Acute Lymphoblastic Leukemia

Medication Adherence in Pediatric ALL Maintenance Therapy

Project Leader: Adam Thompson, BSN RN

Project Team Members: Brooke Cherven, MPH RN CPON®; Teresa Hammarback, MS RN CPN

Institution: Children’s Healthcare of Atlanta | Atlanta, Georgia

Grant Type: APHON Evidence-Based Practice Grant

Year Awarded: 2015


Medication adherence among the pediatric ALL population is an important area of opportunity in these patients. Through a search of the available evidence, lack of understanding among patients and families about the overall management of medications has been shown to be one of several significant barriers to consistent medication adherence. By implementing a standardized form of educational assessment and delivery, this evidence-based project seeks to determine potential improvements in regards to oral medication adherence.

A recent study showed that in a five year period, patients who were adherent with medications had a 4.9% chance of relapse, whereas 17% of non-adherent patients relapsed (Bhatia et al., 2012). While mercaptopurine is critical in the maintenance phase therapy, the 2-3 year length of the phase can be daunting when considering the consistency needed in medication adherence.

Through assessment of learning needs and a standardized educational format, this project hopes to highlight potential barriers to medication adherence in the pediatric ALL population that can be alleviated. We already know the importance of maintaining the prescribed medication routine for maintenance therapy; the focus is now on helping to deliver the appropriate tools to patients and families to help them through this lengthy process.

By focusing on repetitive education, this project will support the link between standardized information and an increase in medication adherence. Surveys have been created for distribution at two hem/onc outpatient clinics for parents of ALL patients in the maintenance phase of their treatment and to patients ages 12 and up.
Repeat surveys will assess change in knowledge, self-reported adherence, and identify barriers to adherence. Each member of the nursing staff involved will receive standardized education to ensure each patient is receiving the same material. Random audits of ALL patients in maintenance will be conducted to assess adherence by confirming the frequency of refills of medication through the patient’s preferred pharmacy. It is expected that all ALL patients in maintenance will participate in this practice change over the course of a year, fitting within the timeline of the APHON EBP grant of 24 months to complete.