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