278 Background: Communication failure is the most common preventable cause of medical adverse event, and almost half of all sentinel events involve handoff failure. Inefficient handoff is labor intensive and time consuming, impacting the quality of patient care provided. A safe and efficient means of exchange of medical information between care teams via a standardized handoff system is essential, especially in high intensity fields such as Pediatric Hematology/Oncology. Methods: Pre-intervention, handoff entailed the physical handover of handwritten notes, carbon copied for various team members. A standardized electronic handoff tool (IPASS) was identified, and significantly modified to fit our needs, since we do not have a complete electronic medical record (EMR). Microsoft Sharepoint (Microsoft, Redmond, WA) was used to develop a tabulated online portal incorporating patient demographic, clinical and laboratory details with physician remarks. This allowed remote access, multiple simultaneous inputs, authenticated use and user-specific access control. Implementation included sensitizing residents to the IPASS template, hands-on training, weekly feedback from the residents, directly observed hand-off by the chief and/or senior resident. Following a four-week pilot this was expanded to other sub specialties, and a pre and post intervention survey was conducted to assess its impact. Results: Pre-implementation survey revealed 74% resident and 87% faculty dissatisfaction with the current handoff process. Weekly compliance audits after initial pilot demonstrated a 100% compliance. Post-Implementation results showed that the resident dissatisfaction has gone down to less than 5%. Conclusions: Implementation of an electronic handoff tool in the absence of an EMR with minimal resources is a major breakthrough and can be replicated in other low-resource settings. We successfully implemented IPASS without any added infrastructure cost. In the next phase of our project we will be measuring trends in reduction in medical errors since implementation.

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Background: CINV is a known distressful symptom in pediatric cancer patients. In a resource-limited setting, insight regarding CINV frequency and current practice can help optimize symptom control. Methods: Prospective study in the pediatric oncology daycare and inpatient services within a tertiary care hospital over 6 months. Patient demographics, chemotherapy and antiemetic regimen details were recorded. Frequency of acute nausea, vomiting and nausea severity for each session was recorded using a self-report questionnaire. Primary outcome was complete control (CC) (defined as no acute nausea or vomiting). Secondary outcomes included nausea severity and antiemetic prescription patterns. Results: A total of 61 (median age 7 years, 45.9% girls) patients received chemotherapy over 265 visits (85 single-day, 56 blocks). Inpatient sessions were more frequently of high emetogenicity (47.8% of 138 sessions) and most daycare sessions moderately emetogenic (79.5% of 127). Overall CC was 65.7%, significantly better for inpatients (73.2%, P<.009) and for sessions with weight-appropriate ondansetron dosing (p = 0.033). Odds of experiencing nausea (median severity 4) were higher in day care (OR 2.11, 95% CI 1.13-3.92) and lower (OR 0.25, 95% CI 0.09-0.72) when ondansetron dosing was weight-appropriate. CC did not vary significantly with age or gender. Conclusion: The overall CC rate was 65%, and was significantly higher for inpatients, highly emetogenic regimens, and when appropriate ondansetron dosing was used. This study identified gaps in our antiemetic practice, with moderately emetogenic sessions failing to receive guideline-recommended antiemetics, correlating with significantly lower complete control for daycare sessions.