This study aimed to determine the effectiveness of oral-hygiene instruction in improving oral health in 100 patients following oral hygiene instruction, with and without use of an intra-oral camera. The two groups of 50 patients were similar in age and sex distributions, frequency of caries, plaque accumulation and gingival bleeding. Prospective improvements in oral hygiene and compliance were measured by means of plaque levels and gingival bleeding at baseline and four weeks later. While both groups showed a clear reduction in plaque accumulation, the test group benefited from the use of the intra-oral camera. A majority of patients (88 per cent) thought that the extra information provided by the camera was helpful and desirable. This study demonstrates that the intra-oral camera can effectively augment oral-hygiene instruction and help create improvements in patient compliance.

Neutropenic fever is an oncologic emergency that requires prompt assessment and treatment with antibiotics. Although the term "prompt" is not defined in numbers of minutes in the biomedical literature, the literature does indicate that the sooner antibiotics are initiated, the greater the likelihood of a positive clinical outcome. At Dartmouth-Hitchcock Medical Center in Lebanon, NH, the oncology team was concerned about the length of time before adult inpatients with febrile neutropenia received their initial dose of antibiotics (cycle time). The purpose of this quality improvement project was to reduce treatment delays in patients with febrile neutropenia. A multidisciplinary team charted the existing admission process and identified three areas for improvement: (a) inpatient orders, (b) the admission communication process, and (c) multidisciplinary staff accountability. Following implementation, the hematology and oncology clinical nurse specialist completed a chart review of all patients with febrile neutropenia, which revealed a nearly 50% reduction in cycle time on the inpatient unit.

QI principles were used by a multidisciplinary team to improve the quality of care for patients with glioma during the perioperative period. Leadership involvement, ongoing dialogue across departments, and reporting of system performance were important for sustaining process improvements.

217 Background: Gliomas account for nearly 80% of primary malignant brain tumors and are associated with poor survival. Developing clinical care pathways to ensure that patients receive coordinated, comprehensive and timely care may result in improved outcomes and patient satisfaction. Methods: A quality improvement (QI) project was chartered to improve the care provided to patients with glioma. A multidisciplinary team was convened and met weekly and then monthly from Feb 2013 – April 2014. Twenty best practice measures were identified from the literature. Using a Plan-Do-Study-Act framework, the team brainstormed and implemented various improvement interventions between Oct 2013 and Feb 2014. Statistical process control charts were used to evaluate progress. A dashboard of quality measures was generated to allow for ongoing reporting. Results: Retrospective data was available for 12 best practice measures; 6 of which could be abstracted from electronic medical records. Eight measures were not part of the current system of care. The baseline population consisted of 98 patients with gliomas. Review of their records suggested wide variation in performance, with compliance ranging from 30% to 100%. Unanticipated opportunities for improvement included a high proportion of outpatient falls (7%) and urinary tract infections (10%). The team hypothesized that lack of standardization in the current process may contribute to less-than-ideal performance. After implementing improvement interventions, the records of 19 consecutive patients with glioma were reviewed. The proportion of patients meeting criteria for 12 practice measures modestly improved (65% pre QI-work; 78% post-QI work). There were no additional cases of urinary tract infections. Barriers to pathway development included difficulties with transforming manual measures into electronic data sets and accounting for portions of care that occurred at outside facilities. Updated outcomes will be presented. Conclusions: Creating evidence based clinical care pathways for addressing the acute care needs of patients with glioma is important. There are many challenges, however, to developing sustainable systems for measuring and reporting performance outcomes overtime.