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275 A quality improvement program (QIP) aimed at improving nutritional status of cystic fibrosis (CF) patients aged 2–12 years at CF Centre Roscoff: Update at the end of the 3 year period
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11. Nursing/Psychosocial/Quality Improvement
273 Influenza vaccination in CF adults: Coverage level and adverse reactions L. Fila1 , A. Grandcourtova1 , L. Valentova Bartakova1 . 1 University Hospital in Motol, Prague CF Centre, Prague, Czech Republic Objectives: Influenza increases morbidity in CF individuals. Annual vaccination against influenza is a recommended measure in people with chronic respiratory diseases including CF. However, there are worries about adverse reactions of influenza vaccine in some patients and coverage level is generally low in the Czech Republic (approximately 5% of population). Methods: We conducted a study in CF adults in Prague CF Centre regarding to coverage level and occurrence of adverse reactions after influenza vaccination using interviews during visits of CF clinic or by phone or e-mail in January 2015. Results: 112 CF adults (59 males) with mean±SD age 27.3±6.2 years and mean±SD FEV1 68±26 pred. were interviewed. Thirty-two (28.6%) patients received influenza vaccine. Among them, three patients experienced adverse reaction of mild intensity. In those who did not received a vaccination, eleven subjects reported adverse reactions in the past (two of them described it as severe), four patients experienced prolonged pulmonary exacerbations and others (58.0% of study group) had no interest in vaccination. Together, current or previous adverse reactions were reported in 14 (12.5%) subjects. Level of vaccination was not associated with sex, age or lung function. Conclusion: Coverage level of influenza vaccination in Czech CF adults is low. The main reason is no interest for vaccination. Adverse reactions were quite frequent but usually with only mild intensity.
274 Nurse prescribing for children with cystic fibrosis (CF). An initiative to improve service delivery C.A. Sharpe1 , J. Bloomer1 , A. Sewell1 , C. Fagin1 . 1 Great North Children’s Hospital, Children’s Respiratory Unit, Newcastle upon Tyne, United Kingdom Children with CF often require medication, particularly antibiotics, at times when they are not being reviewed by the hospital medical team. These medications are usually prescribed by the child’s GP at the request of the CF team. The CF Nurse Specialist (NS) team would assess the patients needs and discuss a course of treatment with the registrar, a faxed prescription request would then be made. This was time consuming and often resulted in a delay in prescription requests being generated hence the possibility of treatment being delayed. Prescriptions for the home intravenous antibiotic therapy service, which is organised by the CF NS, were also reliant on the availability of a registrar or consultant to prescribe. Whilst this did not usually result in delayed treatment it was often time consuming and inefficient. Following completion of a non-medical prescribing course and the subsequent registration of one of the CF NS, these prescribing functions were taken over by the CF Nursing team. In order to ensure that appropriate decisions were made, a tool for telephone consultations was utilised to document the prescribing decision. A review of the prescribing activity was undertaken prior to the initiative being implemented and repeated once it had been established in practice. This review found a reduction in time from prescribing decision being made to generation of prescription or fax from an average of 14 hrs to 1 hr 49minutes. This initiative therefore demonstrates a considerable efficiency saving, hence an improvement to service delivery.
Posters
275 A quality improvement program (QIP) aimed at improving nutritional status of cystic fibrosis (CF) patients aged 2−12 years at CF Centre Roscoff: Update at the end of the 3 year period K. Revert1 , J. Pengam1 , M.-L. Madec1 , L. Audran1 , L. Maitrallin1 , P. Lesn´e1 . CF Center, Roscoff, France
1 Roscoff
Background: Roscoff CF Center enrolled in the French QIP PHARE-M in June 2011 and created a team responsible for carrying out the program in paediatric care. Objectives: In patients aged 2−12 y, to attain a mean BMI Z-score = 0 and improve the mean FEV1 at the end of 2014. Methods: FEV1% and BMI Z-scores were analysed for 139 patients (patient registry data 2010). The children aged 2−12 (n = 34) were selected as the intervention group as BMI Z-score varied from −3.5 to +1.8 (mean −0.5). Children were classified in 4 colour groups according to their BMI Z-score and a new process elaborated: in addition to shared baseline care, the number of consultations with a dietitian, calorie-intake evaluations, stool fat analyses, prescription of oral supplements varied for each group. Information was given to parents about i. the relationship between nutritional status and FEV1 illustrated with results from large international studies, ii. colour-coded BMI curve with the child path on the chart, iii. calorie-equivalent snack suggestions. Home weekly weighing, individual weight gain objectives, psychological follow up and discusssion about G tube feeding were items included for the more severe groups. Results: All children arriving at 2 y were included and those beyond 12 y remained included (n = 44 in December 2014). Their mean BMI Z-score was −0.22 while mean FEV1 remained at 85%. Four children were still in the red zone. The % of children in the green or yellow zones increased from 53% to 64%. Conclusion: PHARE-M helped improve the nutritional status of most children 2−12 y, after three years collaboration between parents and the MDT, who is now focusing of the nutritional status of infants.
