Heather Pile Advanced Nurse Management Facilitator State ... · ... Advanced Nurse Management...
Transcript of Heather Pile Advanced Nurse Management Facilitator State ... · ... Advanced Nurse Management...
Heather Pile – Advanced Nurse Management Facilitator
State wide – Chemotherapy Administration Education and Assessment Project
Brief Project Background In 2009, a review of South Australian Cancer Services was initiated by the SA Minister for Health as a result of two high profile incidents.
The “Communio Report ” made several recommendations to improve the safe delivery of cancer services across South Australia.
Recommendation 9
Improving the credentialing and competence assurance of clinical cancer services
staff, including medical practitioners, nursing staff, pharmacists, radiation
therapists and physicists Specific to this Project Recommendation 9.2 A state-wide standard for the competencies of chemotherapy nurses be adopted. (capabilities)
The Nursing and Midwifery Office, Statewide Framework Chemotherapy Education and Assessment –An Integrated Model for South Australia was developed in response to recommendations from this review.
Project Scope
The state-wide education and assessment framework for nurses and midwives aims to provide direction to public sector health services, educators and clinicians in describing the minimum requirements to support the delivery of safe quality care. Governance Oversight by the Chemotherapy Administration Education and Assessment Steering Committee. Membership: Executive Director Nursing and Midwifery CHSA and Director of Nursing SA Cancer Services. Representatives from all five Local Health Networks (LHN) with clinical and educational background, tertiary sector, Cancer Institute New South Wales (CINSW)
Framework
A key initiative of the framework is the State-wide Chemotherapy Administration Education and Assessment Program developed in partnership between SA Health and the Cancer Institute NSW (CINSW). The program consists of:
an eight module e learning Antineoplastic Drugs Administration course (ADAC),
A one day clinical workshop and
Facilitated clinical learning and competency assessment activities.
Outcomes The Communio Review SA Cancer Services Recommendation 9.2
has been met within two-year timeframe.
The minimum standard for chemotherapy therapy competencies as recommended has been met by nurses and midwives (in 1st instance) in SA Public Health cancer services
Cancer nurses and midwives have a consistent approach to the administering chemotherapy across SA Health in line with the Standards for Chemotherapy Services within South Australia.
Partnerships between SA Health services and NSW Cancer Institute have continued to work collaboratively to maintain an integrated multi disciplinary education and assessment program
Final Report and recommendations written and forwarded to Chief Nurse by 3rd October 2013
Staged Implementation Project funded for 2 years
Re-establish Cancer Nurses Network (local, rural, interstate) i.e. EdCaN, EviqEd
Guidance from the steering committee
Identify facilitators from all five LHNs (no dedicated cancer educator in SA)
Review of the on line modules to contextualise to SA setting
Establish Learning Management System for access to Modules and record keeping ( four different systems)
Agreement of all cancer / chemotherapy nurses for training to ensure standardisation
Evaluation process
Sites that provide Chemotherapy treatment
Northern Adelaide Local Health Network Lyell McEwin Hospital Modbury (no chemotherapy administrated at this site) Women’s & Children’s Health Network
Central Adelaide local Health Network The Queen Elizabeth Hospital Royal Adelaide Hospital
Southern Adelaide Local Health Network Flinders Medical Centre Noarlunga (no chemotherapy administrated at this site) Repatriation Country Health SA Local Health Network (CHSA-LHN) The fifteen identified sites include: Mount Barker Whyalla Murray Bridge Mt Gambier Berri Naracoorte Port Augusta Clare Port Lincoln Port Pirie Gawler Wallaroo South Coast Ceduna Kangaroo Island
Implementation of Program e-Learning Modules developed from EviqEd
Contextualize the modules to SA Evidence based resource packages/ case presentations/ multiple
choice quizzes Assessors/Facilitators
One Facilitators workshops in Adelaide June 2012 Consistent evaluation of competency assessment tool
Workshop/Clinical Placement Incorporate simulation and supervised demonstration 18 workshops across all sites Bring together theory & practice Three day clinical placement for rural staff linked with major
centres’ Independent Competency Assessment
Context of own environment or tertiary cancer unit Annual re-assessment
At the moment
There are 344 participants enrolled into the eight module e learning Antineoplastic Drug Administration Course
The percentage of staff that have completed the online component state-wide is 83%
The percentage of staff that have completed the workshop component state-wide is 75%
The percentage of staff that have completed the full course state-wide is 55%
Potential Challenges Organisational structure changes
Management support
Availability of funding – ongoing costs & resources
No dedicated cancer educator/ facilitator to lead the program
Facilitator availability/ release or backfill
Withdrawal of the rural mentoring program
Poor uptake of education and competency assessment by participants
Sustainable Workforce – expert clinicians
Post implementation - sustainability of program – embedded in daily practice without increase of resources.
