Development of indicators and analysis of barriers for assessment and prevention of cutaneous graft-versus-host disease after haematopoietic stem cell transplantation in children

doi:10.3969/j.issn.1674-8115.2024.12.008

Abstract

Abstract:

Objective ·To gain a comprehensive understanding of the current clinical status of assessment and prevention of cutaneous graft-versus-host disease (GVHD) after haematopoietic stem cell transplantation in children, construct review indicators, analyze obstacles and facilitators in the process of conducting the study in light of clinical reality, and formulate strategies for change. Methods ·Utilizing the JBI Evidence-Based Health Care Model as a theoretical guiding framework, the clinical problem was clarified. An evidence-based practice team was established, and a systematic literature search was conducted. The evidence was then evaluated and summarized. Additionally, review indicators were constructed, and review methods were clarified in relation to the evidence. Using the Ottawa Model of Research Use, the three dimensions of evidence change, potential adopters, and practice environment were analyzed for barriers and facilitators, and corresponding strategies were developed. Results ·A total of 24 pieces of best evidence were included in the study, comprising five dimensions: skin assessment, assessment of protection, management of adverse skin reactions, medication guidance and follow-up and screening. Twenty-two review indicators were constructed on this basis, of which 14 had an implementation rate of <60% and 10 had an implementation rate of 0%; 8 had an implementation rate of >60% and 6 had an implementation rate of 100.00%. The main obstacles were the lack of relevant training and the absence of a rational management mechanism. The main facilitating factors were reliable sources of evidence and a high level of cooperation from potential stakeholders. Considering the results of the analysis of the implementation rate of the indicators under review and the obstacles, alternative measures were formulated. Conclusion ·There is a large gap between the evidence and clinical practice for the assessment and prevention of cutaneous GVHD after paediatric haematopoietic stem cell transplantation. Clinical change should be effectively implemented based on barriers and facilitators.

Key words: haematopoietic stem cell transplantation, graft-versus-host disease (GVHD), review of indicator development, barrier factor, evidence-based nursing

CLC Number:

R725.5

YANG Liling, ZHAN Sha, XUE Xiaoyan, CHEN Kai, LIU Qing, WANG Li, WANG Yiyi, WU Meng, LU Qunfeng. Development of indicators and analysis of barriers for assessment and prevention of cutaneous graft-versus-host disease after haematopoietic stem cell transplantation in children[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(12): 1552-1560.

Figures/Tables 1

TrendMD

References 36

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Dimension	Indicator	Population	Review method	Review adherence rate/%
Skin evaluation	1. The nurse thoroughly examines the child's entire body for skin conditions prior to transplantation	Nurses (n=19)	Participatory observation	100.00
	2. The nurse thoroughly assesses the skin condition of the child's entire body on a daily basis during the transplantation period	Nurses (n=19)	Access to care record sheets	0
	3. The nurse assesses the grade of the child's skin GVHD using the Glucksberg criteria within 7 d of transplantation	Nurses (n=19)	Access to care record sheets	0
	4. The nurse is able to correctly select and use a skin GVHD assessment tool	Nurses (n=19)	Questionnaire method	52.63
	5. The nurse uses a diary to record changes in the child's skin condition	Nurses (n=19)	Access to care record sheets	0
	6. The nurse is able to use the body surface area method to indicate the area of the child's skin that has been damaged	Nurses (n=19)	Access to care record sheets; questionnaire method	21.05
	7. The nurse marks the assessment sheet for the child indicating the use of photosensitive medication	Nurses (n=19)	Access to care record sheets	0
Skin protection	8. The caregiver trims cuts the child's nails short during the transplantation period	Caregivers (n=22)	Participatory observation; interview method	81.80
	9. Caregivers use lukewarm water for cleansing the child's skin, followed by towel drying or patting dry, and then apply moisturizer	Caregivers (n=22)	Interview method	100.00
	10. Caregivers apply moisturiser to the child every 4‒6 h and after the application of steroid creams	Caregivers (n=22)	Participatory observation; interview method	4.54
	11. Caregivers store moisturisers in a cool place	Caregivers (n=22)	Participatory observation	100.00
	12. Caregivers should avoid exposing children to direct sunlight, particularly between 10:00 and 16:00	Caregivers (n=22)	Interview method	100.00
	13. The care givers is able to correctly protect the child from the sun	Caregivers (n=22)	Interview method	100.00
Management of adverse skin reactions	14. The nurse is able to correctly advise the physician to perform a skin culture for non-integrated skin	Nurses (n=19)	Questionnaire method	0
	15. The nurse is able to correctly manage non-integral skin breaks	Nurses (n=19)	Questionnaire method	100.00
	16. The nurse is able to select appropriate skin care products for the care of the child's slow-healing wounds	Nurses (n=19)	Questionnaire method	10.50
Guidance on the use of medication	17. The nurse should inform the caregivers and the child of the side effects of tacrolimus ointment	Nurses (n=19)	Participatory observation; interview method	0
Guidance on the use of medication	18. The nurse should assess the skin condition of a child who has been using steroid creams for a long period of time	Nurses (n=19)	Participatory observation; interview method	89.47
Follow-up and screening	19. On discharge, nurses should instruct caregivers and children to carry out their own comprehensive skin checks once a month	Nurses (n=19)	Participatory observation; interview method	0
	20. At discharge, the nurse should instruct the caregivers and the child on the correct frequency of skin follow-up visits	Nurses (n=19)	Questionnaire method; participatory observation	0
	21. At the time of discharge, nurses should instruct female children to have regular gynaecological outpatient follow-up visits	Nurses (n=19)	Questionnaire method; interview method	0
	22. At discharge, nurses should instruct male children to have regular follow-up visits to the urology clinic	Nurses (n=19)	Questionnaire method; interview method	0

