Stress to a complex system caring for high-risk patients can challenge CLABSI rates. Identifying key processes and executing them reliably can stabilise outcomes during times of system stress.

Oral care algorithm and order set, daily text message reminders, and physician intervention with noncompliant and high-risk patients has improved our compliance. Units where compliance with ADL participation is low can benefit from incorporating elements from this ADL 1-2-3 initiative.

Topic Significance & Study Purpose/Background/ Rationale: The organisms of the human flora are the most common cause of bacteremia and sepsis in immunocompromised and bone marrow transplant (BMT) patients. Activities of daily living (ADL) may potentially lower the risk of infection by decreasing pathogenic bacteria on the skin and mouth. A literature review was inconclusive for ADLs lowering the risk of infections in BMT patients. To address ADL compliance, a multidisciplinary team of both oncology and BMT units consisting of PCAs, RNs, nursing leadership and physicians was created. Methods, Intervention, & Analysis: To improve compliance, the team adopted the ADL 1-2-3 initiative: Daily bath/ chlorhexidine (CHG) bath and linen change, at least 2 activities per day, and oral care 3 times per day. Using the Model of Improvement and through Plan Do Study Act (PDSA) testing, we created a standardized ADL process that involved all providers. Interventions included addressing 1-2-3 compliance during rounds, creating accountability in care delivery, creation of an algorithm and order set for oral care, daily text message reminders, and physician intervention with non-compliant and high-risk patients. Findings & Interpretation: Our baseline compliance with the 1-2-3 initiative was 25%. With our interventions we increased our median compliance to 66% in 90 days. The greatest impact on compliance was seen with text message reminders to staff to complete the 1-2-3 components, designated roles and responsibilities, and physician discussion with noncompliant and high-risk patients. Our current compliance, as of September 3 rd, 2015, is 78.7%. Discussion & Implications: The 53% increase in ADL compliance for BMT validates the importance of a multidisciplinary team collaborating with the patient and family. Multiple factors were found to disrupt the flow of care being provided to the patient. Utilizing the oral care algorithm and order set, daily text message reminders, and physician intervention with non-compliant and high-risk patients were found to offset these disruptions. Units where compliance with ADL participation is low would be an ideal environment to incorporate the ADL 1-2-3 initiative.

Background: Parents of adolescents and young adults (AYAs) with cancer offer primary support to their children and often experience their own high levels of distress, affecting parent-AYA communication and quality of life. Objective: To reduce parent distress and improve communication during high-risk cancer treatment, we examined efficacy of a self-care and communication intervention for parents and indirect benefit for AYAs receiving a therapeutic music video (TMV) intervention. Methods: In this study, we conducted a multisite, randomized controlled trial with AYAs and parents enrolled as dyads (n = 110).Parents were randomized to intervention or low-dose control; all AYAs received TMV.Data collection occurred at baseline, 2 weeks post intervention (T2), and 90 days post intervention (T3). Results: There were no significant between-group differences on primary outcomes for parents or AYAs. We did find significant differences favoring the parent intervention group on parenting confidence at T2 and marginally better outcomes for family adaptability/cohesion at T3. Both groups exhibited significant within-group improvement for parent distress (state anxiety, T3; perceived stress, T2 and T3; mood, T3), state anxiety (T2) intervention only, and family strengths control group only. Qualitative data demonstrate the parent intervention raised self-awareness and parent confidence in the short term. Conclusion:Parents found their intervention helpful. Absence of significant results may be due to short intervention duration, need for tailored content, underpowered sample, and potential indirect parent benefit from AYA participation in TMV. The parent intervention did not provide an indirect benefit for AYAs. Implications for Nursing: Parents identified their own need for communication and support from nurses. Nurses can optimize AYA care by attending to parent needs through supportive listening and encouraging self-care.