title: Increasing Activities of Daily Living Is as Easy as 1-2-3.
abstract: Human flora are the most common cause of bacteremia in immunocompromised patients. Activities of daily living (ADL), including oral care and daily chlorhexidine gluconate bathing, can lower the risk of infection.
  
  
  
  To address ADL compliance in our pediatric oncology and bone marrow transplant patients, we adopted the ADL 1-2-3 initiative: daily chlorhexidine gluconate bath and linen change, at least 2 activities per day, and oral care 3 times per day. Using the Model for Improvement we created a standardized ADL process that involved all providers. Interventions included addressing ADL 1-2-3 compliance during rounds, establishing accountability in care delivery, an oral care order set and algorithm, daily text message reminders, and physician intervention with noncompliant and high-risk patients.
  
  
  
  With our interventions, we increased our median compliance with the all-or-none ADL 1-2-3 initiative from 25% to 66% in 90 days. We have sustained our median compliance to 75% sixteen months after implementation. The greatest impact on compliance was seen with text message reminders to staff to complete and document the ADL 1-2-3 components, designated roles and responsibilities, and physician discussion with noncompliant and high-risk patients.
  
  
  
  Oral care algorithm and order set, daily text message reminders, and physician intervention with noncompliant and high-risk patients has improved our compliance. Units where compliance with ADL participation is low can benefit from incorporating elements from this ADL 1-2-3 initiative.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Best
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA erin.osterkamp@cchmc.org.
authors.forename: Erin
authors.initials: E
authors.lastname: Osterkamp
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Demmel
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Shivonne
authors.initials: S
authors.lastname: Kiniyalocts
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Mock
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Mulligan
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Bell
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Crystal
authors.initials: C
authors.lastname: Doughman
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Miranda
authors.initials: M
authors.lastname: Flemming
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Flesch
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Hawkins
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Pate
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Bedel
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Lori Ann
authors.initials: LA
authors.lastname: McKenna
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Teusink
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Sonata
authors.initials: S
authors.lastname: Jodele
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Rajaram
authors.initials: R
authors.lastname: Nagarajan
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: John
authors.initials: J
authors.lastname: Perentesis
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Dandoy
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000293:Adolescent; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D001494:Baths; D016026:Bone Marrow Transplantation / Q000451:nursing; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000451:nursing; D009820:Ohio; D009859:Oncology Nursing / Q000379:methods*; D009910:Oral Hygiene / Q000379:methods*; D010349:Patient Compliance / Q000523:psychology*
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: activities of daily living; blood stream infection; chlorhexidine bathing; compliance; pediatric bone marrow transplantation; pediatric oncology; quality improvement