplantation.

S271 Nurses are still making many efforts to minimize the side Questions are the following: effects of treatment and to prevent and treat oral mucositis. 1.do you find these prospects useful? yes, no, partially (YES Oral mucositis is a an acute, painful and often dose-limiting 42pts -97,7%, PARTIALLY 1pts -2,3%) toxicity and significantly affects functional status and quality of 2.do you find them difficult to understand? yes, no, partially life. (YES 1pts -2,3%, NO 42 pts -97,7%) Methods: In a Named Patient Program patients with 3.do you think the operator explained the prospect in a correct hematologic cancers undergoing high-dose chemotherapy and exhaustive mode? yes, no, partially (YES 42 pts -97,7%, with autologous stem cell transplantation were treated with PARTIALLY 1pts -2,3%) palifermin to decrease oral mucositis injury induced by 4.do you think it would be complicated to practise these cytotoxic therapy and total body irradiation. Palifermin advices? yes, no, partially (YES 1 pts -2,3%, NO 38 pts - stimulates epithelial cell growth through interaction with the 88,4%, PARTIALLY 4 pts -9,3%) KGF (Keratinocyte Growth Factor) receptor, which leads to Results: 43 pts have reply to questionnaire. increased thickening of the oral epithelium. Patients received Conclusions: The results evidence that the patients appreciate palifermin for three consecutive days before and after this mode of approach, adding also some suggestions and autologous stem-cell transplantation. Oral mucositis was comments. Our future target is to evaluate if one complete evaluated for 28 days after transplantation. Oral mucositis was and accurate information could reduce appearance of measured by the nurses using an assessment tool based on infections. the World Health Organization (WHO) scale to grade the level of mucositis. Difficulties with daily living such as eating and talking, or the need for parenteral feeding were also observed. Additionally, basic oral care for all patients on a regular basis had special attention. Results: Sixteen patients were treated with palifermin. Oral mucositis of WHO grade 2 or 3 developed in two patients. Only one patient had difficulties with food intake. Adverse events, mainly white film coating of the mouth and tongue, taste alteration, rash and erythema were mild to moderate and lasting approximately three to four days. Conclusion: Use of palifermin to reduce the incidence, severity and duration of oral mucositis was successful in hematologic patients receiving an autologous stem cell transplantation and N971 likely it can be associated with improved quality of life. Autologous stem cell transplantation for children with Continuous assessment and monitoring of high-risk patients idiopathic juvenile arthritis – the challenge for nurse and the use of oral care protocols are essential components specialists for the effective management of oral mucositis. The H. Harvey (1), M. Rowe (1), R. Wylie (2), B. Davies (2) development of a standardized assessment scale is also (1)Newcastle General Hospital (Newcastle upon Tyne, UK); recommended. (2)Royal Victoria Infirmary (Newcastle upon Tyne, UK)

The benefits of stem cell transplantation for this group of children are striking however preparing the child and family for Practice development the procedure has produced challenges for the bone marrow transplant and rheumatology nurse specialists. The BMT perspective: These children have usually had N970 several years of hospitalisation, pain, chronic immune The patient's point of view in being educated and in suppression, poor disease control, increasing disability and receving information: role of nurse associated side effects from treatment. However, despite the L. Orlando, M. Clerici, A. Babic, G. Cavedini, D. Laszlo, A. immune suppressive nature of their treatments they have not Alietti, A. Agazzi, A. Cocquio, G. Martinelli usually considered that they could die as a result of their European Institute of Oncology (Milan, I) illness. The child and family often feel that the BMT is too risky. Once the child and family decide on BMT the BMT unit In chemotherapy treated patients, especially in those patients then has to plan how they can accommodate the child’s which has been treated with HDCT, the subsequent disability within the isolation cubicle and how the staff can neutropenia and toxicity of anticancer drugs increase the risk care for them appropriately. of infections. The rheumatology perspective: JIA covers a spectrum of The nurse staff decided to improve the way of transmission of inflammatory diseases which are characterised by information for better quality of patient’s education. exacerbations and remissions. It is perceived that children From October 2004 to October 2005 we evaluated 46 pts with JIA will grow out of their disease and that its effects are submitted to EBMT; 24 male, 22 female, median age 47 mild. However 1/3 of children diagnosed will go into adult life (range 19-67). 42 pts submitted to high dose chemotherapy with active disease and many require joint replacement. with peripheral blood stem cells support, 4 pts underwent to Caring for a child with chronic disease has a massive impact allogeneic peripheral stem cell transplantation from HLA upon the family. The new developments in treatment enable related donors a reduced conditioning regimen . the child, family and rheumatology team to consider BMT as Each patient received the brochures concerning generic treatment for those with aggressive disease, which has not indications of hygienic and the specific alimentary indications responded to conventional treatment. to be adopted during the protective isolation period, for himself This presentation will highlight the challenges presented to and for visitors. The aim of the study is to evaluate the utility nurse specialists when preparing children with idiopathic of provided information and educational quality of nurse juvenile arthritis (JIA) for BMT and will demonstrate the activities. benefits of BMT to these children. Objectives: 1. Improving quality and way of information (optimise modality and the time of information); 2. Education of patients and their family in a correct nourish. All information material was submitted to patients’ evaluation by a questionnaire.

S272 N972 Since several neutropenic patients are admitted to the Autologous peripheral blood stem cell transplant for oncology/haematology unit via emergency department, and on crohn's disease: the need for detailed imaging and many occasions emergency-care nurses have contacted the assessment pre-transplant oncology/haematology wards to seek advice regarding the V. Bevan (1), R. Barrett (2), J. Hurst (2), S. Tueger (2), J. management of these patients, the group decided to Sanderson (2), M. Kazmi (2) disseminate information about neutropenia, and the (1)Guy's and St Thomas' NHS Foundation Trust Hospital associated complications targeting emergency-care nurses. (London, UK); (2)Guy's and St Thomas' NHS Foundation The group reviewed what the emergency-care nurses most Trust (London, UK) frequently asked. As a result the following three learning objectives were designed: High dose chemotherapy and Autologus Peripheral Blood To improve a nurse`s understanding of neutropenia Stem Cell Transplantation (PBSCT) have been used, as a To promote awareness of the need for prompt treatment of the treatment for refractory Crohn’s Disease, however there is neutropenic patient very little data on Crohn’s-related complications associated To enhance the care given to the neutropenic patient in the with the procedure. We report a case study of a patient with emergency department. refractory, progressive Crohn’s Disease who underwent a Once a week, for four weeks, emergency-care nurses of all PBSCT. The importance of assessing pre transplant co- grades were invited to attend a presentation about morbid factors and their impact on the patient’s recovery are neutropenia. At the start of each session the nurses were discussed. asked to briefly discuss what they knew about the correct A 40-year-old female was referred for transplant with a history management of neutropenic patient. This level of knowledge of predominantly upper GI Crohn’s with ongoing symptoms of was very variable. Each individual from the group then briefly pain, dysphagia, vomiting, and weight loss. She was refractory spoke on one of the following topics: to multiple lines of therapy and had a surgical history of pan- What is neutropenia proctocolectomy and ileostomy, and a series of hernia and How does neturopenia arise fistula repairs. Eight weeks prior to transplant she had How to recognise neutropenia undergone mesh abdominal hernia repair. Loss of appetite, How to treat neutropenia malabsorption and weight loss, were the immediate problems Who to contact for advice regarding the care of neutropenic prior to referral for transplant, and she had commenced a TPN patients program. The pre-transplant investigations were within normal The aims of the group are to identify risk factors for limits apart from an albumin of 16g/l and she proceeded to neutropenia and its consequences, to develop predictive stem cell mobilisation using GCSF followed by a models capable of identifying patients at greater risk for such Cyclophosphamide (200mg/kg) ATG (7.5mg/kg) PBSCT. a complication, and to guide and enhance nurses knowledge Crohn’s-related complications included diarrhoea, on being proactive and vigilant in looking after this vulnerable compromising stoma integrity, and cellulitis of the abdominal group of patients. wall with development of abdominal fistulae requiring The paper details the need for fostering and encouraging drainage. Subsequent imaging suggested a jejunal stricture, communication and on-going educationals needs of the which had not been visualised pre-transplant. Haematological emergency-care staff, encompassing both nurses & doctors, recovery was good but overall recovery was protracted due to and the role of audits to identify gaps in our practice. complications arsing from her Crohn’s disease. Long-term her upper GI symptoms have significantly improved, but she has undergone further abdominal surgery and she is now maintaining her weight on TPN. In summary, PBSCT in Crohns Disease can have a positive Donor issues effect on disease outcome and quality of life. Detailed specific assessment of the GI tract, in particular the small bowel, and overall nutritional status may help to prevent specific Crohn’s– N974 related sequelae. In addition, it may be prudent to avoid A retrospective study to determine the percentage and surgery or delay the transplant to allow for post-surgical degree of tetany experienced by patients undergoing healing to occur but clearly this may be difficult in cases of peripheral blood stem cell harvest rapidly progressing disease. The next stage will be to devise E. Dannie, J. Apperley, E. Olavarria a comprehensive pre-transplant assessment in collaboration Hammersmith Hospital (London, UK) with the dietician, radiologists and gastro-enterologists and evaluate transplant outcomes according to pre-transplant Peripheral blood stem cell transplant (PBSCT) is now widely disease activity and nutritional status. used to repopulate the bone marrow following high dose chemotherapy. Its safety and effectiveness makes it a preference in some situations above bone marrow harvest. N973 Harvesting stem cells via an Apheresis machine requires the Dissemination project on management of neutropenia recommended anticoagulant, ACD This however binds and febrile neutropenia in patients receiving calcium, sometimes resulting in tetany in some patients. We myelosuppressive chemotherapy currently perform 400-500 apheresis procedures per year for R. Haynes, L. Patterson, C. El-tohami, C. Tynan, M. Tan both fluid and solid tumours; we therefore undertook a study Charing Cross Hospital (London, UK) to establish the percentage of patients who experienced ACD toxicity, the degree of toxicity experienced, the time at which Inspite of a plethora of studies demonstrating substantial the toxicity was experienced. The results will help to review clinical benefit of colony-stimulating factors (CSF) in our current practice with the possible use of prophylaxis. myelosuppressive chemotherapy, with 60% expected Between June and October 2005, 86 patients who underwent incidence of neutropenia, it remains a major challenge for stem cell harvest were audited. Information was extracted doctors and nurses to contain and reduce morbidity and from our in-house apheresis database and apheresis flow mortality due to neutropenia and its complication including charts. 30 females and 54 males with a median age of 41.3 febrile neutropenia. (range 17-76) of which there were 14 donations for sibling With this in mind, five haem/onc nurses at Hammersmith allografts and 71 autologous collections Hospitals NHS Trust in London, UK attempted to look at this Result: 16 (20%) experienced mild tetany. Symptoms included on going challenge of combating the risk of infection-related tingling in lips, trembling of facial muscles, mild itching of face mortality/morbidity due to neutropenia in patients receiving and nose and mild feeling of nausea. All 16 patients myelosuppresive chemotherapy from the education angle. experienced perioral tingling, 2 also experienced facial

S273 trembling and 1 felt nauseated. Mild tetany occurred within N976 the first hour of the procedure and was readily corrected by A review of the stem cell donation experience: PBSC Calcichew. No other intervention was indicated. Of the 16 versus BMH donors patients who experienced toxicity there was no association L. Ritchie (1), L. Hartwell (2), L. Mayne (2), M. Gordon-Box between volumes processed, ACD volume infused, duration of (2), R. Duarte (2) the procedure age or the inlet flow rate and ACD toxicity (1)Royal Free Hospital (London, UK); (2)Anthony Nolan Discussion points: Research Institute (London, UK) 1. Although toxicity was not associated with the volume processed, 6 of the 14 patients had over 10,000 mls Peripheral blood stem cells (PBSC) are being increasingly processed (range 10120 – 14014). Should the ACD flow rate used in the allogeneic setting and are often preferred to the be reduced at commencement if it was evident that large bone marrow harvest (BMH) source. It is accepted that volume processing was indicated although transplant related mortality is similar in the two 2. Use of prophylactic calcium groups, chronic graft versus host disease is increased and 3. Are some patients more sensitive to ACD than others? disease recurrence is lower in recipients of PBSC. Generally, 4. Should calcium levels be measured the procedure and PBSC is indicated for patients with advanced disease, throughout whereas for patients with early-phase disease the two sources Implications for Nursing and Conclusion: It is evident that may give comparable results. It is common for the requesting good nursing care contributes greatly to the successful transplant centre to advise their preference. A degree of outcome of SCT, and specialist nurses now play a pivotal role fatigue and pain may be experienced regardless of the in the patient preparation pre SCT. The results of this study method because of either cytokine administration or has clearly indicated that a percentage of patients will aspiration. Ethically, it must remain the donor's decision experience ACD toxicity during PBSC harvesting, and whether to donate PBSC or undergo a BMH. although this may be an ongoing problem it will encourage To ensure that the donor's interests remain foremost, the specialist nurses to seek better understanding of the role of Anthony Nolan Trust asks all donors to complete a feedback ACD-A on calcium levels. This will help nurses to improve questionnaire. This addresses all aspects of the donation ways of preparation of patients pre procedure and encourage process including: the briefing process, the medical more in-depth discussion of the risk / benefits. And not only examination, the nursing care received on the day of the such studies are part of the JACIE requirement it will also collection, the general donation experience and any highlight pitfalls and contribute to nurse education in order to unresolved side-effects at one year. Between January and deliver quality care safely and effectively. December 2003, 223 volunteer donors (110 PBSC, 113 BMH) underwent harvest at three London facilities and completed questionnaires after donation. Of these, 77 PBSC and 76 N975 BMH donors completed a further questionnaire at one year Put yourself in the patient's shoes post donation. Statistical analysis comparing the feedback of M. Ek, M. Rademaker PBSC vs. BMH donors was performed. AMC (Amsterdam, NL) PBSC donors rated the nursing care they received on the day of the collection significantly higher than BMH donors. In Background: Put yourself into the patients shoes. The aim of a addition, 20% of BMH donors reported unresolved side-effects reflection meeting is to put ourselves into the patients shoes. at one year, compared to 2% of PBSC donors. These results Client oriented care means that you have to be able to put are encouraging as the demand for PBSC as the preferred yourself in the patients position. source of stem cells becomes greater. Further qualitative This is where the reflection meeting comes in. A reflection analysis identified four themes from the donors' general meeting is a group discussion with a selected number of opinion of the donation experience: altruism, the physical clients. The discussion leader asks the clients what they think effects and willingness to donate again, beneficence and the of the service that we provide. The staff involved with the co-ordination of the donation process. patients care is present at the meeting. Clients can be It is proposed that PBSC is not only easier to collect, allows patients, but can also be colleagues. But for our reflection for faster haematologic and immune recovery for the recipient meetings we chose donors as our discussion partners. After but may also have a better long-term outcome for the donor. the transplantation the donor is out of sight. In order to find out By undertaking this review, we are able to better counsel how the donor experienced the transplantation process, we donors on what to expect during the donation process and use a so-called reflection meeting. help them to make a more informed choice regarding the Objective: The aim of the reflection meeting is to become donation method. aware of the views of clients and staff Methods: An important factor of the reflection meeting is the preparation; a lot of effort goes into this. Firstly would be to N977 identify areas of concern. We know from experience that there A European survey of related donor care are certain areas in the donor process that deserve particular S. Clare, A. Mank, B. Stone, M. Davies, C. Potting, B. Quinn attention. We then made a selection within the donor group. on behalf of the EBMT NG We decided that donors, who underwent the transplantation process in 2003 and 2004, were to be invited to participate in Introduction: Giving bone marrow or peripheral stem cells the discussion. We invited 33 donors, sixteen of which requires significant commitment on the part of the donating accepted to participate. individual and raises many psycho-social issues around We also invited others who were involved in the donor informed consent and the wellbeing of individuals involved. process to participate in the meeting. These are nurses Whilst most unrelated donors benefit from standardised working within the hospital, nurses of the outpatients clinic, protocol guidelines, the care of related donors varies short stay and dialysis nurses as well as some of the medical according to the local centre. staff who were involved in the patients care. Objectives: The European Group for Blood and Marrow Conclusions: As a result of this meeting we have now Transplantation-Nurses Group (EBMT-NG) Research Sub- identified several items that need special attention in the Group wished to establish a baseline understanding of current future. A few improved projects have been initiated. European practices for related donor care. This included enquiring about informed consent, psychological care of donors and the extent of follow-up care. Methods: A questionnaire to collect data was developed by the research sub-group, then circulated for comment and amended. This was distributed at randomly selected sessions

