2012 CAPH SNI Quality Leaders Awards Application Cover Sheet and CEO Approval Form

Transcription

1 2012 CAPH SNI Quality Leaders Awards Application Cover Sheet and CEO Approval Form Title of Improvement/Entry: Comprehensive and Coordinated Cancer Care Through Nursing Leadership Initiatives CAPH Member Institution: UC Davis Health System Name of contact person for this entry: Terri Wolf, RN, MS Contact person s title/job description: Nursing & Quality Coordinator, UC Davis Cancer Care Network. To provide clinical and quality support to community cancer centers affiliated with UC Davis. Phone number for contact person: for contact person: terri.wolf@ucdmc.ucdavis.edu Triple Aim Categories (you may check more than one): _X_ Improving the Patient Experience Improvements the Health of Populations Value and Cost Containment CHECKLIST OF MATERIALS INCLUDED: **NOTE: You application will not be considered complete without items 1 3** 1. _X_ This cover sheet with CEO (or designee) approval 2. _X_ Description of improvement (use the attached Narrative Description form) 3. _X_ 3-5 digital photos depicting improvement in action (send to sasham@caph.org) 4. SNI Program form, if applicable (see explanation) 5. Supplemental materials (optional) CEO or designated hospital administrator: Please sign below to indicate your approval of submission of this entry. I certify that this entry has been reviewed and approved by hospital/health system administration. Name/title: Signature: Date: 1

2 Narrative Description of Improvement Please check here if you DO NOT want this application shared on the SNI website. Please answer the following questions with detailed, but succinct answers. (Answers should total no more than three pages) 1) Please summarize your improvement/project in 200 words or less. Include the start and end dates, and indicate what your team aimed to achieve through this effort, and by when? Many small or rural community-based oncology practices and inpatient units have limited access to resources for quality improvement and professional development. By creating a Nursing and Quality Initiative at the UC Davis Health System (UCDHS) Cancer Care Network (CCN), clinical oncology nurses at four affiliates (Rideout Cancer Center in Marysville, AIS Cancer Center in Bakersfield, the Gene Upshaw Tahoe Forest Memorial Cancer Center in Truckee, and Mercy Cancer Center in Merced) were supported to address quality issues at their cancer centers. The Affiliate Oncology Nursing Excellence Program connected nurses to mentors and materials to create change in the patient experience. These changes included creation of a strategic plan for nursing care, an inpatient oncology mentoring program to improve medical-surgical nurses comfort with chemotherapy administration and oncology care, on-site education seminars, a nursing professional governance council, simulation and skills events, and weekly leadership communications. Each initiative provided the supportive structure and processes to improve care across the continuum. 2) What is the problem that the improvement was designed to address and what was the organizational context? What there a business case driving the decision to address this issue? The UCDHS CCN was established to facilitate the delivery of quality comprehensive cancer care in local and rural communities, through partnerships involving community hospitals and an academic medical center and National Cancer Institute (NCI) designated cancer center. The majority of cancer care occurs in the outpatient setting. Inpatient cancer care in community hospitals can be fragmented and fall into the medical surgical service. Nurses in the community oncology setting, especially inpatient nurses, may see fewer cancer patients, limiting skill development. These patients have multiple care needs, and require highly trained nurses. The problem was devising a way to provide the professional development to care for the complex cancer patient in both settings inpatient and outpatient. A multi-pronged approach was used to offer nurses multiple opportunities and skills to improve patient care. 3) Who were the intended customers /stakeholders and what was the impact on them? Oncology patients, caregivers and family members were the ultimate customers in providing seamless safe care, meeting the standards of oncology nursing care across the inpatient and outpatient oncology setting. This project focused on working with nurses in four community oncology settings, because the fragmented care between the cancer center and inpatient nursing staff impacted the patient care experience. Even though the nurses were in the same organizations, the procedural differences between the outpatient and inpatient areas could be immense. Patients experienced a coordinated care effort, as well as inpatient nurses with increasing confidence in their chemotherapy administration and symptom management skills. These quality initiatives were developed by the community nurses who were supported by the UC Davis Cancer Care Network to take leadership roles to improve care processes. 2

