Level 5 New Ward Block-

Model of Care 11 CIPU Beds Prepared by: James Jenkins Version: 0.3 | 21 February 2019

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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Document Control

Version Date Prepared by Comments

0.1 23.1.19 James Jenkins Draft

0.2 30.1.19 James Jenkins Draft 2

0.3 21.2.19 James Jenkins Draft 3

*Drafts should use format vX.1 (eg. start at v0.1). Final versions should use format vX.0 (eg. v1.0).

Distribution

Name Title Function*

Kieran Kinsella Executive Director Rural and District Wide Services

Wendy Hoey Executive Director Rockhampton Hospital

Deb Hirning Director of Nursing, Aged Care Clinical and Rehabilitation Services

Struan Ferguson Deputy Director, Allied Health, Clinical Support Services

Celia Anich Deputy Director, Allied Health, Clinical Support Services

Dr Dhiraj Saini Geriatrician SAGE Unit

Colin Bartlem Manager Health Planning, District Finance

Kaylene Tansley ABF Coordinator, Business Analysis & Decision Support Unit

Leanne Law Senior Administration Officer, Corp Serv

Kim Kekewick Director of Corporate and Support Services, Rockhampton Business Unit

* The values applicable to the function field are Review, Approve, For Information

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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Table of contents

Executive summary 4 1 Background 5 2 Service Scope and Description 6

2.1 Description of the Service 6

2.2 Purpose of the Service 6

Service Processes 7 2.3 Referral process 7

2.4 Patient Flow 8

2.4.1 Outlier patients 8 2.5 Discharge process 8

2.6 The team 8

2.6.1 MEDICAL 8 2.6.2 NURSING 9

2.6.2.1 Staff training 9 2.6.2.2 Projected Nursing staff profile: (See Attached HPDDS and Roster Coster) 10

2.6.3 Allied Health Team 10 2.6.4 Operational Service Officer Resource Allocation 10 2.6.5 Administration Officer Resource Allocation 11

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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Executive summary

Level 5 of the New Ward Block at Rockhampton Hospital will provide care for 2 key patient cohorts including:

- 11 Bed Cancer Inpatient Unit (Model of care included within)

- 16 Bed Acute Care of the Elderly (Frailty and GEM)

The 11 beds will provide inpatient care for patients within the 4 services of the Cancer Care Framework. These being:

Medical Oncology

Haematology

Radiation Oncology

Specialist Palliative Care

The Cancer Inpatient Unit aims to provide high quality person centred care that addresses the needs of the Central Queensland Community. Our service provides a holistic approach to care and encompasses the provision of inpatient and community based care to support the physical, psychological, emotional, cultural, social and spiritual needs of the patient and the family. We promote home and community based care as appropriate, facilitating the most effective utilisation of all available resources. The Key Objectives of our Service are:

Provide an integrated cancer care service that maximises opportunities to support a continuum of care.

Support regular clinical, human resource, equipment and fiscal audit, review and benchmarking processes to ensure efficiency, effectiveness and consistency with recognised best practice standards for these specialties.

Actively use quality improvement processes to address identified variances in meeting Key Performance Indicators.

Support performance responsibility and accountability through the provision of evidence based policies, procedures and guidelines and through the Performance, Appraisal and Development process.

Provide a teaching and learning environment that supports safe, quality care provision by meeting staff needs for orientation, transition to practice and on-going learning.

Build capability and capacity, within the clinical service capability framework, to provide a sustainable service that meets the needs of the community, including recruitment to specialty staffing requirements

Provide cancer services that support care close to home.

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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Ensure consumer participation in planning, implementation and evaluation of the Model of Care.

Ensure that standards of care of the Cancer Outreach Service are consistent with the guidelines provided by Palliative Care Australia Standards for Palliative Care Provision, the Palliative Care Outcome Collaborative and the Australian Council on Healthcare Standards and the National Safety & Quality Health Service Standards.

Support carers and families within the home setting.