S274 of the 21st meeting of the EBMT-NG in Prague and delegates N979 were invited to complete it. Completed questionnaires were From paper to laptop: electronic patient record in BMT collected and the data coded for analysis using a coding unit matrix developed by the research sub-group. S. Harrari, S. Ben Ami Results: The research group will present data gathered from Sheba Medical Center (Ramat Gan, IL) 76 respondents from 20 countries. 92% of the respondents indicated that their centres performed HLA typing and related The Bone Marrow Transplantation (BMT) unit is one of the donor counselling. 76% indicated that their centres had most challenging fields for oncology nurses. Today health guidelines designed to assess the fitness of related donors to care providers are facing the need for professional and high donate, with 64% of these being formal written guidelines. standard care for their patients. When centres were duplicated a removal criteria was Background: During the year 2001 "Sheba" medical center in established based upon the closeness of contact an individual Israel starts the process of computerizing the patient medical had with related donor care. The final results will be record. This software included the patient medical history, presented, taking into account this correction strategy. medical notes, nursing intervention and access to other Conclusions: The results represent(s) a comprehensive hospital services such as: imaging, hematological and assessment of current European practices and are useful as a biochemical laboratory, blood bank services, emergency room baseline for exploring the feasibility of developing ect. The transition was progressively and accompanied with standardised protocols for the information and care available technical and professional support. The BMT unit was one of for related donors. the first departments in the hospital to join this process which consisted on staff education and program implementation. The purpose of the current survey was to explore how the electronic patient record (EPR) influences the working environment in our unit and what were its advantages and Moving forward disadvantages among the staff. Twenty three questionnaires were distributed to 20 nurses and 3 physicians. 52% of the medical staff described the transition to a computerized N978 system as easy and 34% as very easy. Feasibility study of nasojejunal feeding in a randomised Most of the participants agreed that working with this new patient population undergoing peripheral blood stem cell program: transplant 1. saves time and enables providing care more efficiently E.E. Smith, M.C. Brown, M.B. Devaney, J.M. Davies 2. Prevent mistakes by receiving clear medical orders. Western General Hospital (Edinburgh, UK) 3. Improves communication among staff members. 4. The system enables the team members to get a complete Malnutrition is prevalent in patients undergoing picture of the patient’s condition. transplantation. Nutritional support of these patients is 5. Finally the systems improved the quality of care given to a challenging and there is a lack of published evidence on which patient. to base practice. Currently we initiate parenteral nutrition (PN) The participant pointed that using the EPR allows: easier and if 5% weight loss is experienced and oral intake is < 50% faster access to the over all past and present medical estimated requirements (%ER) for 3 days. We report a information, better follow-up of the patient, as well as better feasibility study comparing nasojejunal feeding (NJ) versus quality control and risk management. The EMR disadvantages current practice. showed unexpected technical failures and lack of customized 60 consecutive peripheral blood stem cell transplant patients program to the BMT special needs such as: (allogeneic and autologous) were considered for entry into the 1.assessment tools for symptoms management, study of endoscopically inserted NJ tube feeding versus PN. 2.patient blood transfusion status Patients were randomly assigned to receive NJ feeding from 3.Chemotherapy and other protocols regarding special day +1 versus oral feeding +/- PN. 25 patients declined information of transplantation process. randomisation, the reasons being anxiety about tube The system may be optimized in the future by building an alert aesthetics (7), the endoscopy procedure (9), other anxieties program warning for problems like allergies, drugs toxics and surrounding the transplant (6) and no reason given (3). 5 were other contraindications. excluded, three due to psychological evaluation and two due Conclusion: Electronic Patient Record (EPR) improved patient to recent gastro-intestinal surgery. care and nursing, medical and Para-medical management and Of the 17 patients randomised to NJ feeding 1 patient failed communication among the BMT units staff. tube placement and 1 patient withdrew from the study prior to endoscopy. Tube placement was uncomplicated in 15 patients. 7 patients were successfully NJ fed throughout the N980 transplant (mean duration 12.9 days). 4 patients did not Findings from an exchange between bone marrow tolerate feeding due to vomiting. 4 patients tolerated feeding transplant nurses from Zurich (CH) and Liverpool (UK) but discontinued due to tube blockage (2) and dislodgement B. Oulevey (1), S.J. Watmough (2) (2). (1)University Hospital Zurich (Zurich, CH); (2)Royal Liverpool In the PN group 1 patient relapsed prior to transplant, 1 University Hospital (Liverpool, UK) patient met 50% ER through oral diet, 4 patients successfully fed (mean duration 10 days) without interruption, 7 patients Introduction: Comparing practice can allow nurses to share had PN feeding interrupted due to line infection/displacement their experience, knowledge and standards of care. (3) or metabolic complications (4). Percentage body weight Background: In November 2005 a nursing exchange visit took loss, dietary intake, anthropometric measurements and place between the University Hospital Zurich, Switzerland and gastrointestinal toxicity did not differ significantly between the the Royal Liverpool University Hospital, England. The purpose two groups. was to compare practice in order to share ideas and NJ feeding is feasible but no feeding method is ideal, as both knowledge and to learn from the clinical practice of another NJ and PN have specific complications. We are currently Bone Marrow Transplant Unit. exploring the use of NJ feeding, using bedside tube placement Method: A nurse was chosen from each unit to spend time in conjunction with long acting 5HT antagonists. working together in each others environment to enable comparisons in practice and standards of care to take place. Findings: During the exchange many similarities and differences in practice were observed. The most obvious difference in practice between the two areas was the method

S275 and practice of isolation. It was therefore decided this would We chose this group, thinking that with time, these issues are be the focus for further examination. In both units patients are more matured and are dealt with more comprehension and nursed in isolation but utilising extremely different methods. In tranquillity. order to determine a research base for care a literature review The fact of overcoming a period with numerous challenges, was undertaken. Evidence was found to support and dispel gives the patients maturity to transmit to the nursing staff the methods used in each area. difficulties felt and the way to lessen them. Discussion/Conclusions: The exchange enabled us to We asked the patients if they had tried to clarify their doubts question and challenge our own practice and to share ideas with the staff, and the perceived availability and knowledge. We show in graphic form the main preoccupations and fears Despite the specialised nature of Bone Marrow Transplant experienced by these patients. nursing it is clear diametrically opposed practices exist, We are aware that the patients must be considered in their especially with regard to methods of isolation. A review of the globality and that no problems even secondary ones, should literature is controversial and there is a lack of empirical data be discarded. to support any one method of isolation. There is clearly a need We have used this data to create informative leaflets clarifying for further research in this area to enable best practice these issues, in order to help the patients verbalize their standards to exist. questions. Working together in such different environments was We have found this work highly gratifying, as it gave us the fascinating, educational, insightful and certainly a great possibility to improve the comprehension and quality of life of experience! the transplanted patient.

P986 Needs and fears of patients during the transplantation Supporting the patient process M. Conceição, A.L. Jesus Hospital Santa Maria (Lisbon, P) P984 Caring for the young adult with cancer Choosing a transplant as treatment for the malignant and non C. Barton malignant hematological illness carries a large variety of The John Radcliffe Hospital (Oxford, UK) reactions, changes in life styles and changes in the family dynamic. Patients and family may feel anxiety, fear, Erickson (1968) believed in young adulthood a person breaks depression, denial our even despair. Normally this kind of away from the family identity to form their own identity. During suffering is associated to the fear of the unknown. this period a person may experiment with many different Several patients submitted to blood and marrow transplants, identifies to find one, which suits. He saw this process as vital between October 2003 and June 2005, were interviewed with in order become a psychologically healthy adult. If this the following goals: identify needs and fears felt and process is interrupted a person may enter adulthood without a expressed during the hospitalization. The need of information sense of personal identity, which can lead to psychological and the fear connected to an uncertain future were the problems such as low self-esteem. A diagnosis of cancer can distinguished issues. interfere with young persons natural psychological Nurses are the ideal health professionals to intervene and development and therefore have a devastating effect in later support patients during this therapeutic process, once they life. In 1995 the Calman-Hine Report identified the complex have the possibility and privilege to be in the unique position needs of adolescent patients with cancer and recommended of being an immediate source of information. commissions of cancer services to provide specialist units. We believe that it's our professional duty to go some way in Many specialist adolescent centres care for patients aged meeting the patients needs. Education and elucidation of between 14-25 years of age. Personal clinical experience has doubts are the best way to minimize their anxiety and pain, to shown that young adults continue to be treated on adult wards secure a more active participation by the patient and to where they are often in the same ward area as elderly encourage not only physical but psychosocial adaptation. patients. The complex needs of the young adults often mean Based on this research it makes sense to us that a support that nurses feel ill equipped to offer psychological support to guide should be elaborated and implemented for the patients them (Woodgate 2005). This poster aims to act as a prompt to that are submitted to bone and marrow transplantation in our highlight issues a young person with cancer may experience. unit. This poster will look at the effects a diagnosis of cancer can have on a young persons life looking at how it effects a persons identity, sexuality, relationships with friends and P987 family and life plans such as career and education. Health, performance and psychosocial adjustment of haematopoietic stem cell transplantation in children K.S. Kim, S.E. Choi, J.N. Bok, S.Y. Lee P985 Catholic HSCT Center (Seoul, KOR) Reactions of transplanted patients to altered sexuality I. Maestre, T. Moreno, A. Jesus, L. Guerra, J. Fajardo Recently, pediatric stem cell transplantation is increasing. H.S.M (Lisbon, P) However, most of patients are suffering from a high degree of depression, anxiety and lowered self-esteem due to painful As nurses in a bone marrow/stem cell/transplantation unit, we invasive treatment for high dose chemotherapy, radiation have observed that sexuality is a theme seldom mentioned by therapy and admission. HSCT Survivors have experienced the patients. physical weakness, loneliness and isolation as well as The secondary effects of chemotherapy, anxiety, fear, physical symptoms. Especially, the psychosocial aspect of changes in body image, pain and the necessary isolation, children after HSCT is very important in health, performance predispose to sexual dysfunction. and psychosocial adjustment. We tried to investigate, with a small questionnaire, in patients We studied 48 children who are 4-17 years old at least 100 transplanted more than to two years before, with ages days after HSCT. We used Nine symptom checklist of EORTC between 16 and 55 years, what were the most frequent (European Organization for Research and Treatment of doubts and anxieties emerging, either before, during or after cancer Therapy) QOL-C30; fatigue, nausea and vomiting, the transplant procedure. pain, dyspnea, insomnia, loss of appetite, constipation, diarrhea and financial difficulties, Lansky scale (Physical

S276 performance) and K-CBCL (Korea-child behavior Checklist); noteworthy PC are Observation (18%), Handling of Social competence scale, Behavior problem scale. Specimens (12%), Monitoring Vital Signs (8%), Administering Results: The general characteristics were male 32 (66.7%), Medication (7%), and Presence (6%). (See Fig. 2) We have female 16 (33.3%), and median age 11 years old (range 4- also obtained other significant data, such as the fact that the 17).The diagnosis were AML 30 (62.5%), SAA 14 (29.2%) and percentage of psychosocial interventions in DdE is 35% as type of transplantation were unrelated SCT 23 (47.9%), sibling opposed to 32% of interventions carried out to attend to the allogeneic SCT 19 (39.6%), Cord 4 (8.3%) and autologous patient’s physiopathological issues; also, in terms of SCT 2 (4.2%). cooperation problems, the percentage of physiopathological In Nine symptom checklist of EORTC, fatigue (35.6) was the interventions is much greater (61%) than those used to attend highest and then financial difficulties (25.7), poor appetites to the patient’s psychosocial needs (2%). (12.8) and pain (12.6). The Play performance status ratings Conclusion: The nurse is the professional who detects the were 39 (84.8%) of Lansky score 80 to 100. patient’s and family members’ needs, which include their In conclusion, the major health problems of boy between4-17 fears, doubts and worries concerning the diagnosis, treatment years were fatigue and poor appetites. However, the physical and process of the illness. The nurse also provides care to the performance competence was affected to maintain active life. patient as a whole, taking into consideration his/her The psychosocial adjustment was high males and females. physiopathological needs as well as any psychosocial issues. However, the total behavior problem scale of females was Therefore we consider the nurse to be THE GUARDIAN OF very high. We suggest continuous assessment, focus in early THE PATIENT’S WELLBEING. detection and care for social adjustment post HSCT.

P988 Serious diagnosis: leukaemia, emotional impact R. Muñoz, I. Durán, V. de la Osa Hospital Virgen del Rocio (Seville, E)

Objectives: To underline those nursing interventions oriented toward emotional support of the patient and his/her family during Marrow Transplant treatment of inpatients at the Adult Clinical Haematology Unit in the Virgen del Rocío University Hospital (HUVR), Seville, Spain. Material and method: P989 Materials: Care plans for transplant patients in the Adult The impact of chemotherapy on employment status in Clinical Haematology Unit at HUVR; Nursing diagnostics individuals with lymphoma approved by the North American Nursing Diagnosis J. Horn, A. T. Shaw Association (NANDA) up to the thirteenth conference; NHS Grampian (Aberdeen, UK) Classification of nursing outcomes according to Nursing Outcomes Classification (NOC) and classification of nursing A significant proportion of patients undergoing chemotherapy interventions as per Nursing Interventions Classification (NIC). for lymphoma are of working age and are in employment prior Methods: Selection of nursing diagnostics oriented toward to diagnosis. emotional support of the haematology patient, of NOC results At present we are unaware of the numbers of those who and NIC interventions. continue to work during their treatment, and how this impacts Results: We have obtained 31 nursing diagnostics (DdE) and on their working life. As a result, there is no clear consensus 24 cooperation problems (PC). The most noteworthy nursing on what advice should be offered. interventions in DdE are Observation (15%), Presence (10%), This small-scale study seeks to explore the impact that Assessment (8%), Emotional support (6%), Active Listening chemotherapy for lymphoma has on employment. (5%), and Handling of Medication (4%). (See Fig. 1) The most Methods:All individuals presenting with lymphoma over a 12 month period were identified retrospectively.

S277 In order to gain a clearer understanding of the impact on · Create a trusting relationship so that the patient feels secure employment, only individuals of official working age, and who enough to express doubts about the treatment were receiving out-patient chemotherapy (i.e. who had the Patient education: ability to be working at the time) were invited to participate. · Information on illness and medication (possible side effects) Participants completed a questionnaire designed to explore · Dosage schedule of medication their experiences during this time. · Discuss what the expectation of the patient is Results: Behaviour modification: 33 patients were invited to participate and a return rate of 66% · Corrective feedback was achieved. · Formulating a written or verbal contract with the patient 5 patients(23%)had already retired prior to diagnosis. Social support: 12 patients(54%)continued to work during their chemotherapy · Enlist family support treatment. Of these, 6(50%) continued to work the same hours These methods are not standard, they are guidelines best and 6(50%)worked an altered pattern. applied within a multidisciplinary setting. 5 patients stopped working for the duration of treatment, one In conclusion it is important to improve patients' health by has not returned. addressing adherence. Creating a trusting relationship The qualitative data obtained from this small-scale study gives between patients and HCP's is crucial. a clearer insight into the many issues faced by the patient and Proposal: in patients whom poor adherence is employer when undergoing chemotherapy. suspected/determined a mentor (ward nurse) should be Difficulty in coping with side-effects of treatment, particularly appointed for weekly evaluations. When the patient is fatigue, were commonly cited. Emotional effects such as discharged this function can be taken over by the care- stress and anxiety were also alluded to. managers. Despite this, those who continued to work reported benefit from retaining a normal lifestyle, support from co-workers and the diversion of focus away from treatment. P991 Several who continued to work cited financial reasons for this Nurses and palliative care decision. E. Mourao, H. Martins Silva 2 patients went on to have an autologous stem cell transplant. IPO (Lisbon, P) Neither cited the transplant as having any greater impact on employment than chemotherapy in general. Introduction: At bone marrow transplant (BMT) units, nurses Conclusion: A clearer understanding of these issues can only frequently deal with patients who are dying or even with improve the level of support offered by the multi-disciplinary patients death. Many authors point out that the nurse’s care is team. This may apply to other patient groups in addition to influenced by their own concept of death. those with lymphoma. Aim of study: This is an exploratory study aimed to find out the The curative nature of many lymphomas demands that long- nurses concept of death and their opinions about palliatives term complications of the disease and treatment are fully cares, and to ascertain the difficulties and suggestions to addressed at the time of diagnosis. Social, economic and improve the caring of BMT patients. employment welfare are important issues, especially in a Methods: 3 interviews to nurses with two years experience in group of individuals who are likely to be long-term survivors. BMT units and 3 interviews with nurses with more than 10 years of experience To all of them was asked: 1- What death mean to you? P990 2- What’s the most important aspects of caring for these Take it or leave it? Patient adherence in taking medication patients? S.Y. Zulu 3- What are your dificulties? Leiden University Hospital (Leiden, NL) 4- What do you suggest to improve nurse’s care to these patients? The objective of this abstract is to present general guidelines Results: We made analysis of contents and the results, after for methods to improve patient adherence to taking prescribed evaluation of all the answers, are as follows:What is death for medication. you? (Question 1) Death is the end of life for 3 nurses (3n) On our haematology/bone marrow transplant ward 30 and was refered 7 times (7t); life step 4n refered for 1 t ; unfair autologus and 35 allogeneic transplants are performed per 5n in 2t; and for two nurses was something unknown. What year. An important part of treatment is correct consumption of are the most important aspects of care this patients? prescribed medication. In 2005 there were 2 cases on our (Question 2) To confort 6n refered 18 t; pain relief 3n six ward of patients who did not take their medication as directed times; to attend the moment of death and the terminal patient which resulted in several acute readmissions due to 8n for 15 times; to please the patients hopes and priorities 10 t complications (infections). in 4n; and enhance quality of life 1t in 1n.What are your A definition of adherence is "acting on a consensually agreed- difficult? (Question 3) Patient’s age 4n in 10 times (youngest upon plan that (the patient) may have had a part in designing, more difficult); knowing the patient for a long time more or at least accepting the importance of specific difficult to care 3n 10 times; low nurses graduation on actions"(Meichenbaum 1987.) palliative cares 3 n 6times. Suggest to improve nurse’s cares: Before presenting guidelines for methods to improve (Question 4) increase in the nurse’ s graduation 3n in 8 times; adherence it is important to understand possible reasons why psychological support by psychiatrics 2n in 10 times; patients might not take the prescribed medication. Some psychological nurses support 2n in 10 times; frequent health care professionals (HCP's) may label the patient as meetings with multidisciplinary team and talk about problems being difficult or uncooperative. with this patients 2n in 6times. According to the World Health Organisation (WHO 2003) Conclusion: Caring for terminal patients is a very difficult task, medical adherence is based on 3 pillars: patient information, and poses many concerns. A palliative care police lies in the motivation and behavioural skills. Influencing factors could relief from distressing, regarding the patients willingness, include mistrust of HCP's, inadequate education/counselling, easing of pain and /or enhance quality of life. Nurses had to poor social support/family instability, health beliefs, apathy or be more graduated to feel that they are able to care. Both pessimism and characteristics of the medication (unpleasant patients and nurses must have psychological support. side effects, bad taste). Dialogue between pairs and multidisciplinary team is Methods for improving adherence can be grouped into fundamental for good work. different categories: Communication: · HCP's must be flexible and willing to negotiate within reason

