Background and Aims

In Sub-Saharan Africa there is no standardized approach to paediatric palliative care assessment. Because of this, there is a critical demand for evidence-based assessment tools that identify specialized needs of children and their families requiring palliative care in developing countries.

The aim of this project was to develop a standardized approach to pediatric palliative care (PPC) assessment for use in sub-Saharan Africa.

Methods

The Delphi method is a group facilitation procedure that involves iterative multistage processes designed to transform opinion into group consensus. In this project Delphi method approach used five rounds to explore core elements that define the essential assessment attributes mandatory for providing excellence in PPC. Consensus from 11 PPC multidisciplinary experts was obtained during four Delphi rounds regarding the most important questions to include in a PPC assessment tool. During the final Delphi round five, expert consensus was confirmed in a separate group of 36 childhood cancer/palliative care clinical providers.

Results

Five core elements were developed as the foundation for a PPC assessment: symptom assessment, goals of care, spiritual beliefs and values, psychosocial support and grief and bereavement. Symptom assessment, one of the core elements, includes 15 symptoms that all PPC experts agreed are experienced more than 65% of the time in their patients.

Conclusions

The need for a culturally sensitive PPC assessment tool is crucial to promoting excellence in palliative care around the globe. The Delphi method was an effective tool to develop a consensus on a PPC assessment tool to use with children and their families in sub-Saharan Africa. This standardized approach will focus on symptom assessment and improve the quality of care for children and their families at the end of life.

Background and Aims

The Ugandan Cancer Institute (UCI) is a tertiary referral unit for pediatric oncology that receives 700 new referrals annually. As in many LMIC, the staff to patient ratio is low. This led to concern about the potential for errors in the prescription and administration of chemotherapy, and highlighted the need to improve overall safety in this area.

Methods

An audit tool was developed to look at prescription and administration of chemotherapy, which was conducted in the clinic and inpatient ward over a 2-week period. It included demographic data, diagnosis and staging information, assignment of correct treatment protocol, pre-chemo checks, details of prescribed chemotherapy and supportive medications.

Results

A total of 83 patients were audited over a 2-week period (34 inpatients and 59 outpatients). Some areas of good practice were noted, but areas for improvement were also identified.

Notable areas of good practice included: 94% patients had complete staging documented, and 95% had histological confirmation. 88% had the correct protocol assigned and signed off by a consultant or fellow. 100% had a documented body surface area. Over 98% had the correct cycle prescribed, and 94% of prescriptions had consultant or fellow sign-off. 98% prescriptions were administered on time.

Areas for improvement included fluid charts, antiemetic and supportive medication prescription. 64% had a fluid chart appropriate for the patient’s chemotherapy and 65% had an appropriate antiemetic prescribed. 66% patients had an appropriate prescription for other supportive medication. No significant harm was identified as a result of any error of prescription or administration.

Conclusions

The formation of a multidisciplinary committee of doctors, nurses and pharmacy was proposed to improve the safety of chemotherapy prescription and administration, ensuring protocols were assigned correctly, checked by senior staff, prescriptions were clear and included appropriate supportive fluids and medication.

Background and Aims

Novel therapies have led to improved outcomes in pediatric cancer care. Successful implementation of novel therapies requires specialized training on administration and management. We describe our experience creating and implementing a standardized training toolkit for nurses administering blinatumomab in low- and middle-income countries (LMICs).

Methods

The core multidisciplinary team of the Blincyto Humanitarian Access Program, a partnership between St. Jude Children’s Research Hospital and AMGEN, identified key administration and management issues for blinatumomab. These were used to create a questionnaire assessing baseline capacity at LMIC pilot sites. Survey results informed content creation for a training program including didactic presentations, administration and management guidelines, workflow tools, and caregiver information sheets. Nursing workflow tools include daily care checklist, infusion record, and quick reference sheet. Training included virtual, synchronous sessions that were recorded and posted to an online classroom with other toolkit materials. Following pilot site implementation, feedback sessions were held to evaluate effectiveness of training and iteratively revise toolkit materials.

Results

Pilot site training included 40 nurses at five sites in two countries. Two virtual, interactive sessions were held; the first session was multi-disciplinary and the second was nursing-specific, focused on administration and bedside management. Feedback sessions indicated that the training toolkit was effective preparation for nurses. The need for video training tools and edits to workflow tools was identified. Four video segments were created to demonstrate aspects of administration and handling of blinatumomab and added to the toolkit along with revised tools. Future sites will undergo standardized evaluations, including pre- and post-tests.

Conclusions

Implementation of novel therapeutics requires multidisciplinary collaboration and discipline-specific training. A standardized training toolkit aids in the scalability of implementation of novel therapeutics and could be replicated for other medications. Future sites will benefit from adaptations and experience from pilot, along with further adaptations for resource level and language.

