Download Country cancer services project

Country Cancer Services Project
New Chemotherapy Services in Country SA:
-Bringing Cancer Services Closer to home
-Winner: Enhancing Hospital Care, SA Health Awards 2013
-Winner: National Lead Clinicians Group Award for Excellence
in Innovative Implementation of Clinical Practice, 2014
-Dr Jacqui Adams
-Clinical Director Cancer Services
-CHSALHN and NALHN
Cancer in Rural and Remote SA
compared to Metro SA
> nearly 1 million km2
> 1/3rd of SA population (456,854 people
2009 ABS ERP)
> Lower cancer survival rates
> 5 year survival decreases with increasing
distance from Metropolitan area
> Poorer survival for R&R Aboriginal
residents
> Lower rates chemotherapy and
radiotherapy uptake
SA Health
Chemotherapy in Rural and
Remote SA
> Historically, majority of R&R patients
travelled to Metro to receive chemotherapy
> Some chemotherapy has been provided
sporadically in a range of health services
across Country SA inclusive of doctor
surgeries and day centres.
> Visiting Oncologists to Whyalla, Mt Gambier
and Port Pirie
> Chemotherapy is known to be highly toxic
and needs to be provided in a safe and
secure setting ensuring the safety of
patients, staff and the environment.
SA Health
Media Release 2010
> In May 2010 Federal and State
governments announced joint funding of
$84.8 million for new and enhanced
regional cancer services in Regional
South Australia.
• $69.3m for Whyalla Regional Cancer Centre
• $2.48m for Digital Telehealth Network
• $5.4m towards establishing 10 chemotherapy
units in country hospitals (total 15 country
chemotherapy units)
• $7.6m for a second radiotherapy machine at
Lyell McEwin Health Service.
SA Health
Country Cancer Services Project
> A project team comprised of Clinical
Director (Medical), cancer nurse, cancer
pharmacist and senior project officer was
established to develop the country cancer
service
> Reviewed statewide and national
standards and guidelines for safety and
qualityMB(3
in chemotherapy services
SA Health
Slide 5
MB(3
Delete
Morris, Belinda (CO), 20/02/2014
2012: Standards and Guidelines
for chemotherapy services
National
MB(4
>Australasian Health Facility Guideline. (2006). Australasian
Health Facility Guideline in association with the University of
New South Wales: Sydney.
>Carrington, C., Stone, L., Koczwara, B., Searle, C., Siderov, J.,
Stevenson, B., Michael, M., Hyde, S., Booth, A. & Rushton, S.
(2010). The Clinical Oncological Society of Australia (COSA)
guidelines for the safe prescribing, dispensing and
administration of cancer chemotherapy. Asia-Pacific, Journal of
Clinical Oncology. 6, pp.220-237.
>National Occupational Health and Safety Commission (NOSCH).
Statewide SA Health
>Communio. (2009). Report on the review of South Australian
Cancer Services. Communio: Adelaide.
>Communio. (2011). Performance Indicator Framework for
Cancer Services in SA: Adelaide.
SA Health
Slide 6
MB(4
delete the 's'
Morris, Belinda (CO), 20/02/2014
2012: Standards and Guidelines
for chemotherapy services
Statewide SA Health (cont)
>SA Health. (2011). Aboriginal and Torres Strait Islander
Companion Document to the Statewide Cancer Control Plan
(2011-2015) and Cancer Care Pathway. Aboriginal and Torres
Strait Islander Committee of the SA Cancer Clinical Network.
>SA Health. (2012). Safe Handling Cytotoxic Drugs and related
wastes: Guidelines for South Australian Health Services. SA
Health: Adelaide.
>SA Health. (2010). Standards for Chemotherapy Services in
South Australia. SA Health: Adelaide.
>SA Health. (2011). Statewide Cancer Control Plan – 20112015. SA Health: Adelaide.
>SA Health. (2010). Statewide framework Chemotherapy
Education and Assessment: An integrated model for South
Australia. SA Health: Adelaide.