S278 P992 patients accepted the intervention program. For these Mourning: a dying process in my life patients, smoking withdrawal was well tolerated. Several R. Muñoz, I. Durán, V. de la Osa weeks after discharge, five of them were still abstinent. Hospital Virgen del Rocio (Seville, E) Conclusion: These results show the positive impact of a multidisciplinary intervention program to help this particular Objectives: To report on the manner in which the patient, her population to quit smoking. husband (our informant) and daughters handled the diagnosis of a serious illness such as acute leukaemia, which suddenly came into their lives, and how they dealt with the illness P994 ending in death as well as the mourning process one year Care for relatives after a bereavement later. S. Eldor, L. Gustaffsson, E.M. Stenling Material and methods: Biography of our informant after an in- The National University Hospital (Oslo, N) depth interview. Results: We have obtained the narrative of a life-experience in Introduction: Research and practice indicate that losing a our informant’s own words, regarding the diagnosis of his relative can lead to symptoms such as exhaustion, burn-out, wife’s serious illness, the evolution thereof culminating in her fatigue, sleeplessness and weight loss. Research stresses death 11 months later, and his experience of the mourning that caring for bereaved relatives can help them to deal with process until the present day, one year after her death. grief. At the Haematology Department, staff encourages Conclusion: relatives to be with the patients throughout the period of 1. I am enormously surprised by the repercussions on medical treatment. It is an important task for nurses to support people’s lives caused by the manner of giving a serious the relatives as well as the patient. diagnosis. Objectives: The main objective was to develop an evidence- 2. Also, if the group of people who comprise a family unit is based program for the follow up of bereaved relatives. To not taken into consideration, dealing with the illness can have date, the department has had no structured follow up of negative repercussions. In the present case, the daughters felt relatives. Another objective is to support relatives in their the impact of the diagnosis 11 months after it was given, grieving. Through conversation, they can ask questions about reacting in a manner which is logical and usual at the the illness and death, and talk about experiences and beginning of an illness. impressions from the time on the department. 3. As professionals, we are enabled to detect attitudes of Methods: Data collection was performed by sending unconcern (but never abandonment) or not attaching questionnaire to institutions in Norway and Sweden. The data importance to events, such as manifestly being unaware of was thereafter analysed and systemized. The program is the mother’s terminal illness. In this way, we can prevent based upon literature review and the nurses`clinical pathological mourning. experience. Nursing practice at other University Hospitals and Hospice in Norway was also examined, as well as material from The Cancer Association of Norway and a cancer charity P993 organisation. Many institutions cared for the relatives, but What can we do for our smoker patients in the isolation none had systemized follow up routines. Telephone- and room? personal meetings were held in order to exchange literature, N. Mezhoud, B. Geoffroy, L. Azizi, V. Mileur, I. Dudziak, S. documentation and experiences. Ouidir, A. Destal, F. Plassard, A. Bretel, P. Genet, D. Results: The work resulted in the development of a program Lefrançois for follow up bereaved relatives. When a death has occurred CH Victor Dupouy (Argenteuil, F) on the department, it is recorded. The relatives receive written and oral invitation to arrange a follow up conversation with the Design: smoker patients suffering from hematological relevant nurse and doctor. This conversation takes place after malignancies are compelled to quit smoking when they are four weeks, on the department or can be held by telephone. A hospitalized for aplasia following intensive chemotherapy. This written guide for the staff has been developed, which acute smoking withdrawal may generate many physical and describes the goals, planning and outcome of the follow up. neuropsychic troubles and may interfere with the quality of Conclusion: The nurses and doctors have had an increased care. focus on follow up bereaved relatives after the introduction of Objective The main objective of this study was to evaluate the the program. Clinical experience with the program, indicates benefice of a tobacco intervention program aiming to minimize that conversations with relatives require competence and that the nicotine withdrawal symptoms in patients hospitalized in staff is familiar with their roles. The Project-group is isolation room after intensive chemotherapy. responsible for implementation of the program and guidance Methods: at admission, each patient was questioned by the of staff if needed. nurse staff about his tobacco use. Smoker patients were offered assistance. 10 smoker patients were included in this study: There were 8 men and 2 women. Mean age was 50 (45-58). They were hospitalized in single room isolation for induction chemotherapy for acute leukemia or high therapy SCT and children with autologous stem cell transplantation for Hodgkin’s disease or non-Hodgkin’s lymphoma. Initially, nicotinic dependence was accessed by a tabacologist P995 by using the french adaptation of the Fargerström Tolerance Introducing paediatric shared records in a stem cell Questionnary. For a more precise evaluation of nicotinic transplant unit dependence and risks of secondary anxiety and depression, A. Wearing, H. Braggins, C. Mkandawire the Horn Test and the Demenia et Lagure Test were used. St Marys NHS Trust (London, UK) Prescription of medications such as nicotinic patches, gums, inhalers or tablets were offered to patients. During the entire We are a paediatric unit comprising of a Stem Cell Transplant stay, patients were regularly visited by the tabacologist and by (SCT) Unit, 2 general wards, haematology daycare, paediatric the pscychologist. Nicotinic withdrawal symptoms were intensive therapy unit and outpatients. regularly evaluated by the nurses allowing a prompt The SCT programme performs sibling SCT, matched / adaptation of nicotinic replacement therapy or anxiolytic mismatched and haploidentical SCT’s. drugs. In 2003 2 nurses from the unit started to investigate the Results: 1 patient was not evaluable because of early toxic feasibility of introducing shared records for all paediatric death. Another patient initially refused any assistance. 8

S279 patients up to the age of 16 including those going through a SCT planning meetings are held monthly whilst guidelines for stem cell transplant. supportive care were developed and are available on the This was introduced in January 2005 after many meetings intranet. with all professions working within paediatrics, the legal team, Shared records in which all health professionals write have clinical governance and medical records. provided a more unified approach. Reasons: Child Protection - the Laming Report (2003) was Results: We have successfully diversified available therapies published, reinforcing the importance of multi-professional including administration of: documentation within a single set of records to improve Anti-infectives (e.g. antiviral drugs (gangciclovir), antifungal communication and ensure that important information is not drugs (caspofungin and ambisome), pneumocystis missed. prophylaxis (nebulised pentamidine)). National Service Framework for Children (NSF) (2003) Therapies for severe graft versus host disease (GVHD) – e.g. advocates the importance of Children’s Records being monoclonal antibodies, and modalities to augment contemporaneous, clear and accurate. engraftment, e.g. CD34 selected stem cell top-ups and donor To develop inter-professional relationships, with each lymphocyte infusions. acknowledging the others input. Outcomes: Subsequently more services are available to Method: Nursing Care Plan Booklets were developed, families. It has enhanced the emphasis on planning for different ones for different areas: discharge from the initiation of the transplant process. Hence Stem Cell Transplant – including pre transplant and work up, the normalisation of family life can start. The nursing staff feel during the transplant and post transplant an being seen on the empowered with this widened scope of knowledge and day ward and beyond. expertise, which has been achieved using a cohesive Inpatients Care Plan Booklet multidisciplinary approach which has made a cost effective Day care Booklets contribution. Intensive Care Booklets Teaching was done in the 3 months prior to the introduction with all the nurses, junior medical staff and other Professions P997 allied to Medicine (PAMS) Facing the challenges of play in isolation All paediatric notes have an extra divider placed within them P. Askew titled “paediatric shared record” and all communication about Newcastle General Hospital (Newcastle upon Tyne,UK) the child is written in this section, all in and out patient records are filed in this section chronologically. Children are often referred to the unit in poor condition. They Outcome: A 3 month audit was carried out after introduction are frequently malnourished, have a history of long standing and the outcomes were: illness with previous hospital admissions, may have specific Improved care, which was evidence based and consistent developmental problems relating to their disorder and Improved communication frequently demonstrate developmental delay due to their Raised awareness of importance of documentation and previous history. The challenge for the Nursery Nurse begins patient records with assessing the child and formulating a plan to support their All risk assessments being carried out and discharge planning on going development that works alongside medical and being started prior to admission nursing interventions. This has the ultimate aim of aiding More efficient use of time and resources as little or no individual children to meet their developmental potential. repetition I have developed strategies and documentation to support our Model seen as very successful and to be implemented work. On going challenges during this process results from not throughout the trust only the child’s poor condition, but also the limiting nature of the environment. By using Play Plans, Play Diaries, developmental checklists and assessments we are able to P996 offer appropriate, structured, supervised play opportunities. Enhancing supportive care options for paediatric SCT This ensures that the isolated child/young person has: patients in a day-care unit • Normalised everyday experiences within this restricted C. Mkandawire, A. Wearing, M. McCloy environment. St Marys NHS Trust (London, UK) • An environment that encourages a positive learning experience. Introduction: The stem cell transplant (SCT) programme was • Regular assessments made to monitor progress and established in late 2001 at St Mary’s NHS Trust; we perform address any problems that may be encountered. SCT for children with haemoglobinopathies (thalassaemia, • Developmental goals and activities that encourage the sickle cell disease), bone marrow failure syndromes and achievement of these goals. leukaemia. • A Play Plan that encourages and relies on Family Centred Types of SCT procedures undertaken include sibling SCT, Care. matched/mismatched unrelated donor (UD) SCT and • A Play Programme that incorporates the knowledge and haploidentical transplants. skills of the Multi Disciplinary Team. Following in-patient stays that vary from 6 - 8 weeks, on It is my intention, with this presentation, to demonstrate the discharge, we aim to manage children as outpatients in our work we undertake within the Children’s Bone Marrow day-care setting. The period of transition helps to encourage Transplant Unit. My colleagues and I believe that what we do normalisation of family life and increases the confidence of within our unique environment could easily be transferred to both child and parents. any hospitalised child, particularly those with complex and Additionally there are cost implications in admitting children to diverse needs. inpatient beds – day-care is economically a better use of resources. Methods: We ensured adequate P998 resources/staffing/support/training were in place and new Psycho-education: preparing children before undergoing treatment/care plans devised. This was achieved using a haematopoietic stem cell transplantation multi-disciplinary approach involving senior medical/nursing A. Fidder, K. de Witte staff, Clinical Nurse Specialist for SCT, dedicated SCT LUMC (Leiden, NL) pharmacist, involving junior staff who are guided through the rationale for these processes. The child life professionals of the LUMC play a central role in the entire process of Haematopoietic Stem Cell Transplantation. Observing the child comes first, and then an

S280 assessment is made of the needs of the individual child, in order to design an optimal preparation procedure. Child life professionals of the LUMC have developed a concept of preparation to medical procedures in general, and also specifically for SCT. The goal of preparing a child is reducing anxiety, pain and fear and to teach the child coping strategies to deal with difficult situations Preparation entails the following aspects: · Making the child understand what is about to happen: explaining medical procedures, the goal of medical procedures, demonstrating the instruments used, the time, place, length and people involved in the procedure. · Learning to control the situation: teaching the child coping strategies to deal with the medical procedure, such as: relaxation, counting, distracting etc · Making the child comfortable with the situation by teaching the child to have faith in his own capacities. When designing a preparation procedure for children undergoing a SCT, various factors play a role: age, developmental level, personality, strengths and weaknesses, specific interests the child may have and its illness history. Parents are also consulted to learn what the child already knows and how their child can be handled best. Based on all information, the child life professional designs a workbook for the individual child, that contains the various stages of the SCT. Oral information is also given and more and more use is being made of specially developed instructional DVD's. In this fashion, the information given and the mode of delivering the information are tailored tot the individual child, hereby taking the child serious as a patient. Child life professionals have learned, through their long-time experience, that a sound preparation, tailored to the individual child, is crucial for the way the child handles the difficult and P1000 stressful procedure of SCT, because it is reduces stress and Evaluating pre-admission preparation for paediatric stem anxiety and gives the child a much needed sense of control. cell transplant in the home environment: the parents perspective M. Conboy, N. O'Brien, C. Lowther P999 St Mary's Hospital (London, UK) It's fun to brighten up my room S. Levy Introduction: St. Mary’s hospital has been providing Stem Cell Hadassah Hospital (Jerusalem, IL) Transplant (SCT) For children with a range of blood disorders, predominantly Children in an isolation room before, during and after a bone Thalassaemia and Sickle Cell Anaemia. Over 4.5 years St. marrow transplant are often unoccupied, bored and not Mary’s has performed 36 SCT’s (age 9 months - 15 years). stimulated for maybe weeks or months. These children are Psychological preparation of the child and family in the form of unsettled because the transplant process takes such a long information regarding the process has been clearly identified time. as a key component of care. Effective preparation empowers Our experience has taught that many children and their the child and family, reduces anxiety, enhances coping families consider their time in the isolation room as a "waiting strategies, and arguably improves family experience and period". patient outcomes. Within our unit information sources are We aim to reverse this thinking and change this period into a multidisciplinary, with unique emphasis placed on positive experience for the patient and their family. communication by nurse co-ordinator in the family home as Transplant rooms can be bland and colorless. We aim to bring opposed to the hospital setting. In order to optimise color and vitality through this poster. information giving to the children within the family she has Also we wish for the poster to excite and trigger experiences been joined by our Bone Marrow Transplant (BMT) Play for the child patient and their family. The poster is interactive Specialist. encouraging transplant children and their families to react and Aim: To investigate our pre-admission preparation procedure initiate different projects as prompted. from the parent’s perspective with focus on the home visit by Hadassah Hospital serves a multi-cultural population and thus the BMT nurse co-ordinator and Play Specialist. the poster has been produced in Hebrew and Arabic. Method: audit of preparation from parents perspective, using With the introduction of the poster into the isolation rooms in informal interviews (telephone) by a qualified staff nurse not our unit it has been acknowledged that the children are more involved in the pre-admission preparation process (to reduce occupied. The patients and their families take time to decorate bias). Number of families transplanted n=36, number of their room and involve family and staff in activities and families audited n=16, exclusion due to death of child during projects prompted by the poster. SCT (to avoid upset) n=5, exclusion due to living abroad (no interpreter) n=15. Results: Preliminary findings indicate that the information giving process is enhanced when performed in the home environment as opposed to a busy hospital setting. Parents have reported feeling more relaxed during the home visit therefore able to absorb more relevant details regarding the SCT process and ask appropriate questions. As intended,

S281 the introduction of the involvement of the Play Specialist in the allogeneic HSCT in children. First infant was transplanted in home visit has also enhanced the preparation experience for 1994, until now 26 allogeneic HSCT were performed in 20 the children, especially recipient and donor. It has been infants using 22 different donors. Conditioning regimen indicated that the home visits helps build the foundations of a differed according to donor and disease. Non-malignant positive therapeutic relationship between family, Nurse Co- disease predominates (75%) with severe combined ordinator and Play Specialist, which enables the transplant immunodeficiency syndrome (SCID) - 6x, malignant journey. osteopetrosis - 3x, Hurler disease -2x and familial Recommendations: Develop further preparation and explore hemophagocytic lymphohistiocytosis (FHL) - 2x, juvenile other opportunities for care in the home environment. Repeat myelomonocytic leukemia - 3x, other (CEP, WAS, ALL, AHL). the audit to include non-English speaking families before 5 infants were transplanted from family donors (matched returning to native country. siblings in 3, haploidentical parents in 2), 16 (75%) were transplanted from unrelated donor. 16 infants were grafted once, 2 infants twice and 2 three times. 15 children are alive, P1001 5 died due to infection (n=4) or veno-occlussive disease Length of in-patient care in children during the first year (VOD; n=1) median 110 days after HSCT. following haematopoietic stem cell transplantation – Case reports: 1. FHL, F/age 2 months, donor identical brother, single-centre experience severe VOD since day+1, engrafted at day+19, without signs D. Kafkova, P. Keslova, A. Pertlova, R. Formankova, P. of GVHD discharged day+34 into outpatient care, remains Sedlacek well 14 months after HSCT. 2. SCID, M/age 10 months, University Hospital Motol (Prague, CZ) matched unrelated donor (MUD), already 2 months on artificial ventilation for Pneumocystis carinii pneumonia, day+7 Since January 2001 up to August 2004 altogether 135 presented with sepsis (fever, cardiopulmonary instability, haematopoietic stem cell transplantations (HSCT) in 130 coagulopathy), day+24 extubated, day+30 acute GVHD grade children and adolescents (66x peripheral blood stem cells - II, at day+83 discharged to outpatient care, ventilated for PBSC, 62x bone marrow -BM, 5x umbilical cord blood, 1x BM sepsis 2 months later, suffers from repeated attacks of with cord blood, 1x BM with PBSC) were performed using autoimmune hemolytic anemia and hepatitis B, alive. 3. T-ALL unmanipulated graft at our transplant unit. Patients who (acute lymphoblastic leukemia), F/age 12 months, MUD, high underwent HSCT using haploidentical family donors were pre-transplant residual disease (MRD). Engrafted at day+21, excluded from this analysis. Our aim was to study the length suffered from acute GVHD since day+23, received preemptive of stay in hospital based on type of transplantation (graft, therapy for CMV reactivation, since day+60 gradual rise in donor) including period of pre-transplant conditioning. We also MRD and splenomegaly have appeared, mixed chimerisms calculated total hospital stay during first year post HSCT in was detected (10% of autologous signal), all resolved after patients after allogeneic transplantation as they often needed cessation of immunosuppression, nevertheless girl relapsed to be readmitted into hospital for complications related to 13 months after HSCT. After further chemotherapy she was HSCT. Age of patients at HSCT ranged from 2 months to 21 re-transplanted from the same donor. Post-transplant course years (median 8,9 years). Indications were malignant uneventful, discharged home at day+66, remains well, MRD diseases in 85 patients (65%; ALL, AML, MDS, EWS, NBL, remains undetectable 12 months after second HSCT. Care etc), 45 patients underwent HSCT for non-malignant disease about these patients before and after HSCT is very difficult, (SCID, SAA, FA, PNH, etc). 29 patients underwent autologous often they are transplanted in altered stage with active HSCT after myeloablative regimen (22%), 31 patients infection in majority using alternative donors, but HSCT underwent allogeneic HSCT from HLA matched sibling (24%) represents the only curative option. and 70 patients using suitable unrelated donor from registry (54%). 14 (10,7%) children were during post-transplant period transferred to ICU for artificial pulmonary ventilation where P1003 they have spent from one to 140 days (median 19). Four of 'Telling The Story'. The Bead Programme: a child's them (29%) were successfully extubated and have returned personal journey through BMT from ICU, 2 are long term survivors. Patients after HSCT were I. Cullen, S. Portnoy discharged to outpatient care after median of 30 days in St Mary's Hospital (London, UK) autologous, after 55 days in sibling HSCT and after 97 days in unrelated HSCT. Total length of hospital stay during first year Introduction: The Bone Marrow Transplant (BMT) process can post allogeneic HSCT was different and depended highly on be a long one. Children and their families often have the complications occurred in that time, varied from 35 to 241 incorrect perception that it is a single procedure. We explored days. From group of 130 patients (pts), 100 stayed alive and ways to change this misconception, by conveying the concept well (77%) with 21 pts (72%) after autologous, 28 pts (90%) of the BMT process being a journey. A large percentage of our after allogeneic related and 51 pts (73%) after allogeneic Transplanted children are non-English speaking, so a non- unrelated HSCT. Treatment, nursing and social care of these verbal approach was felt to be useful. We discovered the bead patients and families is very exacting as life threatening programme through several sources: the idea was published complications could occur even long time after HSCT and by The British Colombia Children’s Hospital (BCCH) and The readmissions and further long-term stays in hospital are not Royal Marsden Hospital, London, who reported using it rare. Further close cooperation of nurses, physicians, social successfully. A mother of a patient of The BCCH stated that workers, school and physical therapists is therefore essential children used the beads “as a tangible record from the child’s even after first discharge from unit. point of view of their extraordinary journey” (Mackinnon 2002). Method: Our Team agreed we should adapt the bead programme for Patients to record their experiences, an ideal P1002 non-verbal communication tool especially for non-English Allogeneic stem cell transplants in infants in Czech speaking children. The bead programme starts at the Republic (1994-2005), single-centre experience, case beginning of the BMT process by giving a length of thread reports (plastic for infection control purposes) with beads that spell A. Pertlova, D. Kafkova, B. Nagyova, R. Formankova, P. their name. Different beads represent aspects of care, Keslova, P. Sedlacek procedures, and feelings that are associated with the University Hospital Motol (Prague, CZ) transplant process. Each step; investigations, isolation, significant days, horrid days, hair We present our experience with allogeneic hematopoietic loss, is documented using the colour coded bead chart. The stem cell transplantation (HSCT) in infants transplanted in the Bead Chain becomes a visual acknowledgement of the child’s only center in Czech Republic performing since 1989 journey and a memento of this significant period of their life.