Dimension	Indicator	Population	Review method	Review adherence rate/%
Skin evaluation	1. The nurse thoroughly examines the child's entire body for skin conditions prior to transplantation	Nurses (n=19)	Participatory observation	100.00
	2. The nurse thoroughly assesses the skin condition of the child's entire body on a daily basis during the transplantation period	Nurses (n=19)	Access to care record sheets	0
	3. The nurse assesses the grade of the child's skin GVHD using the Glucksberg criteria within 7 d of transplantation	Nurses (n=19)	Access to care record sheets	0
	4. The nurse is able to correctly select and use a skin GVHD assessment tool	Nurses (n=19)	Questionnaire method	52.63
	5. The nurse uses a diary to record changes in the child's skin condition	Nurses (n=19)	Access to care record sheets	0
	6. The nurse is able to use the body surface area method to indicate the area of the child's skin that has been damaged	Nurses (n=19)	Access to care record sheets; questionnaire method	21.05
	7. The nurse marks the assessment sheet for the child indicating the use of photosensitive medication	Nurses (n=19)	Access to care record sheets	0
Skin protection	8. The caregiver trims cuts the child's nails short during the transplantation period	Caregivers (n=22)	Participatory observation; interview method	81.80
	9. Caregivers use lukewarm water for cleansing the child's skin, followed by towel drying or patting dry, and then apply moisturizer	Caregivers (n=22)	Interview method	100.00
	10. Caregivers apply moisturiser to the child every 4‒6 h and after the application of steroid creams	Caregivers (n=22)	Participatory observation; interview method	4.54
	11. Caregivers store moisturisers in a cool place	Caregivers (n=22)	Participatory observation	100.00
	12. Caregivers should avoid exposing children to direct sunlight, particularly between 10:00 and 16:00	Caregivers (n=22)	Interview method	100.00
	13. The care givers is able to correctly protect the child from the sun	Caregivers (n=22)	Interview method	100.00
Management of adverse skin reactions	14. The nurse is able to correctly advise the physician to perform a skin culture for non-integrated skin	Nurses (n=19)	Questionnaire method	0
	15. The nurse is able to correctly manage non-integral skin breaks	Nurses (n=19)	Questionnaire method	100.00
	16. The nurse is able to select appropriate skin care products for the care of the child's slow-healing wounds	Nurses (n=19)	Questionnaire method	10.50
Guidance on the use of medication	17. The nurse should inform the caregivers and the child of the side effects of tacrolimus ointment	Nurses (n=19)	Participatory observation; interview method	0
Guidance on the use of medication	18. The nurse should assess the skin condition of a child who has been using steroid creams for a long period of time	Nurses (n=19)	Participatory observation; interview method	89.47
Follow-up and screening	19. On discharge, nurses should instruct caregivers and children to carry out their own comprehensive skin checks once a month	Nurses (n=19)	Participatory observation; interview method	0
	20. At discharge, the nurse should instruct the caregivers and the child on the correct frequency of skin follow-up visits	Nurses (n=19)	Questionnaire method; participatory observation	0
	21. At the time of discharge, nurses should instruct female children to have regular gynaecological outpatient follow-up visits	Nurses (n=19)	Questionnaire method; interview method	0
	22. At discharge, nurses should instruct male children to have regular follow-up visits to the urology clinic	Nurses (n=19)	Questionnaire method; interview method	0