>SA Health, (2012) Policy Directive: Safe handling of cytotoxic
drugs and related wastes (D0271): Adelaide.
SA Health
Governance and quality
improvement systems
Developed:
> CHSALHN Cancer Services three year
implementation plan (2012)
> Country Cancer Services Foundation
Documents:
• CHSALHN Chemotherapy Services (2012)
• CHSALHN Model of Cancer Care (2012)
• CHSALHN Cancer Services 3 year
Implementation Plan (2012)
SA Health
Governance and quality
improvement systems
> Three Year Quality Improvement Plan
(2012)
• systematic audit schedule for cytotoxic
therapies
• guidelines for multi-disciplinary team function
• clinical case and peer review guidelines
• a targeted approach to improvement activities
• the requirement for mandatory regular
reporting of outcomes of these audits
SA Health
Clinical Practice
> Developing Country Cancer Services web
page on CHSALHN WIKI where all staff
can access documents and information
> Developing a specific data set for
collection of chemotherapy activity in the
15 country units to monitor service uptake
SA Health
Clinical Practice
> Procedures
• development of 52 cancer services procedures
based on accepted best practice guidelines
• progressed through formal consultation process,
with final sign off by CHSALHN Clinical Cabinet
• released as CE check to all CHSALHN staff with
information on each procedure and the staff it
affects
• each health service performs a site-wide gap
analysis, identifying areas of need for
implementation
• held on the WIKI for all CHSALHN staff to access
• Chemotherapy units assisted with implementation
SA Health
Clinical Practice
> Clinical Practice: models of care
• Standardised practices implemented for:
use of equipment
use of invasive devices
unit setup
staff training requirements
clinical procedures
• Models of care for each unit describe:
patient pathways
communication channels
professional roles and responsibilities
drug supply
SA Health
Risk management
> Risk management:
• identified risks are recorded on the relevant
organisation’s risk register and appropriate
mitigation strategies are implemented
• all cancer risks are reviewed at the regional
and state levels
> Chemotherapy-related incidents:
• Identification, reporting and management of
incidents, complaints and adverse events
• Access to easily obtainable incident reports for
service level reviews education and training is
provided to all staff after release of the incident
management policy and guideline.
SA Health
Risk management
> Risk management: cytotoxic
• Developed a CHSALHN Cytotoxic Waste
Management Strategy for all 65 CHSALHN
health services.
• Developed a CHSALHN Cytotoxic Low Risk
Training Package, for staff considered to be at
low risk of exposure.
• Developed a Hazardous Chemicals Register
with:
Drug name and form
Material Safety Data Sheets
Risk Assessments
• Obtained a cyclophosphamide license for the
15 designated chemotherapy units.
SA Health
Performance and skills
management
> Nursing
• Supporting staff to complete the Statewide
Chemotherapy Administration Education and
Assessment Program (8 online modules,
workshop, clinical placement, clinical
assessment)
• Ongoing assessment and re-credentialing of
chemotherapy staff
> Medical
• All medical staff who prescribe chemotherapy
for administration in a country chemotherapy
unit must be credentialed with SA Health and
have chemotherapy prescribing in their scope
of practice
SA Health
Performance and skills
management
> Pharmacy
• Working in co-operation with SA Pharmacy:
to review and develop safe working practices
that meet standards and good practice
guidelines for delivery of chemotherapy
to develop cancer pharmacy training program
• Development of a Pharmacy Model of Service
to support Country Pharmacy Services in
practice development
• Developed a drug supply pathway for each
country chemotherapy unit
SA Health
Consumer communication and
engagement
> Patient, carers and consumers
• Developed “consent for chemotherapy”
medical record form, now used statewide
• Consumers and community were kept involved
in the development of these units:
regular engagement at each site