276 Parental preparation for first admission K. James1 , S. Phillips1 , B. Fulford2 . 1 University Hospitals Bristol NHS Foundation Trust, Bristol Royal Hospital for Children, Psychological Health Services, Bristol, United Kingdom; 2 University of Exeter, Exeter, United Kingdom Objectives: Provision of adequate preparatory information for families prior to a child’s hospitalisation is increasingly recognised as important in reducing parental distress and enabling parents to maintain a key role in care. This is especially important in advance of a child’s first admission. Hughes, Phillips & Daniels (2014) found that parents of children with CF reported feeling unprepared for their child’s admission and emphasised the need to receive preparatory information. Therefore, this qualitative study aimed to collaboratively develop pre-hospitalisation resources addressing the medical, practical and psychosocial aspects of admission with parents. Methods: Semi-structured interviews were completed with parents whose children with CF have been admitted for routine intravenous antibiotic treatment within the last two years. Theme analysis of transcribed interviews was used. Results: Parents’ views on the important medical, practical and psychosocial issues to address, alongside the most effective and timely process of information delivery, led to the collaborative development of information resources. Conclusion: Provision of adequate preparatory information is crucial in reducing parental distress. This study extends previous research by demonstrating the issues that are important for parents in relation to their children’s first hospital admission and meaningfully involving families in service development. The development of a resource for parents by parents aims to ensure that families are informed about their child’s hospital admission, feel more confident about managing this experience, and have increased awareness of ongoing psychosocial support.
11. Nursing/Psychosocial/Quality Improvement
273 Influenza vaccination in CF adults: Coverage level and adverse reactions L. Fila1 , A. Grandcourtova1 , L. Valentova Bartakova1 . 1 University Hospital in Motol, Prague CF Centre, Prague, Czech Republic Objectives: Influenza increases morbidity in CF individuals. Annual vaccination against influenza is a recommended measure in people with chronic respiratory diseases including CF. However, there are worries about adverse reactions of influenza vaccine in some patients and coverage level is generally low in the Czech Republic (approximately 5% of population). Methods: We conducted a study in CF adults in Prague CF Centre regarding to coverage level and occurrence of adverse reactions after influenza vaccination using interviews during visits of CF clinic or by phone or e-mail in January 2015. Results: 112 CF adults (59 males) with mean±SD age 27.3±6.2 years and mean±SD FEV1 68±26 pred. were interviewed. Thirty-two (28.6%) patients received influenza vaccine. Among them, three patients experienced adverse reaction of mild intensity. In those who did not received a vaccination, eleven subjects reported adverse reactions in the past (two of them described it as severe), four patients experienced prolonged pulmonary exacerbations and others (58.0% of study group) had no interest in vaccination. Together, current or previous adverse reactions were reported in 14 (12.5%) subjects. Level of vaccination was not associated with sex, age or lung function. Conclusion: Coverage level of influenza vaccination in Czech CF adults is low. The main reason is no interest for vaccination. Adverse reactions were quite frequent but usually with only mild intensity.
