community oncology nursing programme a success story in cancer care where integrated people centred...
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Community Oncology Nursing Programme
A success story in cancer care
Where integrated people centred care is a reality
Terry Hanan October 6th 2015
Context
• Drivers of demand for cancer services
• Strategic Direction
• Community Oncology Nurse Programme
Community Oncology Nurse Education Programme
Aim • enable community nurses to safely deliver aspects of
medical oncology care to patients in their homes. • reduce hospital attendances to the medical oncology
dayward
Interventions include – head to toe patient assessment, medication
management – disconnection of chemotherapy infusions and – central venous access device care and management
Governance
National Governance
Local Implementation Group
Methodology
Quantitative and Qualitative
components
Four areas • Impact on patient • Impact on the community • Impact on the medical
oncology dayward facilities • Appropriateness of training
O Toole E, Mullen L, Hanan T, Laffoy M (2013) O Toole E, Mullen L, Hanan T, Laffoy M (2013)
It saved me a journey of an hour and a half when I wasn’t feeling well at all, I was at ease with the
nurse in my own home
Patient
She came most days at the same time I had the rest of the day to myself to rest. The nurses in the hospital are great but there is a lot of hustle and
bustle Patient
Evaluation OutcomesPatient experience
• No adverse effects• Improved quality of life and reduced burden of travel (Average 60km per trip)
I could ask questions about things that didn’t sink in at the
hospital and I could take my time
Patient
Instead of just doing a task like giving an injection or
disconnecting a line, I do a full patient assessment from head to toe, I am more confident now and
know what to do when I come across something
Community Nurse
Community Nurses
Have a direct line to the unit, we have a great relationship with them and can pick up the phone to them, we
feel really supportedCommunity Nurse
Enhanced knowledge, skills and competence
Integrated care
Workload Prioritisation
You have to rearrange your work to suit the oncology patient to factor in chemo schedules, so
there are times when you have to rearrange visits for example
childcare checks Community Nurse
Impact on the Medical Oncology DaywardDonegal
95
29
0
10
20
30
40
50
60
70
80
90
100
2012 2014
69% decrease
Community Nursing Referrals Galway
364
204
449 2012
2013
2014
Community Intervention Team Nurses
388
546
0
100
200
300
400
500
600
Jan/Feb 2015 July/Aug 2015
41% increase in oncology activity following completion of community oncology programme
41% increase in oncology activity following completion of community oncology programme
Share knowledge and
expertise
Mutual Respect Patient is front and centre
Be Innovative;Manage the Risk
A support system that works
Willingness for change
Measure / evaluate;Make it better
Do it Right
Excellent Governance
Critical Success Factors of the Community Oncology Nursing Programme
A better culture A better culture
Health Personnel Public and Patients
Organisations and Management
Policies Systems
Processes
Safe Integrated Health Care requires Vision, Leadership, Active Change Management
Acknowledgements
• Patients
• Hospital personnel and community nursing personnel who have supported the programme
• NCCP & ONMSD & CNME colleagues
Delivering care to patients in the community: an innovative integratedapproach. Br J Community Nurs. Aug 2; 2015 19(8):382-7