1 Background

The CQHHS is one of seventeen Hospital and Health Services in Queensland charged with responsibility for administering public health services in the State. The CQHHS covers an area of 114,000 square kilometres in regional Queensland, extending from Miriam Vale in the south, inland to the Central Highlands and north along the Capricorn Coast. The CQHHS services a resident population of more than 221,000 and includes the regional centres of Rockhampton and Gladstone. Rockhampton Base Hospital is the main referral centre for the catchment and is a secondary level service with tertiary referral links to Brisbane facilities. The population is culturally diverse and is dispersed over a wide and largely rural geographical area. The CQHHS is home to an increasing refugee population and a growing non-resident population associated with the mining industry. There is an increasing population within CQHHS including an aging population requiring cancer care services. Service demand has increased over the years and is expected to steadily continue to increase in 2018-2019. Oncology and Haematology service demand has steadily increased with the opening of the new ward block in 2015. The new facility, combined with the recruitment of onsite medical oncologists and haematologists, has seen patients opt for care within this public facility and an increase of clinical trials. Radiation oncology services commenced in 2016 has already seen an increase demand in bed availability for frail patients that require admission during their treatments. The Specialist Palliative Care Service in integrated with the community based palliative care service and GP’s to support the non-complex patients requiring a palliative approach to care. The rationale for this model of care change includes:

- Overuse of outlier patients within CIPU, reducing capacity of provision of specialist care - ALOS of CIPU outliers increasing - Volume of patients requiring specialist palliative care review

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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2 Service Scope and Description

2.1 Description of the Service

The inpatient service will offer; Direct access [Refer CQHHS Admission Policy] CQHHS Procedural document portal

24/7 phone support service

Provision of an interdisciplinary team

Maintenance of a person-orientated environment

Support for the patient’s family and carers

Symptom prevention and management

Telehealth services

The Cancer Inpatient Unit is a 11-bed unit which primarily provides holistic multidisciplinary care for patients under the care of Medical Oncology, Haematology, Radiation Oncology, and Specialist Palliative Care teams. Due to hospital wide bed utilisation and management practices, the unit will often provide care for outlier medical and surgical patients. Additional to the inpatient unit, the service has a 7-day Cancer Outreach Service, primarily for palliating patients and their carer’s in the home setting. This service additionally supports Oncology and Haematology patients undergoing chemotherapy as required.

2.2 Purpose of the Service

The Cancer Inpatient Unit provides nursing staff to deliver care for patients within a wide trajectory of cancer diagnosis. Care is provided for patients requiring inpatient chemotherapy regimens, patients with side effects from their treatments, patients undergoing radiotherapy treatment and potential side effects. Care is also provided for those patients who are in the palliating phase of their cancer trajectory. Inclusive of the specialist palliative care are patients with life limiting cardiac, respiratory, renal, and other conditions. Exposure to this diversity of varying phases in disease trajectory provides staff to see the ‘big picture’ of holistic cancer care. The Cancer Inpatient Unit works in collaboration with the Cancer Ambulatory Care and Day Therapy Unit, to provide nursing staff with educational support for their ongoing cancer nursing educational requirements. This unit also has the ability to have outlier patients from other multifaceted departments. It has been identified that the staff require further education and support to sustain their skills and knowledge in other areas of nursing that is required to maintain patient safety.

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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The Cancer Inpatient Unit incorporates 5 services within its model. 1. Inpatient care – currently open at 11 bed unit comprising of Medical Oncology,

Haematology, Radiation Oncology and Specialist Palliative Care.

2. Phone advisory support service – 24/7 support provided for patients/carers.

3. Community based care – a Cancer Outreach Service operates 7 days a week. This service offers follow-up post discharge care. Co-ordinates external agencies as required [domiciliary nurses, equipment hire], provides ongoing educational and emotional support.

4. Consultancy Service – provided by the Palliative Care Specialist. This consultancy service aligns with Palliative Care Australia model of Specialist Palliative Care Service [SPCS] as Level 3 service, providing consultation and support to Level 2 & 1 services.

5. Clinics – clinics are currently conducted by the SPC consultant 2 days a week within the ambulatory floor. There is an additional SPC clinic at the Capricorn Coast Hospital & Health Service once a fortnight. This clinic is conducted by the SPC consultant and the community liaison CN.

Service Processes

2.3 Referral process

1. Admission to the unit will be as per procedural document: Admissions – CQHHS Facilities 2. https://qheps.health.qld.gov.au/cqld/procedure 3. Admissions can be direct to the unit [ as per policy] 4. Medical Oncology, Haematology Specialist Palliative Care Referral -

https://qheps.health.qld.gov.au/cqld/procedure Referral to external agencies The unit has strong partnerships with various external supportive agencies to assist with discharge planning. Referrals are the responsibility of the shift co-ordinator position.

