TOP 18 - Using a Quality Improvement Framework to Standardize Oral Mucositis Care after Pediatric Hematopoietic Stem Cell Transplant

Publication Number: 3746.TOP 18

Maria E. Prado, Pontificia Universidad Católica de Chile, Santiago, Region Metropolitana, Chile; Maria Conejero, 166108047, las condes, Region Metropolitana, Chile; Cristian Sotomayor, Pontificia Universidad Católica de Chile, Santiago, Region Metropolitana, Chile; Fernanda Munoz, Pontificia universidad católica de chile, Santiago, Region Metropolitana, Chile; Jose C.. Hassi, PONTIFICIA UNIVERSIDAD CATOLICA DE CHILE, SANTIAGO, Region Metropolitana, Chile; Cristobal Aranda, Pontificia Universidad Católica de Chile, Santiago de Chile, Region Metropolitana, Chile

Background: Oral mucositis (OM) is a common complication in children undergoing hematopoietic stem cell transplant (HSCT). An audit in our pediatric oncology unit showed that 86% of HSCT patients developed OM and 55% had severe OM (Table 1). Evidence highlights the impact of standardized prevention strategies, oral hygiene education, and photobiomodulation (PBM) in improving outcomes. Currently, Hospital Clínico UC Christus (HCUC) has no standardized OM care protocol and does not use PBM.

Objective: To develop a Quality Improvement (QI) framework to standardize post-HSCT OM management in pediatric patients at HCUC.

Design/Methods: This on-going QI project is being conducted in a tertiary academic pediatric oncology unit. An interdisciplinary team was formed, including a pediatric oncologist, oncology nurses, two pediatric dentists, a pediatric hospitalist, and a pediatric resident as project lead. The project was exempt from ethics review.
A context assessment was conducted to inform the design phase. Process mapping and a driver diagram were used to identify key gaps in current OM care, including limited coordination between nursing and dentistry, low awareness of evidence-based interventions, and variability in OM assessment. PBM effectiveness was largely unknown among staff, but high motivation for improvement was identified as a key enabler.

Based on these findings, the team co-designed an evidence-based OM care protocol, an educational brochure for patients and families, and delivered training sessions for nurses and residents to build capacity for practice change. Early Plan-Do-Study-Act (PDSA) cycles focused on improving inter-team communication through targeted education and structured collaborative meetings, which supported protocol alignment and adoption.
As the project advanced, delays in protocol implementation were observed. A Fishbone Diagram was conducted to explore contributing causes for these delays, revealing barriers such as limited institutional familiarity with QI methodology and challenges securing funding for PBM equipment. In response, institutional awareness efforts and external funding avenues (including philanthropic support) were initiated.
Protocol implementation is planned for November 2025, followed by a 3-month initial impact evaluation period.

Process Map of Oral Mucositis Care for Pediatric HSCT Patients (Pre-Intervention)


Key Driver Diagram for Oral Mucositis Care Standardization


Fishbone Diagram of Barriers to Implementing Standardized Oral Mucositis Care