Quality Improvement Initiative to Improve Sleep in Pediatric HSCT Patients and Caregivers

Quality Improvement Initiative to Improve Sleep in Pediatric HSCT Patients and Caregivers

S68 Abstracts / Biol Blood Marrow Transplant 25 (2019) S7 S75 of sleep efficacy results and follow up of quantitative and qualitative sleep assessmen...

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S68

Abstracts / Biol Blood Marrow Transplant 25 (2019) S7 S75

of sleep efficacy results and follow up of quantitative and qualitative sleep assessments of patients and caregivers will be available by February 2019. Conclusions: With a quality improvement initiative, we identified factors that negatively impact sleep and performed interventions that successfully mitigate these factors, leading to improved quality of sleep in HSCT patients and their caregivers. Figs. 1 and 2.

Figure 2. Box plots depicting the days between intervals of interest including: (1) primary diagnosis to first FP claim, (2) FP to HCT and the complete interval (3) from primary diagnosis to HCT.

86 Quality Improvement Initiative to Improve Sleep in Pediatric HSCT Patients and Caregivers Priscila Badia Alonso MD1,*, Victoria Hickey MSN, RN1, Laura Flesch MSN, RN, CRNP1, Megan Byerly BSN, RN, CPN1, Chelsea Sensibaugh BSN, RN, BMTCN2, Katherine Potts RN2, Celia Michel RN2, Alisha Drozd RN2, Stella M Davies MBBS, PhD1, Christopher E Dandoy MD, MSc1. 1 Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH Background: Sleep is an essential biological function vital for physiological rest, healing and emotional well-being. Sleep disruption, defined as interruptions or alterations to the normal sleeping patterns, is commonly seen in patients and caregivers with lengthy hospital stays such as patients undergoing hematopoietic stem cell transplant (HSCT). Sleep disruption in the caregivers of hospitalized patients can lead to increased stress and fatigue, decrease quality of life and ultimately affect the caregiver ability to support their loved one. Methods: Through a longitudinal observational cohort study, the quality and quantity of sleep in pediatric patients undergoing HSCT and their caregivers was studied; we identified a high level of sleep disturbance utilizing actigraphy and recounted poor sleep through qualitative assessments. We then performed a cross sectional focus group analysis of patients, caregivers and medical staff to identify the factors associated with poor sleep. The global aim of our quality improvement initiative was to improve sleep quality in HSCT patients and caregivers. The smart aim of our project was to decrease nighttime noise from 46 decibels (dB) (mean baseline data) to 38dB (WHO recommends night outside noise of less than 40dB) in a 6 month period and increase sleep efficacy from a mean of 60 % (combined patient and caregiver) to 90% in the following 6 month period. We worked on achieving this goal through an overnight nighttime sleep hygiene bundle to decrease sleep disruption along with reduction of the hallway nighttime noise (9pm-7am). Results: The most common factors associated with sleep disruption were noisy room entries, overnight trash pulls, loud hallway noise and noisy hospital staff. A simplified failure mode analysis identified four main key drivers; reliable nighttime awareness system, quiet nighttime nursing system, unobtrusive nighttime cleaning process and nighttime awareness maintenance system. Several PDSA (plan-do-study-act) interventions for each key driver took place and were adapted. The overnight mean dB decreased to 42dB (9% reduction). Overnight noise spikes above 60dB have decreased from a mean of 271 spikes to a mean of 151 spikes (44% reduction). Percentage

Figure 1.

Figure 2. Control chart of nighttime decibel measurements.

87 Impact of Individual Vs. Composite Endpoints for Prediction of Long-Term Survival in Gvhd Clinical Trials Research John M Magenau MD1,*, Thomas Braun PhD2, Erin Gatza PhD1, Tracey L. Churay MS1, Amanda Mazzoli BA1, Grant Chappell1, Lyndsey Runaas MD3, Sarah Anand MD1, Monalisa Ghosh MD1, Mary M Riwes DO1, Attaphol Pawarode MD1, Gregory A. Yanik MD1, Pavan Reddy MD1, Sung Won Choi MD MS1. 1 Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI; 2 Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI; 3 BMT & Cellular Therapy Program, Medicine, Hematology/ Oncology, Medical College of Wisconsin, Milwaukee, WI INTRODUCTION: The composite endpoint of GVHD-free, relapse-free survival (GRFS), defined as survival free from grade 3 4 acute GVHD (aGVHD), chronic GVHD (cGVHD) requiring systemic immunosuppressive therapy (IST), or relapse has emerged as an outcome to capture clinically meaningful events. In the present study, we validated GRFS as a useful surrogate endpoint by examining the relative importance of individual events and the GRFS composite itself on overall survival (OS) at 5-years after allogeneic HCT. METHODS: We conducted an IRB-approved retrospective cohort study on 565 consecutive patients (age 18 years) undergoing first-time allogeneic HCT for hematologic