S282 To implement the bead programme we had to acquire funding P1005 to purchase consumables (including printing of information Sexuality and BMT/SZT: a patient information leaflets), this was undertaken by The Rays of Sunshine H. Mueller, D. Kuhnert, M. Schneider, H. Schoen on behalf of Charity. the German National BMT Nurses Group Results: Preliminary indications show that patients and staff find the bead programme a valuable method of Sexuality is one of the basic needs of the person. In the communication particularly for pre-verbal and non-English general public of our modern society the subject Sexuality is speaking children. Children are not just vessels to be filled constantly present in nearly all media and seems to be not with knowledge, on the contrary, they are active, longer a taboo. experimenting and learning from their experience at all times In the individual, private area, nevertheless, this subject is still (Landsdown & Walker 1991). The bead programme gives an covered often with inhibitions and taboos. This concerns the opportunity to learn and explore by expressing their personal patients as well as healthcare professionals like physicans journey through BMT in a creative way. and nurses. Recommendations; assisting other units to use the Bead After bonemarrow or stemmcell transplant nearly all patients Programme, collaborate in a multi centre audit. have changes in their physical or mental well beeing, caused References: Lansdown R, Walker M (1991) Your child’s by the treatment. Most of these changes have an effect - development from birth to adolescence. London: Frances directly or indirectly - on the sexuality of the patients. Lincoln Ltd. Within the national German BMT-Nurses Group an intensive Mackinnon DJ (2002) Patients draw a bead on bravery, The discussion about the subject "sexuality and stemcell Toronto Star, May 30, G14-15. transplant“ took place during the last years. Within the scope of this discussion the need of education and information for patients and nurses was recognized and the idea of the booklet was born. An editorial team co-ordinated the process of creating the Advancing knowledge booklet. A network of physicians, nurses and patients supported the work during the different stages of development. Editorial contributions and constructive criticism P1004 in addition to the texts made the Booklet understandable, Safety first! Are patients and their relatives aware of the attractive and easy to read. So a printable version was risks posed by the toxic medication they receive? developed in the course of the time. A. Devos, E. Mermans, K. Bal, G. Van Ackerbroeck, V. The main target group of the Booklet are the patients and their Janssens families. It gives easy access to information on the topic of Antwerp University Hospital (Edegem-Antwerp, B) sexuality and BMT. But it also encourages the Patients and their families to discuss this subject with their physicians, Patients undergoing transplantation for hematological nurses or other healthcare professionals. malignancies receive large amounts of chemotherapeutic For the healthcare professionals the booklet will be a baseline agents. Many data have been published about the side-effects to discuss the consequences of BMT on their sexuality with of these drugs for the patients and the possible effects on the the patients and their families. nurses and pharmacy staff handling toxic and potentially The publication of the booklet was supported and printed by teratogenic or carcinogenic agents. Two main hazards can be the (DLH) German Leukaemia and Lymphom Patient Support identified concerning the use of chemotherapeutic and other Group. potentially toxic agents like pentamidin, antiviral medication, etc. First, there are the dangers arising from the handling and administration of these drugs. Many transplant centres have P1006 biohazard procedures in place and much attention is paid to Thrombotic thrombocytopenic purpura and adequate training and education of the nurses. Second, and thrombocytopenic idiopathic purpura: so similar, yet so less obvious, are the dangers posed by the bodily fluids of the different patients undergoing the treatment with the toxic chemicals. M. Alamo Pulgares, M. Flores Barrios What is the risk of sweat, blood, vomit, stool, urine, and nasal Hospital Virgen del Rocio (Seville, E) discharge of a patient receiving chemotherapy or other potentially hazardous drugs for himself, the nursing staff, Introduction: Thrombotic thrombocytopenic purpura (TTP), relatives and the environment? and thrombocytopenic idiopathic purpura (TIP) are two It is important that the nursing staffs are aware of the diseases which involve a decrease in platelets, and although problems these bodily fluids can cause, and that the in principle they may seem very similar, they are very different necessary hygienic measures are taken. Training and in terms of symptoms, analytical data and the evolution of the education of the nurses is a hot topic and many initiatives disease. have been taken in this area. The cause of TTP is unknown, though there are factors The patients themselves have also to be made aware of the associated with its emergence such as pregnancy, the use of risks. Little attention has been paid to this in the past, other oral contraceptives, antineoplastic chemotherapy agents, and than the oral information the patients receive or through what human immunodeficiency virus (HIV). they pick up indirectly from the way care is handled by the TIP is an autoimmune disease in which antiplatelet antibodies nursing staff. Few hospitals have clear guidelines on this topic join to the platelets causing extravascular destruction, mainly and almost no patient information material is available. in the spleen. On our hematology ward we have started an information Material and Method: campaign directed at the patients and their relatives to make • Patient’s initial assessment sheet. them aware of the potential risk their bodily fluids mean for • Care plan for inpatients in the Haematology Unit of Virgen them and their surroundings, but without causing too much del Rocio Hospital, Seville, Spain, using nursing diagnostics anxiety. In this campaign information leaflets and posters are approved by the North American Nursing Diagnosis used to make these potential hazards understandable to the Association (NANDA) up to the thirteenth conference, patients in a simple and clearly identifiable way. The patients classification of nursing outcomes according to Nursing are advised of simple, but important, measures they can take Outcomes Classification (NOC), and classification of nursing themselves to decrease the risks of contamination for their interventions as per Nursing Interventions Classification (NIC). surroundings if applied correctly. • Clinical histories. The didactic material we developed will be presented at the meeting.

S283 Results: In care plans plan for inpatients at the Haematology P1008 Unit with TTP and TIP, we have obtained similar nursing The "from scratch" programme. Stem cell return: diagnostics and different interdisciplinary problems. administration, training and competence, haematology Conclusions: S. Piggott, C. McCaughey 1. Nursing diagnostics in both TTP and TIP are directed Belfast City Hospital Trust (Belfast,UK) toward controlling the disease; this includes changes in lifestyle (avoiding physical strain, protection against infections, Since the amalgamation of two Haematology services in 2001, etc.) in order to prevent the appearance of haematomas and there has been dilution of staff experienced in stem cell return. infectious processes, which may make the thrombopenia This has been compounded by an increasingly junior worse. workforce and motility of senior staff due to promotional and 2. One of the most frequent nursing interventions is developmental opportunities. There has never been observation, which is of the greatest importance in cases of formalised training in this specialist area for either nursing or TTP due to the seriousness of the disease, especially in the medical staff. Additionally, there is an increasing recognition first days of diagnosis. internationally of the potential risk attributed to stem cell 3. Purpura is a pathology about which society knows nothing, infusion (mild to catastrophic reactions) and a consequent and at the moment of diagnosis the patient suffers the anguish emergence in the literature of best practice strategies to of a serious diagnosis. The nurse’s role is very important in minimise and manage these complications. This programme helping the patient to overcome his/her fear at this time. is a nurse-led initiative which has transformed a clinical challenge into a timely developmental opportunity. The aim of this project, jointly led by a Practice Educator and P1007 Bone Marrow Transplant Co-ordinator, was to construct and Review of nursing knowledge for early recognition of develop a supportive education and training programme to symptoms of veno-occlusive disease equip nurses in Belfast, Northern Ireland with the necessary C. Bedlow, Y. Mahady knowledge and skills to be competent in the management of St Marys Hospital (London, UK) the stem cell administration, for allogeneic and autologous transplant patients. The training programme was supported by St Mary's Hospital provides a paediatric stem cell transplant the development of standard operating procedures which service which has performed 36 SCT'S for children aged were benchmarked against national standards to ensure between 6 months and 16 years. safety, clarity and standardisation of practice. This programme Many of these children have Beta Thalassaemia whichh are at is being monitored and evaluated to ensure training is meeting an increased risk of developing Veno Occlusive Disease the identified needs of patients and practitioners and is in (VOD)which usually occurs within the first three weeks of the compliance with governance and continuing professional transplant process. Symptoms include unexplained weight requirements. A communication network has been established gain and ascities coupled with clotting abnormailites and to inform stakeholders and for reporting work stream progress hypoalbuminaemia in severe forms of VOD. to management forums. The purpose of the study is to measure the effectiveness of Methods: monitoring for signs of VOD particularly the area around - A baseline assessment of current practice abdominal girth measurements. the need for education of - Development of standard operating procedures, an nurses caring for BMT patients has been recognised within algorithm, a programme of education, and a risk assessment the unit and therefore a questionnaire has been developed tool in relation to risk of adverse events which has enabled the development of a new care plan. the Evaluation: implementation of the care plan will hopefully help detect VOD - Follow up audit to measure changes in and satisfaction with symptoms earlier. at present we are currently auditing the practice effectiveness. - Recording and analysing adverse events and/or variances the goal of this project was to heighten the awareness among nursing staff of the importancce of VOD by implemeting a new care plan. P1009 the questionnaire was sent to all nursing staff within the unit to Family information leaflets: food restrictions post blood help highlight knowledge of VOD, how it is detected and the and marrow transplant significance of measuring weight and abdominal girth twice L. Young daily. Great Ormond Street Hospital (London, UK) The care plan then detailed the issues that were highlighted from the result of the questionnaire. a teaching session was Good communication between nursing staff, patients and also performed based on the issues and the implementation of families is essential. With nurses spending a considerable the new care plans, limited research has been available proportion of their time in direct patient contact it is clear that regarding the effectiveness of girth measurements. the giving of information to patients and especially families in From the analysis of the results to date the teaching sessions the paediatric setting forms a vital part of nursing duties. and care plans have been effective in raising awareness, this Written information, such as leaflets has been used to is especcially encouraging in view of the research which enhance such communications between patients, families and suggests that conditioning regimes where Busulphan is used nurses. Unfortunately a national audit in 1993 (Audit increases the risk of developing VOD. Commission, 1993) reported that written information for the early signs from the care plan are promising; however we patients was of poor quality and has been followed by a are awaiting a longer period of implementation to fully assess number of interrelated studies reinforcing aspects of the study. the effectiveness. The questionnaire suggested a lack of As with most patient populations, paediatric bone marrow comprehensive knowledge of VOD which has now improved transplantation (BMT) patients and their families have both across the unit. their own set of learning needs and barriers to learning making discharge planning often a long and complex process. With this in mind and the fact that discharge from a BMT centre is an extremely anxious time for patient and families we decided to review our patient information booklets at Great Ormond Street Hospital. In the UK the average reading age is approximately 9 years, yet evaluations of health care leaflets indicated a higher reading level is required to understand most of them (Alderson, 1994). In addition to this there is evidence that

S284 approximately 20% of the adult population may have limited 90% about the prognosis, 40% about treatment and literacy skills. secondary effects and 50% about physical care. Due to the nature of our clients, it was decided to produce On the basis of the previous results we elaborated monthly information leaflets around the area of food restrictions post meetings, with the participation of a physician and a nurse, in BMT, aimed at both the family/carers and the older child who a room attached to the Haematology department. The target was able to make his own meals/snacks. group are AL patients and their relatives. Bearing in mind that our client group covers a broad spectrum The meeting content was: blood components and their of literacy skills it was decided to pitch our leaflets at the function, ¿What is AL?, illness symptoms, diagnosis, average reading age 9, therefore hopefully including all. treatment, secondary effects, preventive measures and auto Although many people with low literacy skills have adequate care recommendations. intelligence they tend to have less well-developed skills in At the end of the meeting a satisfaction inquiry investigation reading, analysis and synthesis. Therefore the leaflets have a with six items, 5 closed items and one open was performed. mainly pictorial basis with simple plain language for guidance Results and Discussion: Forty eight people came to the and follow a traffic light system, enabling easy recognition of meetings. Sixteen were patients and 32 relatives. 58.3% of foods. them considered that they had poor previous knowledge level, The written information in the leaflets is not intended to the 22.99% nothingness, and only 2.1% consider that they replace the face to face contact with nurses, but it does mean had good level. that the patients and families have a reference point to use as 100% of them answered that they were satisfied with the a backup. Good information has been shown to reduce meeting, because they could express doubts and clarify anxiety and increase complianceThese leaflets with further concepts. In order to improve next meetings some people supportive information will form the basis of the poster display made suggestions as to use audiovisual support. being presented. Conclusion: The previous knowledge of the disease and its treatment of patients and relatives is low. All attending people positively evaluated the meeting program. P1010 The meetings can promote the individual capacity to confront The Human Rights Act (1998) in the paediatric bone disease. marrow transplant setting R.K. Lant Great Ormond Street Hospital (London, UK) P1012 Information seminar for patients about high-dose The Human Rights Act (1998) has been accepted by chemotherapy governments across Europe, and came into effect in Britain in A. Beylich the year 2000. This poster explores the significance of the act Klinikum Oldenburg (Oldenburg, D) for the paediatric bone marrow transplant (BMT) setting. The presentation will explore the conflicts occurring in practice Since 1993 high - dose chemotherapy with autologous stem particularly in reference to Articles 2 (the right to life), 6 (the cell transplantation has been performed with yearly increasing right to a fair hearing), 8 (the right to respect for private and numbers of patients in the Klinikum Oldenburg. In 1999 family life, for home and correspondence), 10 (freedom of occured the problem that regarding time the extensive expression and freedom to receive information without information of patients exceeded considerably the possibilities interference), 11 (freedom of association) and 14 (the right not of the daily routine on the ward. In order to do justice to the to be discriminated against in the enjoyment of these rights). patients and to answer the numerous additional questions of By drawing upon issues of consent, competence, siblings, concerned relatives, the idea of initiating information seminars compliance and limited research to inform best practice, for this target group was born. confounding issues will be highlighted and the role of the Nurses, the consultant of the transplantaion unit, a social paediatric nurse reflected upon with regards to their positive worker of the hospital, the psychologist of the department and obligation to secure these rights for the child. employees of the department of physiotherapy could be won The poster will allow the issues to be presented in an easy to for the project.The final draft was developed by all participants view format, showing direct links from the articles to practice, together with their particularly skilled workers and since 2000 and points of consideration for the BMT nurse. a quarterly preparation seminar concerning high - dose chemotherapy has been taking place for patients and their relatives. P1011 The presented poster relevant to the project gives an overview Information programme for patients diagnosed wiht AL of the history of the origin and the contents of the seminar, and their relatives first evaluation results and an analysis of the questions of how M. Mansilla Suárez, T. Peralta Lacambra many of the transplanted patients have been reached with the Oncology Catalan Institute (Hospitalet (Barcelona), E) seminar.

Introduction: Acute leukaemia (AL) constitutes less than 5% of the total malignant tumours. The pathology and treatment of P1013 AL involve a high tax of morbidity/ mortality. The health Educating nurses about sinusoidal obstructive syndrome worker set oneself up as a basic pillar when is necessary to M. Talimay inform the patient and the family about the illness, possible The Royal Marsden Hospital (Sutton, UK) complications and secondary effects, as well as to favour their psychosocial adaptation. The information helps them to turn Having worked in a 30 bedded bone marrow transplant unit for into active participants on the care of them and it can promote three years my colleagues and myself recognised that we a feeling of security and control. Although it is realized in a have come a long way with educating/supporting nurses to casual way, it is necessary further and to develop positive become specialists in disorders associated with transplant. I attitudes and promote habits and healthy conducts. felt however that there remained gaps in nurses' knowledge Objective: To evaluate the meeting program for information in regarding Sinusoidal Obstructive Syndrome (SOS). AL at Oncology Catalan Institute. Despite having very detailed Haemato-Oncology modules as Material and Methods: A previous transverse study to 20 AL part of our diploma and degree cancer nursing programmes, I patients was performed. Individualized interviews were carried felt there was still a theory practice gap remaining on our unit out in order to determine the interest areas of the patients. in relation to S.O.S. The 80 % wished to receive information about the pathology, Twelve months ago a formal teaching session was established on the unit. Once a week senior nurses, doctors,