liaison with Health Advisory Councils
more generally through interviews with
ABC radio and local newspapers
• Many community groups financially
contributed to purchasing of new equipment
for their local unit
SA Health
Communication
> Communication: GPs
• bi-monthly newsletter is distributed updating
GPs on progress to date
• evening information sessions held in each
region on country cancer services combined
with an educational session. The 2nd round of
GP information evenings has commenced
• invitation to their local chemotherapy unit
opening
• receive ongoing communication regarding
their patients treatment
SA Health
Communication
> Communication: Metropolitan cancer
specialists
• Two evening information sessions
• Regular updates at SA Cancer Directors
meetings
• Individual meetings with staff at each Local
Health Network
• Letter to each specialist
SA Health
Level 4 Chemotherapy Units
Level 1-3 Chemotherapy Units
Primary Cancer Care
SA Health
Chemotherapy Unit Locations
Low Risk Units
(level 1-3)
> Berri
> Ceduna
> Clare
> Gawler
> Kangaroo Island
> Mt Barker
> Murray Bridge
> Naracoorte
>
>
>
>
Port Augusta
Port Lincoln
South Coast
Wallaroo
Medium Risk Units
(level 4)
> Mount Gambier
> Port Pirie
> Whyalla
SA Health
Country Cancer Services:
Outcomes
> All 15 chemotherapy units are now
operational and treating patients
> Over 100 nurses have commenced the
Statewide training program with over 80
credentialed as chemotherapy competent
> Each country chemotherapy unit has a
digital telehealth network unit for
provision of consultations via
telemedicine
SA Health
Country Cancer Services:
Outcomes
> Developed a coordinated cancer service
across the state through the formation of
affiliations for each country chemotherapy
unit with a metropolitan cancer centre
> Affiliations have been used to:
• create clear communication channels
• support safe and effective pharmacy pathways
for drug transport
• continual staff education
• clinical support pathways
• networking opportunities for country hospital
staff and General Practitioners
SA Health
Country Cancer Services:
Outcomes
> a number of country patients who
previously chose not to undertake
treatment due to; distance, cost and
inconvenience or frustration of the regular
travel requirements, have now taken up
treatment locally
> more patients are now accessing safe
and secure cancer services locally,
increasing their quality of life and survival
and significantly improving their emotional
wellbeing.
SA Health
Aspects transferred to rest of
state
> The Three Year Quality Improvement
Plan.
> Suite of 52 procedures supporting best
practice chemotherapy services
> Cytotoxic Waste Management Strategy
> Low Risk Training Package
> Country Cancer Pharmacy Model
SA Health
Increase in Activity
> Opening country chemotherapy units has
increased the percentage of patients
receiving treatment closer to home
between 19-77% per month in the last
Calender year.
SA Health
2012/2013/2014 Comparison
350
No. of treatments
300
276
250
220
189
207
200
150
316
308
291
262
245
260
252
231
183
174
161
242
211
208
199
163
152
146
234
220
308
300
290
176
2012
146
2013
100
2014
50
0
Jan
Feb
March
April
May
June
July
Aug
Sept
Oct
Nov
Dec
Oct
Nov
Dec
Months
Jan
Feb
March
April
May
June
July
Aug
Sept
TOTAL
2012
146
152
163
161
231
199
174
208
146
183
211
176
2150
2013
207
189
220
245
300
308
308
291
260
316
252
242
3138
% Increase
42%
24%
35%
52%
30%
55%
77%
40%
78%
73%
19%
38%
46%
2014
276
220
234
290
262
33%
16%
6%
18%
13%
% Increase
1282
100%
100%
100%
100%
100%
100%
100%
59%
SA Health
SA Health
Any questions?
> Please contact a member of the Cancer
Services Project Team:
• Belinda Morris, Lead Cancer Pharmacist
Based in King William Street Office, Adelaide
MB(6
• Tamika Calver, A/Lead Cancer Nurse
Based at Lyell McEwin Hospital, Elizabeth Vale
• Alexis Nicholson, Senior Project Officer
Based at Lyell McEwin Hospital, Elizabeth Vale
• Dr Jacqui Adams, Clinical Director
Based at Lyell McEwin Hospital, Elizabeth Vale
SA Health
Slide 29
MB(6
Why is my name at the top and why are you using my 'Sunday' name???????
Morris, Belinda (CO), 20/02/2014