About one-third of patients perceived themselves to be at low risk for falls despite a nurse rating of high risk. A statistically significant difference existed in the proportion of patients who perceived themselves to be at high risk for falls pre- and postintervention (p = 0.01). Results suggest that tailoring education to the patients' perceived risk for falls can help patients become more aware of fall risk.
A performance improvement project was designed and implemented using a multidisciplinary approach to create a CIBMTR electronic reporting tool in Epic. The Medical University of South Carolina (MUSC) Epic Informatics Team and MUSC BMT Team collaboratively designed a specific activity labeled "CIBMTR" that any BMT provider could access during a patient encounter and record the disease staging. Multiple CIBMTR staging forms were created in an electronic format. A quality assurance process was completed to verify the information was correct once the templates were built. Access rights for staging were restricted to the BMT Attending Physicians and Advance Practice Providers to improve the reporting quality. The multidisciplinary BMT team received education from the MUSC Epic Informatics Team on the new process before implementation. The new Epic tool was shared with the National Epic research and development team. Results/Conclusion: MUSC piloted the first template of the tool built for Epic EHR system to capture the CIBMTR staging criteria for reporting. Creating Epic CIBMTR staging tool in an EHR system will increase the overall quality of the data and improve reporting efficiency by the BMT data management team. This is one the first tool built for the CIBMTR disease staging by the National Epic BMT Working Group and will be added to their database so it can be utilized by other BMT centers using Epic EHR (Figure 1).
119 Background: At University Hospitals Seidman Cancer Center (UHSCC), adult patients with hematologic malignancies (HM) and those undergoing hematopoietic stem cell transplant (HSCT) require a central venous catheter nearly 100% of the time. According to the National Health Safety Network (NSHN), for permanent and temporary line days, the pooled mean infection rate in 2009 was 3.5 and 4.1, respectively. Catheter-associated bloodstream infections (CLABSI) lead to increased morbidity, mortality, length of stay, and cost. At UHSCC, the CLABSI rate for patients on the HM service from August 2010 through August 2011 was 8.0. Methods: It has been demonstrated that the use of Chlorhexidine (CHG) wipes has decreased the CLABSI rate in ICU and long term care patients. We were unable to identify literature evidence or medical centers currently using CHG bathing wipes in their cancer patients, specifically HSCT. A quality improvement project on the effectiveness of CHG bathing on the HSCT and HM populations commenced on April 2, 2012, at UHSCC. This study is also monitoring skin integrity to determine if there are adverse effects. Patient satisfaction is also being assessed. Results: Early results demonstrate a reduction in overall CLABSI rate to 4.3%, and no vancomycin resistant enterococcus (VRE) infections were observed since early April. Adverse effects on skin integrity have not been noted. An unanticipated obstacle is related to the “culture of bathing.” Specifically, caregivers and patients often do not understanding the importance of daily bathing as a key clinical intervention despite repeated education. The team continues to investigate this issue. Conclusions: CHG bathing appears to be an effective, well-tolerated, and minimally invasive intervention in preventing CLABSI in severely immunocompromised cancer patients. Unanticipated obstacles to implementing daily bathing have been encountered and are being addressed. During the course of this project, we also began tracking our CLABSI rate for the entire patient population on the HM HSCT nursing unit along with the service-based rate noted above.
Additionally, the numbers of liters processed was comparable in each cohort. Interestingly, platelet counts in Cohort A (153.5) showed a statistically significant difference (P = .925) from Cohort B platelet counts (191). Discussion: While the sample size is small, there was statistical significance in both the number of days to collect and the pre-collection platelet counts. This analysis demonstrates effective mobilization using 4 days of Tbo-filgrastim as it relates to CD34+ product yields, less use of Plerixafor and fewer days of collection. Future analysis will include additional factors such as age, disease mix, prior treatment, mobilization regimen, and financial impacts. (Table 1) 464
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