S285 including microbiologists and haematology registrars have P1015 used this time to share their knowledge with more junior staff. Nursing care in granulocyte transfusions in haematology A teaching board was also established where nurses within patients during the neutropenic stage the unit could share their knowledge with colleagues. This P. van Hove created an opportunity for all members of staff to share their Leiden University Hospital (Leiden, NL) learning on a clinical aspect of transplant care. I took this opportunity to share my knowledge of S.O.S. Patients with haematological diseases are treated on the The teaching session included the following: haematology/bonemarrowtransplant ward. 35 allogeneic and 1) How a definitive diagnosis of S.O.S is made and the 30 autologus stemcelltransplants are performed per year. complications associated with neutropenic and During the neutropenic stage the patient can develop a life- thrombocytopenic patients. threatening infection. Based on the following criteria a 2) An understanding of the clinical presentation of S.O.S granulocyte transfusion is considered. including jaundice, pain, tender hepatomegally, ascitis, and Criteria: unexplained gain weight as well as elevation of bilirubin, - Severe granulopenia (<0.5 x 109 per liter) alkaline phosphatase, and gamma-glutamyltransferase - Progressive infection (GGT). - No response to antibiotics and antifungal treatments 3) The Anatomy and Physiology of the Liver - Bone marrow recuperation is only expected within a few 4) The Pathophysiology of the disease weeks. 5) Risk Factors associated with S.O.S Since 1998 23 granulocyte transfusions have been given to 7 6) The Incidence of S.O.S adult patients on the ward, varying from 1 to 6 transfusions 7) The Treatment and Prevention of S.O.S per patient. In the LUMC only related donors are used. Having received positive feedback from this teaching initiative, Unrelated donors are not used because it is impossible to find I feel that the increased awareness of this disease will a donor within such a short space of time and because of the improve nursing care, and ensure early detection of S.O.S so inconvenience for the donor (granulocytes have to be that this serious transplant complication can be addressed transplanted within 6 hours). The relative should preferably be and treated. HLA –identical, if not the search will be for a haplo-identical donor. The nurse is responsible for checking the vital functions and supporting the patient, anticipating and acting on short and long term complications and family support. Nursing Standardising care observations, interventions and the procedure of administering the granulocyte transfusion are described in a standard protocol. P1014 Short-term complications: Nursing care for critically ill patients after allogeneic - Allergic reaction transplantation of haamatopoietic cells at haematologic - Bacteriemie intensive care unit - Adult Respiratory Distress Syndrome A. Molcanova, M. Patorkova, K. Rejskova, M. Prochazkova Long-term complications: Institute of Hematology and Transfusion (Prague, CZ) - Graft versus Host Disease - Allo-immunisation against HLA and granulocyte specific Introduction: High level of contemporary medical treatment in antigens the field of haematological and intensive care is accompanied All seven patients who received 1 or more granulocyte with augmentation of special nursing care for critically ill transfusions came through their granulopenic phase and as a patients after allogeneic stem cell transplantation. Therefore result recovered from potentially life-threatening infections. special training and education for all nursing staff is needed. Conclusion: Nurses at the LUMC have an integral role during The special nursing care includes: the entire process of granulocyte transfusion and direct patient 1) Care for mechanically ventilated patients care. - differences of care in accordance with different ventilation regimens - special care for airways P1016 2) Care for patients with continual renal replacement therapy The autologous bone marrow transplant: adding years to - differences of care for different eliminating regimens life - care for intravenous catheters for dialysis M. Flores Barrios, M. Alamo Pulgares 3) Preventive approach for infectious complications Hospital Virgen del Rocio (Seville, E) - augmentation of hygienic regimens - prevention of nosocomial infections Introduction: The haematopoietic transplant is a relatively new 4) Prevention of decubital lesions procedure in clinical practice, which is constantly evolving. - use of antidecubital equipment Autologous bone marrow transplants are carried out in the - patient position changes isolation area of the clinical unit at Virgen del Rocío Hospital in - biochemical markers Seville, Spain. The average hospital stay in our service is 5) Exercise approximately one month. Therefore, it is absolutely essential - airways function targeted exercise to create an adequate care plan. - prevention of muscular changes – atrophy and contractures Material an Methods: - maintenance of optimal locomotive status • Compilation of data from clinical histories of transplant 6) Nutrition patients in our unit during 2005. - parenteral nutrition • Utilization of nursing diagnostics approved by the North - enteral nutrition American Nursing Diagnosis Association (NANDA) - biochemical markers • Application of interventions as per Nursing Interventions Conclusion: Comprehensive nursing care for critically ill Classification (NIC) patients after allogeneic transplantation provided according to • Evaluation of outcomes according to Nursing Outcomes introduced standard operating procedures is essential part of Classification (NOC) their medical care. • Creation of standardized care plans for Bone Marrow Transplant patients.

S286 Results: Care plans for Bone Marrow Transplant patients knowingly at high risk. If these patients are excluded, the TRM using the 5 most frequent nursing diagnostics and 5 is 3/38 (7.8%). interdisciplinary problems: Conclusions: Our results demonstrate relatively high TRM as 1 Nursing diagnostics: compared to the reported incidence of 2-5% TRM in the • Insufficient knowledge relating to care of catheters and literature in patients with a median age of less then 60 years. evolution of illness Nevertheless, the age as of itself should not be the sole • Deterioration of the mucous membranes of the mouth due to reason to deprive patients of transplant. Rather the decision oral respiration, dryness and immunosuppression should be based on the general condition of the patient • Risk of infection due to invasive tests or treatments, surgical (performance status ) and past medical history as well as the wounds (Hickman catheter, immunosuppression) benefit the patient might have from the transplant. • Risk of loneliness due to emotional deprivation, physical isolation, lack of contact with persons or things perceived as important P1018 • Fears relating to a particularly stressful situation, invasive Treatment of oropharyngeal mucositis after the high-dose treatment, sensory deterioration chemotherapy with stem cell transplantation 2. Interdisciplinary Problems: A. Grubisic • Plateletopenia-induced haemorrhage Military Medical Academy (Belgrade, CS) • Immunosuppression-induced hyperthermia • Chemotherapy-induced mucositis Introduction: Nurses role is well defined in the treatment of • Chemotherapy-induced nausea and/or vomiting hematological patients (pts). Concidering the fact that • Chemotherapy-induced diarrhoea, infectious processes oropharyngeal mucositis is one of the major side effect of all These interdisciplinary problems consist of 44 nursing treatment modalities ( radio or chemotherapy), and especially interventions. after the high – dose chemotherapy with stem cell Conclusions: transplantation (SCT) and that mucositis is connected with • Over the long period of hospitalisation, the patient is extreme morbidity on the one side and with infectious attended by a multidisciplinary team, in which the nurse has a complications on the other, than prophylaxis is crucial. fundamental role during the transplant and recovery Aim: Basic nursing responsibility should be prevention of such processes. problems. • The patient suffers great physical deterioration exacerbated Method :To educate pts about oral hygiene that means rutine by social isolation. The nurse is the professional who detects teeth brushing and rinsing mouth with either saline or mixture these needs and provides the emotional support which will of saline and sodium bicarbonate In the case of diagnosed help the patient and principal caregiver to bear this loneliness. mucositis when brushing is not possible it is nurses obligation • Observation is the main intervention, as it is a duty of to remove debris from teeth and tongue using saline and nursing to anticipate problems by observing signs and bicarbonate soaked gauze and if necessary to use local symptoms that may appear in order to avoid complications. anaesthetic according to institutional approach, as well to treat secondary infections with topical antifugal agents . Results: In our transplant center we have performed 26 P1017 transplantations ( 20 autologous and 6 allogeneic). Mucositis Autologous stem cells transplant in elderly patients have developed in 10 pts ( 38,46 % ), and all of those pts above the age of 60 have received more agressive conditioning regimens and D. Tchernjak, G. Sakharov, L. Froymovich, M. Reiner concidering allogeneic transplants, those pts who received Rambam Medical Center (Haifa, IL) Metothrexat in the GvHD prophylaxis also had severe forms of mucositis ( gradus III and IV). High dose chemotherapy followed by autologous stem cell Conclusion: Oral care according to strict guidelines seems to transplantation (ASCT) is a common procedure with curative be major part of nurses duties in this cohort of pts. In order to potential for some hematological malignancies. However, reduce mucositis incidence more attention should be based there is a dilemma as to whether elderly patients can receive on pts and stuff education, and early treatment maybe with this treatment in its optimal form and whether such therapy some new agents. could be more harmful than beneficial for them, due to their poor tolerance of the treatment and possibility of developing serious complications, which result in high level of transplant- P1019 related mortality. Granulocyte therapy for high-risk bone marrow tranplant Purpose: The aim of the study was to assess how elderly patients patients tolerate high dose chemotherapy (including major R. Morrell, H.E Broadbent complications and survival rate) and whether the age may be Bristol Royal Hospital for Children (Bristol, UK) considered a crucial factor for ASCT. Methods and materials: We evaluated medical history of 40 Granulocytes are key white blood cells for fighting infections. patients over the age of 60 (with the median age of 66.5 Conditioning for a Bone Marrow Transplant with years) who underwent SCT at the Rambam Medical Center chemotherapy and radiotherapy can cause prolonged over the last 3 years. 28 out of 40 were above the age of 65 neutropenia and the subsequent immune suppression that years old. We estimated the following parameters: disease needs to follow in order to control Graft Versus Host Diease. status before the SCT, the number of CD 34 cells/ kg Unfortunately this leaves the patients at risk of serious administered, day of engraftment, serious complications such infection. All bone marrow patients are routinely given broad as respiratory failure/ renal failure ect during 100 days post spectrum antibiotics, antivirals and anti-fungals, in a protective transplant, duration of hospitalization , survival or the date and environment, in order to support them until their new immune cause of death. The results obtained will be presented in the system begins to recover. database table. Granulocyte therapy is becoming a common and standard Results: Five out of 40 patients died during the 100 days post practise on our unit, as an additional protection during the transplant for a transplant related mortality (TRM) of 12.5%. transplant period, for patients that have had past fungal Most deaths occurred during the immediate post transplant infection, severe refractory bacterial infection and fever period (during the first 30days). The main cause of death was unresponsive to antibiotics and anti-fungal treatment. For the septic shock in 4 out of 5 patients and cardiac arrest in one. 3 patients requiring this therapy, members of their family and patients entered the transplant with chronic renal failure. close friends are invited to volunteer as granulocyte donors. Importantly, two of the deaths were in patients with primary There are standard operating procedures for all members of amyloidosis and cardiac failure, who entered transplant

S287 the transplant team involved in donor selection, work up, follow-up care, and facilitates a healthy, lively and safe collection and adminstration of granulocytes. environment through his supervision and presence. Since the use of granulocyte therapy on our unit, the number • The Nursing staff at the Transplant Unit plays a relevant of deaths related to severe infections has decreased. More role during each phase of the procedure, offers direct attention patients are now eligible for transplant who would previously to patients and discloses the proper education to both the not have been considered. Our poster presentation will aim to patient and his family, in order to avoid complications and illustrate the procedure of granulocyte therapy from donor promote/encourage self-care. selection through to safe administration of the cells on our ward. P1021 Checklist discharge interview for stem cell transplant P1020 patients Complications in the early post-BMT period R. Hoogeveen J. Ramirez Fernández, M. Mantilla Fernández, V. de la Osa Leiden University Hospital (Leiden, NL) García Hospital Virgen del Rocio (Seville, E) On the Haematology and Bone marrow transplant ward of Leiden University Hospital 35 allogeneic and 30 autologus Introduction: Complications occurring within the first 100 days stem cell transplants are performed each year. after bone marrow transplant (post-BMT) may be multiple and The care involved in discharging a stem cell transplant patient depending on known and well differenciated factors, with a is an important part of the course of the stem cell transplant. clearly established chronology. This includes a discharge interview with the patient during The most remarkable early complications are: which advice for home is given, and filling out a transfer form • Infectious: bacterial, viral and fungal etiology. for the outpatients' clinic and bone marrow transplant (BMT) • Graft-versus-host-disease (GVHD) coordinators. Before 2004 this used to fall under the • Gastro-intestinal: Nausea, vomiting, mucositis, diarrhea responsibility of the BMT coordinators. Since 2004 nurses on • Hepatic toxicity: hepatic veno-occlusive-disease (VOD) the ward have included this in their tasks. Nurses were first • Cardiac toxicity opposed to this new task mainly because they felt insecure. • Pulmonar toxicity Through developing the checklist and a procedure for • Renal and urinary tract toxicities conducting the discharge interview nurses were trained in • Graft syndrome their new task. The checklist includes: • Graft failure- graft rejection · A list of subjects on advice for home Materials: · Who needs to be informed about discharge • Clinical records/files • · Where the list has to be kept Nursing diagnostics approved by the North American · Information on how the discharge interview and checklist Nursing Diagnosis Association (NANDA) up to the thirteenth should be implemented conference • To promote the continuity of care, the checklist and transfer Classification of nursing interventions as per Nursing form is faxed to the outpatients' clinic and BMT coordinator. Interventions Classification (NIC). • In order to find out if the checklist was implemented in the Classification of nursing outcomes according to Nursing correct manner and what the nurses' experiences are in using Outcomes Classification (NOC) it, I held a questionnaire amongst nursing staff in October • Patient care regimen for patients attended at the 2005. Clinical Hematology Unit (Hospital Virgen del Rocio, Seville, Results from the questionnaire are: Spain) · 100% find the checklist clear and comprehensible Methods: Selection of nurse diagnosis, results and · 94% state that they always use the checklist for patient interventions performed. discharge Results: Care regimen implementation. · 82% find the subjects listed on the checklist clear 1. Elaboration of the following nurse diagnosis, each of them · 76% state that they always fill in the checklist and fax it to the with its corresponding results and interventions: right person. • Anxiety To find out if the checklist was actually used, I looked through • Fear the medical files of 20 discharged stem cell transplant patients • Nutritional impairment (deficit) from January 2005 to October 2005. In 70% of the patients • Oral mucose involvement the checklist had been used. • Skin involvement Conclusion: Nurses find the checklist a useful tool during the • Sleep disorders discharge interview with a stem cell transplant patient. The 2. Detection of interdisciplinary problems or in colaboration to majority of the nurses use the checklist in the correct manner. a common objective, as well as the interventions required to Nurses use the checklist in the majority of discharged stem solve each of such problems: cell transplant patients. 1. Infection 2. Mucositis 3. Nausea and vomiting P1022 4. Diarrhea Time and efficiency in blood ordering: a nurse's role 5. Pain J. Nicholls 6. Hemorrhage Avon Haematology Unit (Bristol, UK) 7. Dispnea Conclusions: As a multidisciplinary team it was felt that ordering blood • The aim of the nurses work is to minimize the inherent risks products for chemotherapy patients was rather a lengthy and and potential complications during the disease process, since time consuming process with many patients receiving blood the mortality and morbidity risks within the first 100 days after products late in the day. transplant are relevant, especially in allogeneic transplant. To clarify the problem areas a process map looking in detail at • The professional nurse organizes all of the care aspects the system of ordering blood products on the unit was carried provided before and after transplant as well as the proper out alongside an audit of usage. The main problems found education,coordinates the diagnostic procedures and the were: · SOP not consistently followed · High wastage with high cost

S288 · Poor documentation in both medical and nursing notes. P1024 It was therefore decided that a different method for ordering Ribavirin: why the fear? blood products was needed to both improve the patient and C. Mkandawire, A. Wearing, M. McCloy staff experience and reduce inappropriate use and wastage of St Marys NHS Trust (London, UK) b lood products. This was developed in two steps: The Stem Cell Transplant (SCT) programme at St Mary’s Step one performs SCT procedures including sibling, matched / Involved nurses taking a more active role in the ordering mismatched and haploidentical SCT. process: Nebulised ribavirin is the treatment of choice for children with Nurses are now testing blood on the ward via FBC analyser proven Respiratory Syncytial Virus (RSV) infection on our unit. and discussing results at morning handover with medical Nursing anxieties based on perceptions and unsubstantiated team. The nurse in charge is than ordering blood transfusions concerns regarding ribavirin were prevalent . required for that day by 10 am. The vulnerable SCT patients are nursed in rooms with positive Step two pressure ventilation.To allay staff fears and anxieties we have Development of a standing order for blood products. worked with the drug manufacturer, SCT pharmacist and A nurse led blood ordering service is being developed so that consultant virologist in order to initiate a programme of staff nurses can order blood products independently and therefore education and training, to revisit and enhance infection control is more responsive to patients needs. policies and thus minimise nosocomial transmission. Following the introduction of step one we have found that the Nursing staff are trained in the assembly and use of the small system of ordering blood is more efficient and documentation particle aerosol generator (SPAG) and additionally they are has improved. educated in risk factors which would lay a paediatric SCT As a unit we are monitoring and reducing wastage and patient open to RSV, i.e. early stage post SCT, Graft versus patients are transfused during the day. Host Disease (GvHD), systemic steroids.Viral surveillance of Step two is currently underway with the development of a SCT patients by nasal pharyngeal aspirate (NPA) is carried standing order. This is hoped to further reduce ordering time out during the inpatient stay if patients are coryzal. Regular and improve services for the patients and a re-audit will be staff teaching sessions are held on the unit .We have also carried out in 6 months worked to develop a protocol for the administration of ribavirin on this unit. With this ongoing programme of support aerosolized ribavirin P1023 is used successfully and safely in the treatment of RSV on our Oral mucositis as an important factor influencing early unit.Education, training and multidisciplinary (MDT) input have complications in patients after high-dose chemotherapy been key to bringing this about.Good infection control policies and autologous stem cell transplantation are constantly enforced. I. Przewozna, A. Harendarz, M. Komarnicki Clinic of Haematolgy (Poznan, PL) P1025 Oral mucositis is a serious complication of high dose A child in an adult care unit chemotherapy which may lead to pain, malnutrition and M. Bravo Garcia diarrhoea. Moreover, it remains an important factor influencing Santa Maria (Lisbon, P) infection complications in neutropenic patients. The aim of the study was to analyze the correlation between early According with the complexity involving bone marrow complications in patients after high dose chemotherapy and transplantation, we face supplemented difficulties, when such oral mucositis severity assessed by nurses. We present 20 procedure involves children. Even for the child, is a confusing patients (pts), median age 44 (22-66) years with non-Hodgkin frightening environment, to be undertaking a service where all lymphoma (11), Hodgkin lymphoma (3) and multiple myeloma is gigantic and hard to comprehend. (MM) (6) treated with high dose chemotherapy followed by A child is not a miniature adult;to the contrary, he has his own autologous haematopoietic stem cell transplantation characteristics which are normal to his age, having, however, (autoSCT). Two different conditioning regimens were used: the capacity to adapt to his environment, searching for modified DexaBEAM (dexamethason, BCNU, etoposide, balance. The role of health technicians is very important in the cytarabine, melphalan) in 14 pts with lymphoma and process of adaptation. melphalan in 6 pts with MM. The severe neutropenia lasted In the Hospital de Santa Maria having already been median 13 (9-23) days with no statistic difference between transplanted 616 patients from which 75 were children. lymphoma and MM pts group. All pts engrafted. The oral The disease and the bone marrow transplantation are not mucositis, which lasted median 13 (0-23) days, was classified prompt events, it is a long process and it is relevant to in four stage scale. The median time of fever in netropenic pts understand and to work out the situation, professionals need was 4 (0-14) days. Statistical analyses revealed that to facilitate the understanding of the child and teenager, but maximum stage of mucositis (p < 0.05) was positive we feel difficulties to reach such end. The difficulties felt by the correlated only with the number of days of total parenteral team are: nutrition, but the number of days of mucositis was positive Occupying free time: with an average of X days within a small correlated with the number of days of fever, antibiotic therapy, room, it is hard, even with some imagination to keep the child vomit and diarrhoea (p= 0.039, p= 0.001, p= 0.025 and p= occupied 24h per day. Also the physical space is not children 0.022 respectively). In addition, no correlation between the orientated, since they are destined to adults. We do not have number of days of severe neutropenia and number of days of entertainment material adapted to several growth stages that fever, antibiotic therapy, vomit or diarrhoea was found. we know are essential both for a healthy development and to Conclusions: Assessment of oral cavity mucositis performed adapt to the hospital environment. by nurses is a simple method which can be used to predict Psychological support: not having a permanent psychologist in severe complications after high dose chemotherapy and the unit, we are dependent of an occasional support which autoSCT. has to be requested. We miss support, not only for critical stages, but also for prevention. Support by the families: Depending of age and personality of the child, the absence of family can result in a variety of problems such as anxiety, aggressive.. aggravating the child’s health condition and creating a feeling of frustration within the unit.

