Heather Pile – Advanced Nurse Management Facilitator

State wide – Chemotherapy Administration Education and Assessment Project

Project Title

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

3 Low – medium Risk Country Cancer Sites

12 Low Risk country cancer sites

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

Achievements and Challengers

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

Story

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

N

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.