Celebrations Installation of the ADAC program onto four separate
learning management sites
Country Health now has an educational on line system instigated by the program
Establishing twelve facilitators in each of the five LHNs as there is no dedicated cancer educator
Networking / open communication with all services
Strong and ongoing relationship with Cancer Institute of NSW
Educational support to non cancer education (renal and community nurses) ( outside the scope of the project)
Project creep (interests from interstate and private sector in SA to learn from the project)
Country Health SA Brief Background SA Cancer Control Plan aims to provide safe cancer
care closer to home
Country SA model of Cancer Care builds on these recommendations
Primary Cancer Care sites established – 15
12 sites to provide low level chemotherapy
3 sites to continue services with medium risk chemotherapy – including vesicants
Aim 15 identified sites with funding to establish a
consistent approach
Project country cancer team
Overseer the builds- new and or renovation of an existing area or extension.
Standardised equipment
Develop and accessible cancer procedures and policies
Staged approach for unit openings
Chemotherapy training for nurses
Standardised framework Communication with each site was pivotal for success
Program incorporated the EviQEd –ADAC program
Agreement from all sites
Initially 5 staff per site and all staff involved are required to complete the full program
8 on line modules – ADAC complete 100%
1 day workshop
Clinical placement aligned with a tertiary hospital
Assessment competency
Results The majority of nurses had no cancer background and
were supported by Karyn Andrews CPC
Networks between Rural and Metropolitan were embedded.
Currently 79 nurses have enrolled and 53 have completed all the elements of the program
The rural nurses have embraced the blended learning program
Workshop evaluation Currently 69 rural nurses have attended a 1 day
workshop
Evaluation collected from only rural nurses were 40
Summary results
87% nurses work in another area than Cancer
Over 51% have had no cancer training and with 60% identified as first formal chemotherapy training
Fourteen chemotherapy units are being established across regional South Australia along with a new
$69 million cancer centre at Whyalla. A chemotherapy unit at Clare opened in March and units in Naracoorte, Wallaroo, Murray
Bridge and Port Augusta are expected to open before July.
Chemotherapy units at Mount Gambier and Port Lincoln will be
developed as part of wider hospital redevelopments
9th April 2013
Riverland ABC
Post Program Survey
Snap short of 30 nurses with a response rate of 17
19 Varying questions regarding the program
E learning
Workshop
Clinical placements
Future assessment
What changes or improvements since the training Significant changes in the work environment
New unit
New protocols and information
New cleaning procedures
New dedicated area for chemotherapy with appropriate equipment
Introduction of semi closed systems
Better cyto-toxic waste management
Specialised, dedicated trolley and equipment for chemotherapy
What changes or improvements since the training In nursing practice
Better understanding of calculations for BSA and AUC. Felt that I consolidated my knowledge
Time out check list, better patient and family education
More aware of handling , disposing and cleaning waste products for ancillary staff
Consistency between staff
More confidence among the staff
Standardisation Enabling cancer patients to have chemotherapy closer to home Meeting criteria, recommendations and guidelines relating to chemotherapy
education and competency in the Standards for Chemotherapy Services in SA and the SA Guidelines for Safe handling of Cytotoxic Drugs and related Waste.
Standardising minimum chemotherapy education and competency across SA
Health to enable transferability of staff and capabilities across services.
State-wide cancer nursing education program endorsed and recognised at a national level (Cancer Australia)
Decreased duplication across LHN’s as EviQEd will maintain the on-line learning program content.
Increase collaboration and network across all LHN’s on chemotherapy
education, mentorship and support for cancer nurses and nurse education facilitators.
We are about to complete the 15th site in September....for me this has been a wonderful experience and privilege to meet some amazing rural nurses....
This was my first rural nurse to complete the course and open the Clare Cancer unit...she keeps in touch with me and tells me how the unit is progressing..... It is wonderful to make a difference and assist in providing cancer treatment closer to home.....
Acknowledgements I would like to take this opportunity to show my appreciation to the following: Lyn Olsen - Project Sponsor Liz Zwart - Project Supervisor Lucy Cussons -Royal Adelaide Hospital Alison Walsh - Royal Adelaide Hospital Roshan Khodadin - The Queen Elizabeth Hospital Christine Pritchard- The Queen Elizabeth Hospital Karyn Andrews – Country Health South Australia Amanda Fuller – Northern Adelaide LHN Sandra Ridings – Southern Adelaide LHN
Just to name a few of the nurses who have made the program a success and this has been the highlight of my nursing career.