S289 School support: According to Gonçalves e Valle the chemotherapy and on 3 days starting on the day of the interruption of school activities, for a child with cancer, has a infusion of cells, according to the manufacturer instructions. bigger significance than just the educational loss, since social Aim of study: We evaluated the severity and the number of isolation can interfere in the child’s life. This feeling added with days with mucositis, the opiaceous needs, the nutrition other problems lived by the child during treatment, such as support and the toxic effects of palifermin. We have matched fear of death, guilt, deep sadness, anxiety for procedures and this results with a cohort of homologous patients grafted in the pain, amongst others, can unleash a depressive state of being year before. making it difficult to adapt to the treatment. Results: 8 in 9 patients could complete treatment (one drop- We feel gratified by our performance, but there is an undying out for toxicity with severe hypotension related to generalized frustration, since we do not have the adequate means which oedema). Generalized rash with severe itch was observed in minimize such alterations, by which a child goes through. majority of patients treated with palifermin. A significant increase of weight has been observed in the day +3 of transplant. P1026 Mucositis of grade 3/4 was present in 3 out of 9 pts. Four Care of a skin infiltration: chloroma patients still required the use of morphine for pain control. I. Durán, R. Muñoz, V. de la Osa When we matched this results with the historical control group Hospital Virgen del Rocio (Seville, E) we found a decrease in mucositis grade 3/4 (3/9 versus 4/9) a decrease in the morphine need (4/9 versus 8/9). The number Objectives: To provide information about the care plan for a of patients that could maintain oral nutrition was higher in the patient diagnosed with Chronic Myelomonocitic Leukaemia, palifermin group (7/9 versus 5/9). presenting a skin infiltration: Chloroma. This patient was Conclusion: It seems that with the use of Palifermim the admitted to the Adult Clinical Haematology Unit in the Virgen mucositis is still a problem but there is a decrease of morphine del Rocío University Hospital (HUVR), Seville, Spain. needs. With Palifermin the patient could maintain oral nutrition Material and methods: for a long time. However, they have great cutaneous toxicity Materials: Specific care plans for inpatients at the Adult with generalized rash, with severe itch and a significant Clinical Haematology Unit in HURV; Nursing diagnostics increase of weight. approved by the North American Nursing Diagnosis Association (NANDA) up to the thirteenth conference; Classification of nursing outcomes according to Nursing P1028 Outcomes Classification (NOC) and classification of nursing Nutritional programme for patients suffering from gut interventions as per Nursing Interventions Classification (NIC). graft-versus-host disease after allogeneic haematopoietic Methods: Process of nursing attention to patient with Chronic stem cell transplantation Myelomonocitic Leukaemia, which evolved according to NOC M. Kondo, F. Yamada, M. Ouchi, M. Araki, S. Kamiya, K. results, with nursing intervention as per NIC. Koido, S. Kim Results: We obtained a care plan evolving over 4 months, National Cancer Center Hospital (Tokyo, JP) during which time the patient was hospitalised. Upon admission the patient presented an abscess in the puncture Background: graft-versus-host disease (GVHD) involving gut site for aspiration of bone marrow, which was 10 cm in is the primary reason for malnutrition and decreased QOL in diameter. Patient required surgical treatment and very painful patients who underwent allogeneic HSCT. With the lack of postoperative treatment. The lesion did not improve until solid guidelines for oral nutritional support, bowel rest by NPO chemotherapy was initiated; for this reason a diagnosis of until the release of symptomatic diarrhea had been the Chloroma (malignant tumour of the myeloid tissue, associated essential part of our care program, in expense of physical and with myelogenous leukaemia) was reached. emotional deterioration of the patients. Conclusion: This patient’s chloroma reached a diameter To overcome this, we tested the feasibility of early installation greater than 30 cm; thanks to the collaborative efforts of the of programmed oral intake in the course of gut GVHD. healthcare team, the patient was able to maintain cutaneous Methods and Results: The nutritional care practice for those integrity, as shown at later admissions due to a relapse in the suffering from Crohn's disease in reference, we attempted to patient’s illness. develop a sliding scale "GVHD diet" system composed of 6 steps with graded addition of quality and quantity assured nutrients, fibers and minerals. Meal form (fluid to solid) and P1027 personal preference are also taken into consideration. After Palifermin for the prophylaxis of mucositis the confirmation of gut GVHD, all patients with bloody stool or E. Mourão, E. Rodrigues, A. Neves, J. Couto, P. Vivas rapidly deteriorating condition were placed on NPO. IPO (Lisbon, P) Otherwise, GVHD diet was started based on the results of nutritional assessment with an indirect calorimeter and body Introduction: Mucositis is a debilitating side effect of high dose composition analyzer, and decision to step-up/down was chemotherapy, with a significant impact on nutrition and cause made according to tolerability and clinical parameters of important discomfort for transplanted patients. Mucositis including stool nature and volume of diarrhea. From July 2002 can affect all the gastro-intestinal tract, and ranges in severity to October 2005, 32 patients were enrolled into the program from soreness to need of opiaceous and/or total parenteral and 15 patients had started oral diet program. Although no nutrition. significant adverse event including worsening of clinical signs Until very recently only local measures were taken for and symptoms was noted with the initiation of GVHD diet, prophylaxis, with very limited action. nutritional parameters including serum protein and albumin Palifermin is a recombinant form of keratinocyte growth factor had stayed in lower ranges. Nevertheless, we observed a and several studies in animal models and in humans have tendency that body weight loss was slow, with improved described its effectiveness in mucositis prophylaxis. patient satisfaction and emotional status. From August to November 2005 we have used Palifermin for Discussion: Efficient accumulation of validated objective profilaxys of mucositis in adult patients with haematological parameters is essential for establishment of suitable clinical malignancies under autologous BMT. Nine patients (4 females guidelines and exchange of data worldwide. In our feasibility and 5 males) with a median age of 46.8 (range 27 to 56) have study, we defined current limitations of dieting program by been treated after signing informed consent. The predominant demonstrating that there was no improvement in laboratory diagnosis was Non Hodgkin Lymphoma and the conditioning parameters to indicate improved nutritional status. One of the regimen was BEAM . Palifermin, 60 micrograms/kg body reasons may include that with gut GVHD, providing fully weight, was given on 3 days before the starting of required caloric intake is quite difficult with less protein content and simultaneous use of TPN becomes mandatory.

S290 Nevertheless, we still observed clinical merits with this Identifying and managing these key challenges has been an approach, i.e. slowed body weight loss and improved patient essential step in this programme. satisfaction. Method: To review the particular challenges and benefits This very preliminary observation gives a rationale to continue associated with the development of a joint quality to explore our program. management programme between the BMT Unit at BRHC and the AHU. Results: Historically we operate from two separate sites: AHU P1029 providing adult autologous transplants (24 in 2004) and the Observation study of incidence of mouth mucositis in BRHC undertaking allogeneic transplants for adults and patients undergoing chemoterapy and bone marrow children (79 in 2004) as well as autologous transplants for transplantation children (4 in 2004). V. Sabbi, E. Gori The key challenges we experienced in developing our joint S. Orsola Malpighi (Bologna, I) programme were; our physical separation in different hospitals and distinct management structures, valuing the unique needs Objective: locate the chemotherapy and the risk factor having of both paediatric and adult services, operating separate the ability to develop mouth mucositis nurse education programmes, fragmented patient transfer and Methods: we analysed 514 nursing folder of patients (2000 to ad hoc out of hour’s service. 2002),the parameters that we consider are: age, gender, Identifying and prioritising these key elements of practice has diagnosis, phase of the diagnosis, kind of chemotherapy, no improved communication and enabled cooperative working presence of pre-existent mouth mucositis, degree of pain, and quality management practices to become established. We length of mouth mucositis, degree of mouth mucositis, have formalised and improved multidisciplinary team treatment of pain, treatment of feeding, treatment of mouth coordination and decisions, written effective joint Standard mucositis. Operating Procedures, agreed a nursing development Results: Males were most struck by mouth mucositis in strategy, developed a systematic approach to patient transfer, patients undergoing bone marrow transplantation presenting created joint medical notes and established a joint quality with mucositis of 3rd or 4th degrees. 88 patients suffering from review programme. leukaemia were struck by mucositis, the average duration time Conclusion: A robust and dynamic quality management of mucositis is 9 to 15 days, the average time is directly system is foundational to current Stem Cell Transplant service proportional to the degree. The pain for the higher degrees of provision. Following 3 years of committed development mucositis is controlled only by means of drugs derived from Bristol’s SCT programme has integrated quality management morphine (transdermic patch and i.v. infusion of morphine into all aspects of its clinical services. Clear benefits in multi cloridrate) and these are the preferred drugs for oral disciplinary cooperation and communication, improving mucositis. Oral hygiene is one of the first steps to decrease practice and patient care have resulted from these efforts. mucositis and in 73,1% patients undergoing i.v. administration of melphalan we administered oral cryotherapy (ice chips) there was no appearance of oral mucositis. 100% of patients P1031 treated with vincristine and doxorubicin haven't oral mucositis Case management in allogeneic stem cell transplantation: without any treatment, patients from 51 to 65 years are the the Heidelberg experience most suffering from oral mucositis,100% of patients A. Bondong, B. Kopp, P. Dreger, A. Ho undergoing of allogeneic bone marrow transplantation University of Heidelberg (Heidelberg, D) suffered oral mucositis of the 4th degree were supported with total intravenous nutrition, every patient is treated with sodium The multiple tasks performed by an allogeneic stem cell bicarbonate, benzidamide jaluronato and local anesthetic for transplantation (SCT) team go far beyond medical care. the care of the mouth. Problems encountered by patients in addition to cancer Conclusion: patients treated with multiple lines of therapy concern their job situation, financial security, chemotherapy are at risk to develop oral mucositis, accommodation and social network. Therefore the cryotherapy is one of the most effective and cheap methods to Department Medicine V of the University of Heidelberg prevent mucositis in patients undergoing bolus intravenous decided two years ago to implement an integral patient care chemotherapy (5-fluorouracile and methotrexate),oral hygiene program. Aims of this program are patients' well-being, is one of the most important systems to prevent oral improvement of medical pathways, support of the medical mucositis, nurse must enter every change in oral mucosa to staff and cost reduction. The hospital established a case signal potential symptom of infection management which has been put into practice in the USA since the 1970s. In Heidelberg, the diverse responsibilities of case management are fulfilled by a full-time case manager (CM), who has been trained in nursing, hospital management, and case management. The CM is the connecting link Managing care between patients and doctors, therapists, nurses and caretakers in all parts of the hospital in the outpatient setting. Together with the other members of the treatment team the P1030 CM takes responsibility in preparing the patient for SCT. This Successful establishment of a combined paediatric and includes planning all patient appointments, helping to inform adult stem cell transplant quality management patients about the transplantation procedure, documenting, programme organizing and scheduling all medical examinations. The CM W.L. Saegenschnitter, N.M. Som informs the patient about behaviour before and after SCT. The United Bristol Healthcare Trust (Bristol, UK) CM takes part in the regular weekly team meetings and joins the ward rounds in the transplant unit. Altogether, she The BMT Unit at the Bristol Royal Hospital for Children coordinates the complete schedule for preparation and (BRHC) in partnership with the Avon Haematology Unit (AHU) treatment of the patient. The CM has taken over tasks at the Bristol Oncology Centre and collection and processing formerly performed by doctors and which didn't use to be their services at the National Blood Service: Bristol, has been priority. Therefore the new position of the CM relieves successful in achieving level 1 accreditation under JACIE for especially the doctors and other professionals. The patient our busy Stem Cell Transplant Programme. always has a person to talk to. Introduction of CM in Objective: Significant challenges have been overcome during Heidelberg has significantly increased patient satisfaction, the last 3 years in order to develop a robust and dynamic joint accelerated pre- and postransplant processes, and reduced Paediatric and Adult quality management programme. physician time consumption, thereby saving procedure-related

S291 costs. Controversial issues to be solved include additional Background and Purpose: In highly specialised areas of responsibilities which might be taken over by CM, acceptance clinical practice like BMT, CVC's are the major source of by external partners like general practitioners or health access. BMT patients are normally on a range of intravenous insurances, and establishment of a CM-specific image in the interventions such as administration of intravenous drugs, physicians’ view. parenteral nutrition, taking and administering blood products. In summary, in Heidelberg CM was successfully introduced as The CVC provides reliable access for intravenous therapies an instrument to optimize medical pathways, improve patent however, there are many complications associated with CVC's satisfaction and reduce costs. CM will be continuously the most commonly seen is infection.The purpose of this improved and expanded. poster is to review the research and explore which dressing is effective in the prevention of CVC infections. Method: A literature search was done using Pubmed and P1032 CINHAL.The search examined literature published in the last Economical thinking in hospital day care 10year. B. Birkenau, W. Kail, C. Peters, H. Gadner Keyword used: CVC, dressing,infection,bone marrow St. Anna children`s Hospital (Vienna, A) transplantation. Results:Three of the studies compare DSD versus IV 3000. Economizing and reduction of costs are catchwords nowadays Two compared opsite versus IV3000. After reviewing the which have become important in health service as well. literature the evidence suggests that there is no particular Financing of hospital services has been topic of public dressing that is more effective than the other for the discussions again and again recently. That is why everybody, prevention of CVC infections. All the papers critiqued agreed including the nursing staff is asked to limit the increasing on the same advantages and disadvantages of IV 3000 and financial burden by using the given resources in an intelligent DSDs. The authors suggest that there are other contributing way. factors that can influence infection within a patient. These Inspired by a seminar on how to manage a department are:patients underlying condition,cleaning method,number of economically we started a project in 2004, where different lumens on device,skin hygiene. measures to reduce costs were planned, checked, carried out Implication for Practice: As nurses our duty is to educate, and finally evaluated. support patients and relatives to care and manage their CVC More important than keeping the economical aspect in mind dressings adequately and also empowering patients to make was it to keep to hygienic and qualitative standards and a choice of dressing depending on their particular guidelines. We had to discuss all steps which had been circumstances. carried out with the staff responsible for hygiene, the doctors Conclusion:There was no significant difference in the rate of and all other people involved. CVC infection using IV3000,DSD or opsite. However there are At the beginning of 2004 we planned to buy two pump other issues when deciding which dressing to use such as systems for pain management. After carefully comparing two patient care, education and support,patient comfort,cost, different offers and considering prices of purchase, deduction duration of dressing,nursing time and skin integrity. costs, consumption of material, personnel costs and friendly Recommendation for Practice: I will involve other clinical operation we chose to purchase systems which had not been areas within the Trust to develop a CVC assessment tool.This used in our hospital. Compared to already existing equipment would not only include my recommendations for dressings but it was possible to save 7,710 Euros per system after every also all aspects of care of a CVC. hundred applications. After reconsidering and modifying the daily routine at our station and after introducing some new ways of conduct it was P1034 again possible to reduce costs. Influence of preventive measures to prevent the spread of By updating the diagnostic management of our patients, vancomycin-resistant enterococci in haemato-oncological especially by introducing a specific reduction of the routine patients blood sampling we were able to save 18,411.12 Euros per M. Zitkova, Z. Danisova, L. Finova, Z. Racil, I. Kocmanova year. University Hospital (Brno, CZ) The specific modification of our management concerning infusions (changing of infusion tubes) allowed us to reduce the Objectives: The strains of vancomycine resistant enterococci costs of material and personnel as well as the weight of the (VRE) represent a serious medical problem, particularly in resulting waste to about 50 percent. haemato-oncological departments (dept.). In these Our team was sensitized to think economically, we learned departments, antibiotics such as vancomycine and some nice and innovative ideas, which we took up and cefalosporin of the IIIrd generation are used in high amounts, realized. which enables a selection of these resistant enterococcal When our project was evaluated in February 2005 and the strains. In addition in immunocompromised patients treatment results were presented at our hospital we were able to present with the immunosuppressive treatment, including the stem cell an amount of 78,541.18 Euros as total saving of costs. transplantation, facilitates the development of invasive infections caused by VREs. Methods: Between 1998 and 2002 the incidence of VREs was 0.62% of the total number of enterococcal strains recorded in our dept. In 2003 the incidence of VREs Preventing infections dramatically increased to 9.8% of the total number of enterococci; and from January to May, 2004, the incidence of VREs amounted to 25% of the total number of enterococci. In P1033 April, 2004, in addition to a changed antibiotics policy, Central venous catheter realated infection: which intensive preventive measures were introduced . dressing is more effective in preventing infection? These measures included: rectal smears of all patients E. Najeme admitted to the dept., regular rectal smears of all inpatients in Oxford Radcliffe NHS Trust (Oxford, UK) week intervals, careful sanitation measures in isolation rooms and regular education of nursing staff on how to observe the This poster will compare dry sterile dressing (DSD) and sanitary regulations in the isolation rooms in which the IV3000 in the prevention of central venous catheter (CVC) patients colonized with VREs were placed. infections. Within my practice we are currently using mepore The aim of this study was to evaluate the influence of these or IV3000 dressings. CVC's play a major part in assisting us preventive and isolation measures on the incidence of patients with the treatment we provide. colonized with VRE strains.

