Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dianne Conrad, DNP, RN, FNP-BC, FNAP

Second Advisor

Amy Manderscheid, DNP, RN, AGPCNP-BC, AGNP-PC, CMSRN

Third Advisor

Carla Schwalm, MD


Introduction: Researchers have found that pediatric patients with acute lymphoblastic leukemia and adolescent patients with sickle cell disease struggle to adhere to medication treatment requirements. Because of this trend, there is a clear need to address medication adherence. The purpose of this quality improvement project was to enhance medication adherence behaviors among pediatric hematology and oncology patients and their families within an ambulatory hematology and oncology clinic.

Methods: The project included a systematic literature review to identify evidence-based interventions, an organizational assessment, and a three-phase multifaceted quality improvement process. To increase patients bringing medications to appointments, 32 medication transportation bags were distributed. Objective adherence measurements were analyzed via pre and post implementation analysis of mean corpuscular volume and absolute neutrophil counts. Descriptive statistics were used to analyze subjective pre and post implementation survey trends in patient medication behaviors and staff perceptions of interventions.

Results: Ultimately, the changes to subjective and objective adherence measurements were not statistically significant. Although findings were statistically insignificant, the patient population served by this clinic reported high levels of satisfaction in receiving medication adherence interventions (e.g., medication transportation bags).

Discussion: High rates of staff turnover, lack of commitment to the intended interventions, the COVID 19 pandemic, and electronic health record fluctuations greatly influenced the successful integration and adoption of project expectations. Practice knowledge gained emphasized the importance of continuous quality improvement to enhance medication adherence behaviors clinical project work, dissemination of project results and findings, and adaptability in the face of real-time clinical barriers.

Available for download on Monday, May 06, 2024