P145 Paediatric pocket guides: adaptation of an existing local irish resource to overcome challenges to clinical guideline implementation in a limited resource paediatric oncology setting in tanzania

We adapted an existing pocket guide to provide an easily accessible solution to support implementation of paediatric oncology guidelines for staff of the Paediatric Oncology Unit at Muhimbili National Hospital, Tanzania. Background In 2018, a team of Irish Childrens’ Nurses were invited to support the provision of the first 8-week Paediatric Oncology Nursing Course in Muhimbili National Hospital. Support was provided in the classroom, through clinical mentorship on the ward and the development of the Paediatric Pocket Guide (PPG). A detailed, locally appropriate Supportive Care Handbook had been developed for nurses and doctors working in the Paediatric Oncology Unit. However, the printed guidelines were expensive to print, bulky to routinely carry and regularly ‘disappeared’ from the ward. Rapid staff turnover (interns change every week!) also made dissemination difficult. Due to hospital IT issues the document was not available on ward computers. The lack of accessibility was felt to be a contributing factor to the lack of adherence to clinical protocols and guidelines. Gaps in knowledge and understanding of complex oncology issues have a direct impact on the provision of safe consistent care and survival of children treated on Upendo Children’s oncology ward. Similar challenges were noted with the implementation of a tailored Paediatric Early Warning System (PEWS) on the ward. Intervention Two versions (nursing and medical) of a summary pocket-sized paediatric oncology guideline resources were developed and printed on water-resistant cards. All staff attending specific education sessions were given a personal copy. Three months following the introduction of the Paediatric Pocket Guide an evaluation survey was completed. The findings were overwhelmingly positive 100% of staff find it very useful 100% of staff say their knowledge of oncology guidelines has improved and helps them follow the guidelines 67% strongly agree and 33% agree that patients are safer following the introduction of the PPG Examples were given of when the pocket guide was used in clinical practice and suggestions for improvement Learning The PPGs have led to improved adherence by ward staff to oncology protocols and guidelines and improved awareness and implementation of the PEWS. Creating locally relevant clinical guidelines is essential but consideration must also be given to how this information will be imparted to staff. The lightweight but cheap and durable pocket-guides have bridged this very significant gap between knowledge generation and clinical application. They also prompt guidelines to be regularly reviewed and updated with each new printed edition.