S292 Results: Between January and June, 2004, i.e. before the concerning busulphan or GvHD contribution to the skin introduction of the preventive measures, the average number damage in the CVC insertion area, larger cohort of patients is of newly recorded patients colonized with VRE amounted to needed. Further observation is indicated to be focused on 9.4 patients per month. insertion inflammation and positive blood cultures, when After the introduction of the preventive measures, the average antimicrobial CVCs have started being used. numbers of patients colonized with VRE in the individual periods were as followed: July to December, 2004 – 9.2 patients per month, January to June, 2005 – 2.5 patients per P1036 month, July to October no incidence. Thus, no patient with Tick list for a cleaner ward new VRE colonization has been found in our dept. since June B. Tomkies 2005. Avon Haematology Unit (Bristol, UK) Conclusion: In our experience, the preventive measures have proven to play an important role in preventing the spread of During the last year the media has focused a great deal on VRE strains in haemato-oncological patients. In addition to the dirty NHS hospitals and MRSA. Since that time the reduced application of certain antibiotics, particularly of government has brought out initiatives to clean up British vancomycine, the preventive measures have enabled us to hospitals and win back public confidence. Consequently eliminate the VREs incidence in our dept. infection control teams have been set up in all hospitals with infection control link staff in each area or ward. Within the Avon Haematology Unit in Bristol, consisting of a seventeen bedded ward and a day area a cleaning programme was devised to tackle the problem of cleaning, which should be carried out by the nursing staff. This was highlighted by an earlier audit conducted by the infection control team showing areas of duty that were being overlooked. This may have been due to heavy workloads, i.e. clinical duties, lack of staffing or nurses not viewing cleaning as part of their remit. Since the unit care for patients with an immuno-compromised status (neutropenia), and administer stem-cell transplantation, it is therefore of extreme importance that the environment is kept vitally clean. Therefore the aim of this study was to look at areas that needed cleaning regularly and from this, adapt a tool, which could be easily utilised by the nurses. The tool consisted of a list of tasks that had to be carried out P1035 weekly, with a date and signature box after every task. These First experience with once-a-week interval of central lists were distributed throughout the ward in working areas venous catheter occlusive dressing changes in allogeneic frequently used. transplant patients These areas were Clinical areas J. Skardova, E. Bystricka, J. Cervena, V. Kaslova, S. Vokurka Sluice University Hospital in Pilsen (Pilsen, CZ) Side rooms 4 Bedded bays Introduction: Central venous catheter (CVC) occlusive Reception areas. dressings are usually recommended to be changed on a Prior to the implementation of the tool, nursing staff were twice-a-week basis in transplanted patients. As their skin asked to attend a teaching session informing them about the tends to be very sensitive and frequent changes may promote cleaning list, before going live. The tool was then audited over skin damage, we decided to prolong the interval of changes a period of three months and the results charted. These up to 7 days in case no complication will indicate to change results showed an increase in compliance with nurses the dressing sooner. cleaning that was easily monitored and encouraged. Objectives: To verify the CVC insertion area skin damage and related infections in patients with once-a-week frequency of CVC dressing changes. P1037 Methods: Prospective, single-centre audit. Recommendations for controlling nosocomial Characteristics: adult allogeneic transplant patients, CVC non- transmission of Clostridium difficile in a haematopoietic tunneled, polyurethan, inserted into v.subclavia and the site stem cell transplant unit covered by polyurethan semipermeable occlusive dressing J.P. Claisse, K. Tabani, M. Rouveau, F.O. Pinto, G. Socié (Bioclusive). Results: n=70 CVCs were observed in 8/2003- Hôpital St Louis (Paris, F) 5/2005. Total 569 dressing changes per 1930 days were performed for these reasons: on protocol once-a-week 14%, Clostridium difficile (CD) is a ubiquitous spore-forming gram- loose or soiled dressing 49%, site bleeding 18%, site positive bacillus that has been implicated in hospital outbreaks inflammation 11%, others 8%. The mean interval of changes: and is the cause of the antibiotic-related pseudomembranous 3,3 days, resp. twice-a-week. Maximum skin toxicity: colitis. Although clinical manifestations may vary from erythema 11%, erythema with itching or dry desquamation asymptomatic carrier to life-threatening diarrhoea, it is 3%, exfoliation 2%. Tendency toward more damage was common practice to begin full contact isolation for a observed in busulphan patients (81% vs. 19%). In 88% of the hospitalized patient once diagnosis is made, even if non- patients the damage was temporary with spontaneous toxigenic strains are found. This is particularly true in a regression. Pain during the dressing change (VAS 0-10): Haematopoietic Stem Cell Transplant (HSCT) setting where median 1(1-3). The CVC insertion site clinical inflammation myeloablative/immunosuppressive conditioning regimens and observed in 51% with the median diameter of 3(1-50)mm. the frequent use of multiple/large spectrum antibiotics may Positive CVC blood cultures detected in 40% of the CVCs. predispose patients to present with more severe conditions. The most often implicated microorganism were the coagulase CD can be transmitted via fecal-oral, through contact with negative staphylococci. contaminated environmental surfaces or by health care Discussion: The occlusive dressing appears to be safe in workers who became carriers after manipulating CD positive respect to skin toxicity. In case of no other reason indicating diarrhoeic stools and not adequately washing their hands. the dressing change, the once-a-week change frequency will Screening analysis of 254 stool samples from patients who be kept in our patients. To make any fair conclusions presented with diarrhoea after admission to our HSCT Unit in

S293 2004 resulted in 19 positive cultures for CD. Here we describe P1039 the current isolation procedure policies adopted in our HSCT Management of central venous access device: a service for preventing dissemination of CD, once a case is retrospective audit detected. S. Vieira, D. Monroe Recommendations: The Trustee of London Clinic (London,UK) A) Short educational course on CD epidemiology and pathogenesis, delivered to the health care provider team once Hickman line (HL) or other central venous access device a year; (CVAD) insertion is essential prior to Bone marrow transplant B) Information signs placed at the patient’s room door with or high dose chemotherapy. Unfortunately is management of instructions to: CVAD’s is not without complications. 1. wash hands with antiseptic soaps or alcohol-based hand- A retrospective audit was carried out to evaluate CVAD rub, before getting in and out; complications in 69 patients in 104 episodes. 31(45%) 2. wear disposable gloves and gowns before getting in and patients were male and 32(46%) patients were female, 6 (9%) leaving them in the room before getting out; of them unknown as information was lost to poor C) Routine environmental decontamination: documentation and median age 49 yrs (14-80). 1. used bed linen and discarded waste to be placed in double Diagnosis: 14 (21%) Acute Leukaemia, 4 (6%) Chronic plastic bags before proper handling; Leukaemia, 7 (10%) Multiple Myeloma, 6 (9%) Lymphoma, 3 2. bedpans/toilets to be disinfected with sodium hypochloride (4%) Myelo Displasic Syndrome, 28 (41) Solid Tumours 6 (for at least 30 minutes) before being re-used by the patient; (9%) unknown 3. daily surface decontamination with an ammonium chloride based disinfectant (Surfanios®) followed by a sodium hypochloride cleaning solution (e.g.: door handles, bedside tables, call buttons, telephone, blood pressure cuffs, thermometers, etc, but especially the floor). In conclusion, reinforcing contact isolation measures and establishing strict compliance by the health care provider team (through education), both are crucial steps for controlling nosocomial dissemination of CD and preventing outbreaks. 62 patients with CVAD are 46 HL, 16 Groshong 4 Porthacath, 2 picc lines and was 1 neckline. There were 104 recorded complications. 57 (55%) of these were treated as an inpatient P1038 and 47 (45%) as an outpatient.70 (67%) febrile episodes were Risk for infection; a daily battle against germs observed of the 104 episodes. 16(15%) treated as an R. López López, F.J. Márquez Malaver, V. de la Osa García outpatient with oral antibiotics (AB), they were not University Hospital Virgen Del Rocío (Seville, E) neutropenic. 51 (49%) were treated as in patient episodes and with intravenous AB. It is suggesting that patients should care Introduction: In our Hemopoietic Transplant Unit, the most for their own lines during their hospital stays.19 (18%) of frecuent of the prevalent nursing diagnoses is "Risk for complications experienced was a blocked CVAD, only 4 Infection" (00004 NANDA TAXONOMY II). It is always episodes requiring urokinase. Others solved with flushing with present. Nurses invest a great deal of time and effort treating Hepsal. While patients are outside the hospital, the line should this problem. be flushed as per local protocol. 11 (11%) of CVAD ended Aim: The goal of this job is to show you the codified nursing with line removal. Because of either infection or accidental interventions, that in our Transplantation Isolation Unit, we removal by patient at home.19% of blood cultures taken from have to make in order to control and resolve this nursing the CVAD were sterile. 25 (23%) results were lost to poor diagnose (Risk for Infection), trying to establish a standardized documentation. 58% of blood cultures were positive and nursing language. We also want to emphasize the magnitude microorganisms outlined in Table I. Appropriate AB’s were and the importance of these interventions among the others. given. Material and methods: The information was collected from the It is vital that patients receive training in the management of Care Plans for 34 inpatients at the adult hemopoietic their CVAD’s, regarding signs of infection, dressing and transplantation unit over a period of one year (January- flushing of their lines. During any neutropaenia, nursing staff 2004,December-2004). These care plans refer, hospitalized remain responsible for checking the CVAD’s, but care of the patient for allogeneic and autologous stem cell lines, unless infected should continue to lie with the patient. transplantation. As our audit shows some hospitalization episodes are To make the Care Plan we have used an initial evaluation (to preventable with training or early detection of infection. learn more about the patient) by the structure of Human Response Patterns (Marjory Gordon), Nursing Diagnoses: Definitions and Classification (NANDA), Nursing Interventions P1040 Classification (NIC) and Nursing Outcomes classification Role of surveillance blood cultures in management of (NOC). infectious complications in haematopoietic stem cells Conclusions: In our Transplantation Isolation Unit and with the transplant recipient patient undergoing an allogeneic or autologous stem cell A. Torres, L. Casabella transplantation, the nurse has to carry out a lot of Hospital La Paz (Madrid, E) interventions to minimize the risk and to avoid the infection. These interventions mean the 25% of all the interventions that Background and Aims: Central venous catheter (CVC) are the nurse makes to resolve the whole of nursing diagnoses. broadly used in patients with haematologic malignancies, Besides using a standardized language improve the raising the risk of infectious complications during therapy communication between nurses. inasmuch both AML- induction and Haematopoietic Stem Cell Transplant (HSCT) settings. A common practice is the use of surveillance blood cultures for early detection of infection. Care and surveillance by nurses and physicians of infectious signs of CVC and the early beginning of antibiotic therapy may be a more useful measure. The aim of our study was to analyse the feasibility and usefullness of surveillance blood cultures versus observation by nurses and physicians in the detection of CVC infection in patiens following HSCT.

S294 Material and methods: We have retrospectively studied those evaluation on the part of the nursing staff, from the day of patiens undergoing HSCT form January 2001 to August 2004 admittance to the day of discharge from the hospital, in our center. All of them were Hickman carriers and We present the Health Education Program of our Hematology surveillance cultures were taken at the time of hospitalization Service aimed at preventing or minimizing the side effects of prior to conditioning regimen for transplant. As principal bone marrow transplantation variable we analysed signs of CVC infection and fever through transplant procedure by reviewing nursery and medical records, microbiology and radiology reports. P1042 Results: We have included 145 patients, 51% male and 49% The determination of the physiological problems female, median age 40 (range 16-68). All cases underwent experienced by patients undergoing allogenic stem cell peripheral blood stem cell transplantation (84 % autologous, transplantation 14% allogeneic and 2% non-myeloablative regimen) with M. Matrak (1), S. Kapucu (2) diferent haematologic disease. The median time of catheter (1)Ankara University (Ankara, TR); (2)Hacettepe University insertion was 55 days (range 4-612). 17% of surveillance (Ankara, TR) blood cultures obtained form CVC prior to conditioning were positive, whereas fever was documented in 94% of patients. Objectives: This descriptive study has been carried out to Those patients with positive blood cultures were started on determine the physiological problems experienced by patients drug therapy with teicoplanin or vancomycin despite afebrile who undergoing stem cell transplantation. status. All febrile cases successfully resolved on broad- Metods: It was conducted in the stem cell units of Ankara spectrum antibiotic empiric therapy. In 8 cases CVC had to be University Medical School Ýbni Sina Hospital, Numune removed. No deads from CVC infectious complications were Hospital, Hacettepe University Adult Hospital and Gülhane recorded. Military Medical Academy Hospital. Sample included total 51 Conclusions: Surveillance blood cultures prior to patients. The questionnaire form developed by the investigator Haematopoietic Stem cell Transplant as prophylactic was used in the study and in the evaluation of data, measures did not avoid infectious complications during the percentage and chi square tests have been used. transplant. Nursery care and surveillance or infectious signs of Results: According to the findings of the study, of the patients CVC are equally efective to detect CVC-associated infections, included in the study, 47.8% was between the ages of 18-26, which is a more cost-effective measure. According to these 70.6% was male and 33.4% was graduate of primary school. results, in our centre we have suppressed surveillance blood The majority of the patients included in study experienced cultures in absence of fever or infectious signs. problems such as pain (94.1%), fatique (94.1%), fever (92.2%), nausea (92.2%), lack of appetite (84.3%), vomiting (84.3%) and oral mucositis (82.4%). Conclusion: In the study, the patients physiological problems were compared with age, sex, education status, diagnosis, Quality of life treatmant protocol and duration of hospitalization. While as to sex the patients experiencing pruritis and fever rates were higher in male, as to age experiencing headache was P1041 increased related with age, but pruritis was decreased. The A programme of health education aimed at patients difference between groups was found to be statistically undergoing bone marrow transplantation significant (p<0.05). In addition, it has also been established M. Lopez, N. Pelay that the frequancy of physiological problems experienced by Vall d´Hebron (Barcelona, E) the patients increased in patients hospitalized for 41 days and more. In the direction of the results of the research, it is Introduction: The hematologic patient is a complex individual suggested that development of care standards for the experiencing a set of new circumstances that represent a physiological problems experienced by the patients challenge for the nursing staff. The progress in the treatment undergoing allogenic stem cell transplantation. of these patients involves the use of very aggressive therapies, such as bone marrow transplantation, that carry the risk of side effects, at times as devastating at the very same P1043 disease. According to 2003 data from a longitudinal study, in Patients treated at home during the pancytopenic phase 99% of the cases, these patients prefer taking care of after allogeneic haematopoietic stem cell transplantation themselves by means of a program of help. Therefore, we B. Eriksson, M. Blomkvist, B. Svahn prepared an educational program aimed at correcting certain Karolinska University Hospital (Stockholm, S) unhealthy habits, informative of foreseeable complications and oriented toward a better autonomy and quality of life. To prevent neutropenic infections, patients are kept in Objectives: Prevention of complications related to side effects isolation rooms after allogeneic haematopoietic stem cell from bone marrow transplantation and derived from the transplantation (ASCT). Patients living within one hours´ patient’s inadequate information driving distance from our unit were given the opportunity of Patients and methods: We analysed the epidemiological data treatment at home after ASCT during the pancytopenic phase. of patients admitted to the Hematology Service at Vall Hebron We compared 36 patients treated at home during March 1998 hospital. A longitudinal survey was done in order to obtain the until December 2000, with 54 controls treated in the hospital sociological and cultural characteristics of the patients. during September 1995 and September 2001. Homecare An educational program was prepared, aimed at patients ASCT is a novel approach that resulted in less transplant- undergoing a bone marrow transplantation procedure in our related mortality (TRM), similar incidence of chronic graft- Service. This program uses the PRECEDE method, based on versus-host disease (GVHD), relapse and improved long-term the active participation of the subjects in the processes of survival compared to the controls treated in the hospital. After understanding, motivation and abilities oriented towards the this project, homecare is now integrated in the daily work. A resolution or minimization of the problems related to the group of four experienced nurses from the ward takes care of quality of life. To that end, the patient follows the written the patients at home. One of these nurses visits the patients guides, and this is complemented by an interview where the at home every day once or twice to check vital signs, information is discussed in an individualized manner temperature, blood pressure and examine the patients for Discussion: The programs of health education based on the GVHD or other lesions. In the morning, the nurse takes blood acquisition of new knowledge, skills and attitudes on the part samples, give medication intravenously and transfusions if of the patient, promote the development of new healthy habits. needed. At the hospital, the nurse and the physician go These programs also allow unified criteria of conduct and through the clinical and laboratory data. The physician then

S295 calls the patient to tell him about the chemistry results, to evaluation of health care. In the years 2001-2002 a pilot study check the patients status, and to change medications if proceeded which evaluated quality of life during intensive needed. Advantages with homecare include keeping patients chemotherapy. Since 2004 a prospective health-related with their family; they can go to their own kitchen and eat quality of life assessment in patients with autologous bone whatever and whenever they like. Furthermore, the patients marrow or peripheral blood stem cells transplantation (ASCT) can be more active with more things to do at home compared has been in progress. Since July 2005 we have cooperated to being in an isolation room in the hospital, and they can also with most of transplantation centres in Czech Republic – take a walk whenever they want to. Pilsen, Prague, Brno and Hradec Kralove. Inclusion criteria and methods: Signed inform consent form, at least 18 years of age, compliance, hematooncology diagnosis, P1044 planned ASCT. Methods - we used 2 questionnaires for Methodological issues associated with measuring the assesment of quality of life: European Organisation for effect of a novel art intervention in the treatment of Research and Treatment of Cancer (EORTC QLQ-C30 patients undergoing stem cell transplantation version 3 in Czech) and EuroQol group (EQ-5D in Czech) and C. McCabe (1), D. Roche (2), F. Hegarty (3), C. Begley (1), S. other parameters (hemoglobin, platelets, leukocytes, BMI, Collier (3), S. McCann (3) sex, age, duration of hospitalization etc.). How patients (1)Trinity College (Dublin, IRL); (2)National College of Art and evaluate their quality of life may also change over time so the Design (Dublin, IRL); (3)St. James's Hospital (Dublin, IRL) patiens are followed up in days T0 (entrance to transplant unit), T1 (10 days after ASCT), T2 (100 days after ASCT) and Background: This paper reports on the methodological issues T3 (1y after ASCT). associated with evaluating the effect of an art intervention 1st results: Results of questionnaire QOL of patiens before using a randomised control trial design and mixed methods for transplantation are practically identical with healthy data collection and analysis. Over the past 25 years in health population. Important changes can be seen in comparing care, art has become increasingly recognised as a key results of QOL before and after ASCT. The +10 day after ingredient in the planning and development of patient- ASCT most (2/3) of values were worse. Comparing of results centered and healing environments. A literature review on this QOL before ASCT and +100 day´s after ASCT shows topic revealed limited substantive evidence to support this with comeback to QOL in restored values to it´s original („normal“) much of what is documented appearing to be anecdotal, state. descriptive and rarely critical. ‘Open Window’ (‘OW’) is a novel Conclusion: The poster presentation shows results of 100 art intervention in the treatment of patients with included patiens from Czech Republic and follows up with the haematological malignancies that has been available for the results presented on EBMT 2005. From February 2006 the past year at the ‘National Stem Cell Transplant (SCT) Unit’ at prospective study will be in progress also in Slovak Republic. St. James’s Hospital, Dublin Ireland. Acknowledgements: We thank patients, foundation HAIMAOM Aim: The purpose of this study is to measure the effect of and cooperative sites. Study is not supported by sponsor or ‘OW’ on patients’ psychological well-being and explore their grant. perceptions of how it influenced their experience of having a SCT. Methods: Anxiety and depression are regarded as the primary indicators of health related quality of life (HRQoL) for patients with haematological malignancies, therefore, the Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith 1983), the Distress Thermometer (DT) (NCCN 2003) are being used to collect data. Discussion: Using a combination of HRQoL and Individual instruments such as the HADS and the DT can help researchers identify and measure generic and individualised healthcare outcomes related to quality of life. However, researchers also need to consider that although quantitative studies can identify and measure quality of life outcomes using HRQoL or individual instruments, normative data are not meaningful when applied to individual lives. Mixed methods of data collection may provide data that adds meaning to the individual scores of patients and supports and compliments P1046 the overall study scores. Therefore, interviews are also being Quality of life: a prospective, comparative study of conducted which in conjunction with the quantitative data will patients undergoing stem cell transplantation randomised provide an opportunity to reach an understanding of complex, to nasojejunal feeding versus parenteral nutrition multifaceted and individual responses to art in health care. M.B. Devaney, M.C Brown, J.M Davies, E.E Smith Western General Hospital (Edinburgh, UK)

