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Background:Desmopressin (1-deamino-8-D-arginine vasopressin [DDAVP]) has demonstrated efficacy as a treatment option for patients with inherited bleeding disorders. Because of individuals’ variable response to the medication, it is recommended to complete a challenge to document appropriate hemostatic response to the medication before recommending its use prior to surgical procedures or treatment of bleeding symptoms. The project aimed to reduce the errors in hemostatic response assessments for patients with bleeding disorders undergoing a DDAVP challenge (process outcome), particularly timing and number of blood samples drawn, from an error rate baseline of 36% to 0% by December 2021 and sustained for one year. Method:Plan-Do-Study-Act methodology was employed for this qualitative improvement initiative. Interventions designed and implemented included: an order set with medication doses and corresponding laboratory orders as clinically indicated for the bleeding disorder indication, clinical procedure guidelines for infusion nurses to follow, hemostasis nurse coordination of appointments with patients, and family education. Results:Baseline data on 22 patients who completed a DDAVP challenge demonstrated a 36% error rate not involving doses of medication administered. Errors encountered included improper timing of laboratory draw after DDAVP administration, incomplete laboratory evaluation, laboratory results displayed incorrectly due to testing orders released at once instead of in a sequential manner. These interventions resulted in a reduction of DDAVP challenge errors to 0% that were sustained for one year. Conclusion:Improvement in procedural medication administration and appropriate laboratory evaluation of patients undergoing a DDAVP challenge leads to a complete and reliable assessment of hemostatic response following medication administration.

Objective:We hypothesized that we could create and deploy a clinician orchestrated pediatric customized; three-dimensional virtual reality (VR) platform for distraction during IV procedures during a comprehensive hemophilia care visit without lengthening procedure time. We additionally hypothesized that VR would be favourably viewed by patients, caregivers,and clinical orchestrators.

Objectives:Demonstration of age appropriate disease and treatment knowledge is important in preparing adolescents with hemophilia for transition to adult care. Our pediatric hemophilia treatment center (HTC) aimed to use quality improvement (QI) methodology to develop a tool to assess and document transition skills in order to foster medical independence in a complex healthcare environment.