Value of central line care teaching for families of pediatric oncology patients.

Abstract

60 Background: Pediatric oncology care depends on central lines (CLs) in both outpatient and inpatient settings. Although inpatient implementation of CL maintenance bundles has been achieved, little attention has focused on families who care for CLs at home. Families are expected to follow best practice, but most have no prior experience or medical background. We sought to understand the comfort level and knowledge of families caring for external CLs at home and the value of our program’s existing teaching strategies, prior to an improvement initiative. Methods: Families caring for children with new and existing external CLs at home from May 2015-May 2016 were eligible for a survey and approached during outpatient visits if their primary team agreed. Using Likert scales, families were asked to assess their current comfort level with CL care, evaluate existing teaching strategies (instructional sheets; hands-on teaching by program nurses, and by home health nurses), and comment on other potentially helpful strategies. Five content questions regarding CL care were included to evaluate knowledge. Results: 80 of 82 (97.6%) families approached completed the survey. 70% had a CL in place for > 60 days. 46.3% felt "very comfortable" performing CL care, 42.5% were "comfortable", and 11.2% were "sort of or not comfortable". Only 17.5% of families found instruction sheets indispensable. Hands-on teaching was indispensable for 51.3% of families; 1.3% responded that teaching was not performed. 27.5% of families found hands-on teaching by home health nurses indispensable, but 22.5% had not received this. 98% of content questions were answered correctly. Other helpful strategies concentrated on 3 themes: standardization of educational content, increased opportunity for hands-on practice, and cognitive aids (e.g. a checklist) for CL care. Conclusions: A minority of families feel the highest level of comfort with CL care at home even after months of experience. Improvement opportunities and gaps in CL care teaching strategies are prevalent. To help support families caring for CLs at home and ensure adherence to best practice, programs should engage families to better understand their needs and develop solutions to meet them.