Heather Pile Advanced Nurse Management Facilitator State wide Chemotherapy Administration Education and Assessment Project

Transcription

1 Heather Pile Advanced Nurse Management Facilitator State wide Chemotherapy Administration Education and Assessment Project

2 Project Title State wide -Chemotherapy Administration Education and Assessment Project

3 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.

4 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)

5 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.

6 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 1 st 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

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8 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

9 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

10 3 Low medium Risk Country Cancer Sites 12 Low Risk country cancer sites

11 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

12 Achievements and Challengers

13 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%

14 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.

15 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)

16 Country Health Story

17 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 sites to provide low level chemotherapy 3 sites to continue services with medium risk chemotherapy including vesicants

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21 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

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34 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

35 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

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41 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

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44 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 9 th April 2013 Riverland ABC

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46 Post Program Survey Snap short of 30 nurses with a response rate of Varying questions regarding the program E learning Workshop Clinical placements Future assessment

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64 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

65 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

66 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.

67 We are about to complete the 15 th site in September...for me this has been a wonderful experience and privilege to meet some amazing rural nurses...

68 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...

69 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.

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