P1045 Quality of life (QOL) should be addressed prior to a transplant, How patients evaluate health related quality of life after and through every step of the process – including the acute autologous stem cells transplantation in the Czech phase and long-term follow-up of patients. Republic - QOL-A.2004, a multicentre prospective study Peripheral blood stem cell transplant patients (allogeneic and V. Kajaba (1), M. Labudikova (1), L. Novak (2), E. Bystricka autologous) were considered for entry into the study of (2), M. Zitkova (3), K. Moravcova (4), V. Pavlicova (5), J. endoscopically inserted NJ tube feeding versus PN. Patients Vitkova (1), I. Rehorova (4), L. Finova (3), J. Durisova (5), J. were randomly assigned to receive NJ feeding from day +1 Scudlova (1), E. Faber (1), A. Svobodnik (6) versus oral feeding +/- PN. The study questioned whether the (1)University Hospital (Olomouc, CZ); (2)University Hospital type of feeding given affected the patients’ quality of life during (Pilsen, CZ); (3)University Hospital (Brno, CZ); (4)General transplant. Patients were asked to complete quality of life University Hospital (Prague, CZ); (5)University Hospital questionnaires at study entry, 4 weeks, 3 and 6 months post (Hradec Kralove, CZ); (6)Centre of biostatistics and analyses transplant. (Brno, CZ) There were 7 patients in the NJ group and 10 patients in the PN group. 100% of the patients completed and returned their Background: The application of patient assessed measures of baseline questionnaires. 71% of NJ group responded at week health outcome has become increasingly important to 4, 60% at 3 months and 43% at 6 months.

S296 At week 4, 40% of the PN group responded, 60% at 3 months and 50% at 6 months. Both groups in study experienced diminished activity at week 4, however the NJ group level of activity had improved by 3 months and was sustained at 6 months. The PN group demonstrated at 3 months their level of daily activity was still below their baseline levels, but appeared to be recovering by 6 months. All patients reported effects on physical ability. Diminished levels at week 4, improving slightly at 3 and 6 months, but not to baseline levels. Both the NJ and PN group reported similar responses on gastrointestinal (GI) effects at week 4, 3 and 6 months. The NJ group reported their emotions to be ‘a little’ effected through the transplant at week 4, 3 and 6 months. The PN group reported their emotions to be effected ‘a little’ and ‘quite a bit’. Responses at 3 and 6 months were similar to baseline responses. At the same time points, patients’ also graded their overall health and quality of life, from a scale of 1 (very poor) to 7 (excellent). All patients’ median scores were the same at baseline and 3 months for health and QOL. In conclusion, despite small numbers our study has demonstrated that the NJ group was generally better on activity, physically and emotionally over the timescale and the GI effects were similar in both groups, therefore NJ feeding does not appear to adversely affect overall QOL.

P1047 Can stem cell transplant improve the quality of life of the thalassaemic patient; can thalassaemia patients have a transfusion free life? S. Vieira, D. Monroe The Trustee of London Clinic (London,UK)

Thalassaemia is a haemaglobinopathy resulting in absent or reduced beta globulin chain syntheses which may produce haemolytic anaemia, patients are treated with Red blood Cell (RBC) transfusions (Tx) and iron chelation to prevent iron overload. Stem cell Transplants (SCT) have become another treatment option for these patients. In our unit 2 patients with Thalassemia received matched sibling (Allograft) SCT. The regimen used for both patients was Fludarabine 20 mg/m², Busulphan 1 mg/kg, Cyclophosphamide 40 mg/kg with Cyclosporin A + MMF for Graft Versus Host Disease prophylaxis and Defibrotide given as Vena Occlusive Disease prophylaxis. Table I shows patient demographics, and the number of RBC units transfused. Both patients have been followed up to 100 Conclusion: 2 patients with Thalassaemia who received days post transplant. matched sib Allo BMT. Prior to BMT they were hyper From approximately 20 days prior to the commencement of transfused to switch off their own RBC manufacture; their Hb the conditioning regimen until neutropenic the haemoglobin was kept above 14 g/dL. Both patients had only 4 units of (Hb) was kept at 14 g/dL by repeated RBC Tx. RBC transfused from day +2 till day +75. Both patients now In neutropenic phase both patients were transfused if the Hb require venosection as ferritin ›10g/dL .At the time of writing level was lower than 8.5gr/dL or if it was clinically indicated. both patients are RBC independent. One is receiving weekly Aranesp to enable weekly venosection.

Improving harvesting

P1048 Monitoring platelet counts in donors pre and post peripheral blood stem cell collection S. Chapman, T. Wong University Hospital Birmingham (Birmingham, UK)

Objective: There is a requirement, in line with JACIE standards, to monitor blood counts in both healthy donors and patients undergoing peripheral blood stem cell (PBSC) collection to assure a safe and quality service. A single centre

S297 study was performed looking at possible changes in full blood count, especially platelet count. One hundred patients having Care of the carer PBSC collection were monitored. Cobe Spectra Auto PBSC machines were used with a harvest volume of 4ml to achieve maximum CD34 cell yield. As far as possible, consecutive P1050 patients (with a wide range of conditions) were used to ensure First education for nurses in haematology/oncology that the population was representative of other stem cell N. Markwardt, E. Aerts centres using identical machines. University Hospital Zurich (Zurich, CH) Method: Pre- and post-procedure full blood counts were monitored to identify any changes in the 100 donors and Introduction: Haematology/Oncology is a special and many- patients who underwent PBSC collection, using a larger facetted field. Haematological nursing, as we all know, is a volume harvest of 4ml. The majority of those studied were great challenge and a high-qualified education is necessary mobilised using granulocyte colony-stimulating factor (G-CSF) and essential comparable with Anaesthesia or Intensive care. alone - this has been shown to be an effective method of In the German-speaking area a professional further training mobilisation pre-collection. opportunity related to haematological diseases has not been Results: The results showed that although there was a given. reduction in platelet count, averaging 23%, significant After over 3 years of work, the first programme for advanced thrombocytopenia was not a problem. Those with a low training courses in haematology/oncology nursing care in platelet count prior to PBSC collection, however, are seen to Switzerland (and German-speaking area) has been developed be more at risk. Cross-contamination of the collected cells by following medical centres who built the task force: with red cells was not reported as a problem when the product University Hospital Basel was processed despite using the larger volume harvest to Insel Hospital Bern gain maximum CD34 cell yield. HöFa Oncology St.Gallen Conclusion: This study has indicated no significant risk to University Hospital Zürich (Project manager) donors undergoing PBSC collection using a 4ml harvest Work of Task Force: You have to know what you are aiming volume but has shown a need to continue to monitor blood for! At the first meeting in February 2002 the discussion was counts in order to act on a highlighted marked about the priority and proceed of this project. To find some thrombocytopenia post-procedure. common ground on which to base all interests and structure was very complicated. But when there is a common goal, you are going to reach it with hard work together. P1049 In the beginning of January 2005 work was done (first of all) Optimalisation of PBSC collections in children and the programme has been send to nurse experts in V. Hoffova, Z. Koristek, J. Sterba, T. Kepak, M. Petlachova, A. Switzerland, Germany and Austria for opinions and Cetlova statements. Masaryk University Hospital (Brno, CZ) Goals and Results: The main goal is to ensure a professional and competent care for patients with PBSC collections in children are more complicated compared haematological/oncological diseases to adults for several reasons. Special measures are often The opportunity for nurse staff to specialize in haematology needed, such as priming of the separation device tubing set field with irradiated blood, using heparin instead of citrate as a A higher satisfaction for the employees and as a precaution main anticoagulant, different ways how to ensure an adequate against burnout vascular access. The right timing of the initiation of PBSC The first module in 2005/06 will cover 10 days, which are split collection is also more problematic and doubtful than in adults. in 2x3 und 2x2 days Pediatric treatment protocols are highly intensive, bone Qualified tutors ( e.g. physicians) give lessons in anatomy, marrow is frequently involved in pediatric tumors, and, immunology, blood diseases, moreover, there is frequent demand for collection of enough nursing care related to haematological diagnosis, progenitors for three and more autologous supports or chemotherapy, transfusion therapy, palliative and transplantations. In addition, there is tendency to let children psychosocial care and ethical aspects at home as long as possible. Graduation with diploma and the opportunity to undertake the Since 1998, when we started with pediatric PBSC harvests, post graduate oncology course. 340 leukaphereses using COBE Spectra were performed in Discussion/Conclusions: In our opinion is this programme an 115 children, five children were mobilized twice. In heavily essential step and a must to form an independent faculty. pretreated children, the collections were started as soon as To reach this goal, cooperation between such as many number of CD34+ cells reached at least 5 per microliter of hospitals as possible is necessary. peripheral blood and a marked increase in WBC concentration There is still a lot of work to do, but we are heading in the right was seen. In these patients we also preferred LVL (large direction and the feedback and demands of this programme is volume leukapheresis) and 125 LVL were performed with 4 to overwhelming! 8 total blood volumes (TBV) proceeded. In 49 patients with In this poster presentation we would like to discuss about the weight less than 20 kg, we used heparin and since August advantages of a further training and exchange knowledge 2001 dalteparine (Fragmin, Pharmacia, Stockholm, Sweden), about the development of this difficult, but very important which should be more safe and without need of rapid project. laboratory results. Detailed education of parents and attendance of a specialized pediatric nurse known by the child and parent were shown to be very useful and prevented P1051 anxiety and fear of a new kind of procedure. No serious Clinical support for nurses at the bedside complication was observed and except for very few episodes C.E. Gilmour with mild symptoms of hypocalcaemia we experienced only Great Ormond Street Hospital NHS trust (London, UK) rare problems with vascular access in term of its poor capacity. We can conclude, that our methods and practice are This poster is a refection on the role of a Clinical Support safe, effective, and well tolerated. Nurse in the paediatric Bone Marrow Transplant (BMT) setting. The role was created due to a change in nursing education, resulting in poor adaptation of new graduate nurses into high dependency care areas. This position was thought to increase retention and recruitment to the unit, and facilitate staff

S298 development at all levels. The role quickly expanded into the to compare with the starting baseline, allowing us to obtain facilitation of further education of senior staff and the final conclusions. development of student nurses in the BMT setting. To achieve these aims in the research hypothesis we were The intention of this poster is to provide guidance to other forced to formulate the following statement: we wish to check units who may be considering alternate methods for if there are significantly statistical differences in Burnout developing their staff, while keeping within their budget scores, as measured by the MBI, before and after having constraints. The unexpected benefits and costs of received a combined treatment. implementing a role such as this are explored in this poster. - Sample selection, collection and initial data analysis While the specific objectives of the position are difficult to 1. Samples measure, it has been considered a great success. Reasons The samples are made up of nurses and nurse assistants at behind this success, such as excellent support from the the Haematology Ward (9th floor south) of the Hospital education lead, are presented. Universitario Marqués de Valdecilla. Of the 32 initial subjects who declared interest in participating, we got 27, who took the test for the initial data collection. From these 27, 4 rejected P1052 participation by not returning the questionnaire. We finally Implementing change to improve working life, efficiency settled with 23 participants: 12 assistants and 11 nurses from and productivity: one unit's perspective the Haematology Ward (9th floor south) of the Hospital T. Arthur Universitario Marqués de Valdecilla. Avon Haematology Unit (Bristol, UK) 2. Data collection: the MBI The MBI was given to 23 subjects. It was handed personally in The Avon Haematolgy Unit provides a service to a variety of a closed envelope, while informing them of the 15-day return patients with haemato-oncological conditions. The unit period. All questionnaires were returned within this period. consists of six members of nursing staff, one registrar, one 2. Initial analysis of the results. senior house officer and two members of administrative staff. The initial analysis of the gross results show a qualitatively Service provision involves investigation and examination of similar tendency to that obtained in other research using the patients, chemotherapy administration, venesection, blood same text. However, they were quantitatively different to the product support and review of patients following discharge initial prognostic of our research hypothesis. Specifically, the from the in-patient unit. The unit also has an open door policy factors Emotional Exhaustion and Lack of Professional for self-refferal and provides a 24-hour service. Efficacy were significant indices and worth highlighting in the As chemotherapy protocols improve there has been a greater factor sample. emphasis on patients being treated in the day unit setting. Depersonalization is only found statistically relevant in a small This has led to an increase in patients being treated in the day percentage of the study sample. As stated in this study’s aim, unit resulting in a variety of problems. These include a higher the factors of Depersonalization were the most criticized within demand of patients with no increase in capacity, staff working the definition of burnout syndrome, within the different longer hours, low morale, patients waiting time increased and population samples that validated the construct, which was generally the unit feeling pushed to its maximum. not an isolated case for the nurses. The aim of the study was to produce an action plan for change within the haematology day unit to improve working life, efficiency and productivity. The approach carried out was to identify problem areas , observe practice being carried out, process map all activity undertaken and discuss with all staff Complementary therapies concerns and implications. All data collected was examined and various themes emerged. In total there were ten themes. These were P1054 identified as analysing the day, use of time, redefining job Effects of back massage on anxiety and immune roles, booking appointments, scheduling, geography of the responses of patients undergoing allogeneic unit, patients notes, nurse led service, cancer measures and haematopoietic stem cell transplantation other business. In relation to the problems identified within B.Y. Song these themes an action plan was set up and aspects of these St' Mary's Hospital Catholic HSCT Center (Seoul,KOR) issues were changed. It is these points that will be examined and discussed in further. This study was to examine effects of back massage on As a result of the findings an action plan was generated and a anxiety and immune responses of the patients undergoing variety of changes have been made within the unit. allogeneic hematopoietic stem cell transplantation(HSCT). Preliminary results are extremely positive with all staff The study was conducted from July 2002 to February 2005. members suggesting a greater improvement in working life for The subjects of this study were acute myelogenous leukemia them and a more efficient running of the unit. Patients find the patients undergoing sibling allogeneic HSCT in the Catholic unit less chaotic and feel more empowered in relation to their HSCT center in South Korea. There were total 37 patients out-patient care. including 16 in experimental group and 21 in control group. 10-minute back massage was offered to the experimental group once a day and 5 times a week, from one week prior to P1053 the transplant until the third week after the transplant. Visual Of stress to burnout: a preventive proposal for nursing analogue scale (VAS) anxiety, Spielberger's state anxiety, P. Agüeros (1), M. Del Campo (1), M. Bárcena (1), T. Fuente Epinephrine, Norpeinephrine, blood pressure and pulse rates, (2) total leukocyte, neutrophil, lymphocyte(CD3+, CD4+, CD8+, (1)Hospital Marqués de Valdecilla (Santander, E); and CD19+ cells) and CD56+ cell count were measured in (2)University of Salamanca (Salamanca, E) order to examine the effects of the back massage. By using SAS program, the data was analyzed with X2 test, Introduction: The key aims of this investigation were to Fisher's exact test, t-test, repeated measures ANOVA, and decrease the levels of Burnout syndrome found in a sample of Scheffe multiple comparison. The analysis results are as nurses and assistants, with assumed possible levels from follows: previous studies with similar characteristics. This aim is based Anxiety measured by VAS was significantly lower in the on three fundamental aspects: the evaluation of the actual experimental group than in the control group from the third syndrome in a real sample in order to establish a baseline; week after the transplant. No significant difference was shown intervention from the obtained results; and a repeat evaluation for state anxiety between two groups. The differences in blood pressure and pulse rates were significantly greater in the

S299 experimental group than in the control group. No significant differences were shown for Epinephrine and Norepinephrine between the experimental group and the control group. Total leukocyte and neutrophil count were significantly lower in the experimental group than in the control group from the first week after the transplant. however, they tend to increase up to the third week after the transplant. Total leukocyte count was lower in the experimental group than in the control group after a week from the transplant. however, it was significantly higher in the experimental group than in the control group after 3 weeks from the transplant. The numbers of CD3+, CD8+ and CD56+ cells were significantly higher in the experimental group than in the control group after the transplant. As a result of this study, it was found that back massage for the patients undergoing allogeneic hematopoietic stem cell transplant was an effective intervention to reduce anxiety and enhance immune responses.

P1055 Holistic massage for patients undergoing bone marrow transplantation E. Davies United Bristol Healthcare NHS Trust (Bristol, UK)

There has been considerable research, which has demonstrated the significant benefit of massage for patients undergoing treatment in hospital. This poster will report on the psychological and physical benefits of holistic massage, as for both paediatric and adult patients on the Bone Marrow Transplant Unit at the Bristol Royal Hospital for Children. Following the development of the Complimentary Therapies Advisory Group (CTAG), protocols were introduced to allow complimentary practitioners to practice within the hospital trust. This allowed the service on the Bone Marrow Transplant Unit to be introduced in 2002. Massage was chosen as the supportive complementary therapy, as it has been shown to help relieve stress, anxiety and pain. It can also be healing, soothing and comforting for patients who are often deprived of touch. Strict guidelines exist relating to the use of oils, exclusion criteria and documentation. Light effleurage massage for a limited time was the massage technique chosen, as previous research has shown this to be the most beneficial approach for this group of patients in a similar therapeutic setting. Data were collected from observation and questionnaire. Results have shown that the approach has a significant effect on the well being of the patients.

S300