274 Nurse prescribing for children with cystic fibrosis (CF). An initiative to improve service delivery C.A. Sharpe1 , J. Bloomer1 , A. Sewell1 , C. Fagin1 . 1 Great North Children’s Hospital, Children’s Respiratory Unit, Newcastle upon Tyne, United Kingdom Children with CF often require medication, particularly antibiotics, at times when they are not being reviewed by the hospital medical team. These medications are usually prescribed by the child’s GP at the request of the CF team. The CF Nurse Specialist (NS) team would assess the patients needs and discuss a course of treatment with the registrar, a faxed prescription request would then be made. This was time consuming and often resulted in a delay in prescription requests being generated hence the possibility of treatment being delayed. Prescriptions for the home intravenous antibiotic therapy service, which is organised by the CF NS, were also reliant on the availability of a registrar or consultant to prescribe. Whilst this did not usually result in delayed treatment it was often time consuming and inefficient. Following completion of a non-medical prescribing course and the subsequent registration of one of the CF NS, these prescribing functions were taken over by the CF Nursing team. In order to ensure that appropriate decisions were made, a tool for telephone consultations was utilised to document the prescribing decision. A review of the prescribing activity was undertaken prior to the initiative being implemented and repeated once it had been established in practice. This review found a reduction in time from prescribing decision being made to generation of prescription or fax from an average of 14 hrs to 1 hr 49minutes. This initiative therefore demonstrates a considerable efficiency saving, hence an improvement to service delivery.
Posters
275 A quality improvement program (QIP) aimed at improving nutritional status of cystic fibrosis (CF) patients aged 2−12 years at CF Centre Roscoff: Update at the end of the 3 year period K. Revert1 , J. Pengam1 , M.-L. Madec1 , L. Audran1 , L. Maitrallin1 , P. Lesn´e1 . CF Center, Roscoff, France
1 Roscoff
Background: Roscoff CF Center enrolled in the French QIP PHARE-M in June 2011 and created a team responsible for carrying out the program in paediatric care. Objectives: In patients aged 2−12 y, to attain a mean BMI Z-score = 0 and improve the mean FEV1 at the end of 2014. Methods: FEV1% and BMI Z-scores were analysed for 139 patients (patient registry data 2010). The children aged 2−12 (n = 34) were selected as the intervention group as BMI Z-score varied from −3.5 to +1.8 (mean −0.5). Children were classified in 4 colour groups according to their BMI Z-score and a new process elaborated: in addition to shared baseline care, the number of consultations with a dietitian, calorie-intake evaluations, stool fat analyses, prescription of oral supplements varied for each group. Information was given to parents about i. the relationship between nutritional status and FEV1 illustrated with results from large international studies, ii. colour-coded BMI curve with the child path on the chart, iii. calorie-equivalent snack suggestions. Home weekly weighing, individual weight gain objectives, psychological follow up and discusssion about G tube feeding were items included for the more severe groups. Results: All children arriving at 2 y were included and those beyond 12 y remained included (n = 44 in December 2014). Their mean BMI Z-score was −0.22 while mean FEV1 remained at 85%. Four children were still in the red zone. The % of children in the green or yellow zones increased from 53% to 64%. Conclusion: PHARE-M helped improve the nutritional status of most children 2−12 y, after three years collaboration between parents and the MDT, who is now focusing of the nutritional status of infants.
276 Parental preparation for first admission K. James1 , S. Phillips1 , B. Fulford2 . 1 University Hospitals Bristol NHS Foundation Trust, Bristol Royal Hospital for Children, Psychological Health Services, Bristol, United Kingdom; 2 University of Exeter, Exeter, United Kingdom Objectives: Provision of adequate preparatory information for families prior to a child’s hospitalisation is increasingly recognised as important in reducing parental distress and enabling parents to maintain a key role in care. This is especially important in advance of a child’s first admission. Hughes, Phillips & Daniels (2014) found that parents of children with CF reported feeling unprepared for their child’s admission and emphasised the need to receive preparatory information. Therefore, this qualitative study aimed to collaboratively develop pre-hospitalisation resources addressing the medical, practical and psychosocial aspects of admission with parents. Methods: Semi-structured interviews were completed with parents whose children with CF have been admitted for routine intravenous antibiotic treatment within the last two years. Theme analysis of transcribed interviews was used. Results: Parents’ views on the important medical, practical and psychosocial issues to address, alongside the most effective and timely process of information delivery, led to the collaborative development of information resources. Conclusion: Provision of adequate preparatory information is crucial in reducing parental distress. This study extends previous research by demonstrating the issues that are important for parents in relation to their children’s first hospital admission and meaningfully involving families in service development. The development of a resource for parents by parents aims to ensure that families are informed about their child’s hospital admission, feel more confident about managing this experience, and have increased awareness of ongoing psychosocial support.