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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2.4 Patient Flow

The unit requires the ability to self-manage beds separate to the RH bed management so that ‘bed bookings’ can be arranged for inpatient care –

Radiotherapy treatment Chemotherapy treatments Supportive therapies – blood product infusion Invasive procedures – pleural taps, abdominal drains

Patients admitted via the ED will follow normal bed management admission procedures.

2.4.1 Outlier patients

The specialist unit will only accept ‘outlier’ patients when the campus is at capacity and direction is given by the Nursing Director. Outlier’s are to be short-term so there is no bed block, and appropriate admissions in line with the outlier policy.

2.5 Discharge process

Patient discharge will be co-ordinated by the shift co-ordinator position – Mon > Friday This position will liaise with medical staff, Allied Health, external nursing agencies, and the Community Health Palliative Care Service as required. Patients will be discharged from the unit for:

Home Inter-hospital transfer Inter-facility transfer – transfer to SAGE when stable and requiring NHP RACF transfer – discharged back to RACF where previously a patient. Death on the inpatient unit

2.6 The team

2.6.1 MEDICAL

The Medical team is comprised of: - Consultant - Registrar - Resident Medical Officer

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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The Director – Department of Medicine (Clinical Director) is the professional lead of the Division of Medicine and reports professionally and operationally to the Director of Medical Services, RBU. The specialists within Cancer Care, report professionally and operationally to the divisional Director. Note - Positions work across both ambulatory care and inpatient care services. 2 FTE Medical Oncology [when patients admitted to inpatient unit] 2 FTE Haematology [when patients admitted to inpatient unit] 1 FTE Radiation Oncologist [when patients admitted to inpatient unit]

2.6.2 NURSING

Nursing Staff 1.0 FTE NUM/CNC (proposed) 1.0 FTE Clinical Facilitator – support staff training within a specialized unit. [there is no

Educator position attached to this specialty]

4.42 FTE Clinical Nurse – the acute service requires advanced level CN for inpatient chemotherapy, IV immunotherapy as inpatient, IV supportive therapies [iron infusions, blood product infusions] This FTE ensures CN coverage for every shift.

5.0 FTE Registered Nurse 1.5 FTE ENAS 1.5 FTE EN The acute care facility will be unable to support an AIN position. The unit is based on Acuity as per Trend Care, and is not a ratio unit. Refer to 11 bed roster coster. The unit will require 1.0 FTE AO3 support. This position will be required to be positioned at the entrance of level 5. 2.6.2.1 Staff training

Registered nurses will be rotated to Cancer Care Ambulatory Service – Day Therapy Unit for ADAC training as required [ Anti-neoplastic Drug Administration Competency]

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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This training will be supported by the Clinical Facilitator. Staff are required to be trained, and maintain annual competency, in specialist unit specific skills – Port-a-cath management, subcutaneous syringe driver management, chemotherapy administration, cytotoxic management. All training and annual assessments are overseen by the Clinical Facilitator.

2.6.2.2 Projected Nursing staff profile: (See Attached HPDDS and Roster Coster)

See Attached Roster Coster

2.6.3 Allied Health Team

The Allied Health team is comprised of: - Physiotherapist - Occupational Therapist - Social Worker - Speech Pathology - Dietitian - Pharmacist - Podiatrist

They are responsible for providing individual patients assessments and care planning in their field of expertise whilst encouraging a patient centred approach. The aim is to maximise restoration and decrease functional decline leading to the return of the person to the community or facilitate placement in a residential care facility. This may include home assessments conducted by relevant allied health professionals (occupational therapy and physiotherapy).

Allied Health staffing profile will be based on patient care requirements and service demand. As part of the Allied Health Re-alignment, there is now the opportunity to provide a flexible and sustainable allied health workforce that are able to provide services based on clinical demand’

2.6.4 Operational Service Officer Resource Allocation

Operational Staff are managed under Rockhampton Hospital are allocated according to Daniel’s methodology whereby staffing numbers are assigned according to bed number and floor space.

0.7 FTE allocated between inpatient and ambulatory care floor. [0730 -1200 X 7 days a week]

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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2.6.5 Administration Officer Resource Allocation

Administration staff are resourced to provide administration support to both patients and staff for inpatient and outpatient functions.

Central Queensland Hospital and Health Service Level 5 NWB – CIPU

Model of Care – Level 5 NWB Version: 0.3 | 21 February 2019 | Document owner: James Jenkins

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