Background and Aims

Fluid management is an important component of oncology nursing care. It is therefore essential to properly monitor and document all intravenous fluids administered to patients with cancer. We recognized a challenge with fluid management on the Paediatric Oncology Unit (POU) of the Korle Bu Teaching Hospital (KBTH), with majority of patients noted to be receiving less than prescribed fluid volumes at shift handover rounds. This resulted in complications such as delays with start of chemotherapy and the potential for tumour lysis syndrome. The study aim was to describe the fluid monitoring and documentation practices on the unit so that measures, such as continuous nursing education, could be put in place to improve them.

Methods

A quantitative data collection method using patients’ files were used, looking specifically at their total intravenous fluid intake at end of each day. Eleven (11) patients on intravenous fluids were selected at random each day for a week (7days).

Results

Majority of the patients (82%) did not receive the required amount, with 15% having fluid overload and only 3% getting their required amount. Three potential explanations for the problem were identified. 1.Lack of continuous monitoring of fluids after initial set up. 2.Delays in setting intravenous lines when needed. 3. Inappropriate positioning of the cannula resulting in poor flow

Conclusions

There is an urgent need to improve intravenous fluid monitoring and documentation on the unit. This can be done by organising training sessions for staff to educate them on the importance of intravenous fluids and the need for patients to receive the prescribed volume over the specified time period. Checklists should also be developed to remind staff to continuously monitor intravenous fluids. One nurse should be designated per shift to monitor intravenous fluid administration.

Background and Aims

Time-to-antibiotic (TTA) administration is a widely used quality-of-care measure for children with cancer, fever and neutropenia (FN). The aim of this study was to determine the TTA and its relationship with clinical outcomes before and after the implementation of a new Intervention.

Methods

Experimental, prospective and multicenter study between April 2018 and January 2021. We evaluated the TTA, comparing this variable by hospital and presentation location (Emergency Room/ Oncology Units) and the clinical outcomes by the following variables: days of fever, days of hospitalization, hypotension, transfer to intensive care unit, sepsis and mortality, before and after a new Intervention that included education, guidelines and system changes.

Results

A total of 469 episodes of FN were enrolled from 9 hospitals in Chile. Comparing before and after the Intervention, the TTA was 92 vs 83 minutes, and a significance difference was obtained between both periods in the TTA curve (log rank test = 0.0006). In Emergency Room, after the protocol the TTA statistically decreased from 107 to 87 minutes (p=<0.001). In multivariate analysis, the TTA after 120 minutes was associated with negative transfer to intensive care unit, hypotension and sepsis (Odds Ratio 14.7, 95% CI 2.6 – 81.8, p=0.002).

Conclusions

Our results demonstrate that the local implementation of an Intervention can reduce TTA. Also we observed negative outcomes in episodes with TTA > 120 minutes, therefore, prompt attention, proper testing and antibiotic therapy administration as soon as possible are required in this population.

Background and Aims

Pain is a very unpleasant feeling and distress. it can be physical or psychological pain. A lot of pharmacological measures have been used to reduce pain and little attention paid to non-pharmacological measures, which in turn have fewer effects and are less costly.

Therefore, the purpose of this study was to measure the impact of using non-pharmacological measures on chemotherapy-induced pain among pediatric cancer patients. These measures include occasional dance sessions and watching cartoons.

Methods

This study enrolled 125 childhood cancer patients, 78 females and 52 males, age group 3-13 years.

Occasional dance sessions and watching of cartoon movies were introduced and shown to the pediatric cancer patients in the outpatient unit of Uganda Cancer Institute. The effects of watching cartoons were assessed while administrating chemotherapy (for both Liquid and Solid tumors) using the FLACC scale. The effects of the dancer sessions were assessed among patients awaiting intramuscular injection of L-asparaginase (L-aspa) using the FLACC scale (Face, Legs, Activity, Cry, Consolability). The period of assessment was 6 months

Results

There were 20 sessions altogether by the end of the sixth month. On average there were 12 children waiting for chemotherapy daily. A total of 125 childhood cancer patients, 78 females and 52 males participated in this study, with an average age of 8 years. Fifty-nine females –were distracted and 30 males showed varying levels of distraction. Two patients showed mixed reactions (distracted and irritable) on different session days.

Conclusions

Generally, this study showed that non-pharmacological measures are effective in the reduction of distress and pain. This method is safe and has no medicinal side effects. Non-pharmacological measures can be easily applied and are likely to require lesser financial implications, compared to pharmacological measures.

Much as the study looked at the reduction of pain, it may have an impact on anticipatory nausea and Vomiting