3 4) How was the improvement effort staffed and what was each team member s role? How often did the team meet? This improvement effort did not require additional staffing but nurses focused their administration time on the development of comprehensive oncology programs. This improvement effort was coordinated at each site by the Manager and the Nursing and Quality Coordinator for the UCDHS CCN. As part of the overall initiative, teams were formed at two of the affiliates. At the Mercy Cancer Center in Merced, nurses formed an inpatient/outpatient committee that meets monthly to address nursing issues and take action on developing a designated oncology unit so that patients could receive the required specialty nursing care. Policies and procedures were revised to incorporate the knowledge obtained from the mentoring and skills lab experiences provided by the academic medical center. Monthly Cancer Center specific practice meeting participants expanded to include pharmacy and inpatient nurses. Rideout Cancer Center created a professional governance council to systematically address nursing and patient care issues, such as communication and training with the reception staff for triaging patient calls. 5) If a formal improvement methodology was used, please describe. (e.g. IHI s Model for Improvement/PDSA cycles, Lean, etc.) No formal methodology was used at this time as multiple structures needed to be in place prior to utilizing improvement methodology. 6) What activities or changes took place through the improvement effort? The notable changes included nurses taking leadership roles in creating change in their work environment, and being involved in educating nursing leaders throughout the institution on inpatient and outpatient oncology-patient specialized care needs. Nurses voiced a decrease in stress and increased confidence. They have demonstrated that they can make a difference in systems that impact patient care. 7) What are the results from this effort? How do know your improvement project made an impact? Please include the quantitative measures and baseline/outcomes data demonstrating the success of your efforts. Mentoring oncology staff between the academic medical center and the community Outpatient mentoring included 80 hours of experiences with UC Davis (Departments involved: Adult Infusion, Radiation Oncology, Cancer Center Pharmacy, Peri-Operative Services, Cancer Center Clinic, Center for Health and Technology, Patient Care Services Professional Governance). Inpatient mentoring included 96 hours of precepting on the UC Davis Davis 8 Inpatient Oncology Unit. Training network oncology staff Simulation and Skills Training with UC Davis Adult Infusion included chemotherapy anaphylaxis, safe handling of chemotherapy, and professional governance. Inpatient Nursing Education included didactic sessions on Oncologic Emergencies and Supportive Care. Qualitative and quantitative measures included baseline oncology nursing assessments, and evaluations of training and mentoring activities. Exemplars Rideout Cancer Center in Marysville created a strategic plan for nursing. CCN provided coaching and templates for this process. Nursing staff reported a decrease in stress levels, an improved attitude towards working in the unit, and improved working relationships. Management and staff both reported enhanced communication and a supportive environment. Nursing staff also formed a Professional Governance Council for Nursing, taking on patient care and quality concerns, and formulating plans to create change. 3

4 Tahoe Forest Cancer Center in Truckee, AIS Cancer Center in Bakersfield, and Mercy Cancer Center in Merced made changes in chemotherapy administration and emergency protocols because of simulation training. Weekly phone support and coaching with network nurse managers. Result is establishment of relationships, providing information and resources, and identifying areas for collaboration and quality improvement. Mercy Cancer Center in Merced developed an inpatient/outpatient nursing committee to improve communication and processes in caring for cancer patients, including patient handoff during transition of care. Mercy Cancer Center, Merced completed policies and procedures to create a designated area on 5 th floor for oncology patients. Established system changes to facilitate this process including EMR changes for the admission process. Unit closures for periods of low census no longer impact the unit. Advancing Education - Three nurses from Rideout Cancer Center will be applying to the masters of nursing program at UC Davis. Three nurses in the network have completed BSN degrees this year. 8) Please describe your plans for sustaining the improvements made. Describe the challenges or opportunities with maintaining success over time. Challenges can certainly involve maintaining the momentum achieved to date to continue this professional growth, improving communication across the continuum of care, and system improvements. Sustained change will be achieved through direct involvement of nursing staff, facilitating their development and expertise in oncology nursing, in implementing change, enhancing leadership skills, and consistent interaction and monitoring process changes. An evidence-based practice approach to knowledge development will continue to be utilized, along with a development of a comprehensive program to monitor long-term qualitative and quantitative metrics. 9) Is there anything else you would like to report? The UC Davis Cancer Care Network is designed as a quality tool in connecting the resources and expertise of the academic health system to community cancer centers. These centers have their own expertise and community knowledge and by synergizing resources, quality improves at the local level. This Nursing and Quality program leverages nursing leadership at the bedside and chair side to create change within this networked system to benefit patients. 4

5 Infusion nurses from Rideout Cancer Center in Marysville become active participants in quality cancer care by forming a Nursing Professional Governance Council. The group is participating in a training session with nurse leaders from UC Davis Health System to learn about the Professional Governance process and implementation. The Rideout Cancer Center council has launched 3 initiatives to improve interprofessional communication, an electronic medical record project, and development of a PICC line program. The quality initiative was facilitated by the UC Davis Cancer Care Network Nursing & Quality program. 5

6 Community cancer centers do not have access to the resources of an academic medical center for nursing professional development. The UC Davis Cancer Care Network which affiliates with four community cancer centers, collaborated with the UC Davis Comprehensive Cancer Center for a day-long simulation and skills event. Above oncology nurses from UC Davis, Rideout Cancer Center in Marysville, Mercy Cancer Center in Merced, Gene Upshaw Tahoe Forest Cancer Center in Truckee, and AIS Cancer Center in Bakersfield come together to learn about chemotherapy extravasation and participate in emergency simulations in the new Center for Health and Technology at UC Davis. This collaboration resulted in nurses changing emergency protocols at 3 community cancer centers. 6

7 Inpatient and outpatient oncology nurses from community cancer centers affiliated with UC Davis Cancer Care Network participate in chemotherapy emergency simulations at the UC Davis Center for Health and Technology simulation lab. This biannual event includes hands-on simulation and education modules which resulted in practice changes at the community cancer centers. Participants reported more confidence in handling chemotherapy related reactions and emergencies after the event. 7

8 Mercy Medical Center Merced medical-surgical nurses review policies and procedures for cancer care at the UC Davis Medical Center Oncology Unit during a two-day mentoring program set up through the UC Davis Cancer Care Network Nursing & Quality program. This initiative was designed to increase the skills and knowledge of medical-surgical nurses caring for hospitalized cancer patients. This mentoring program lead to the inpatient nurses collaborating with nurse colleagues in the cancer center to improve continuity of care and work towards creating a designated unit in the hospital for cancer patients. 8