Community Oncology Nursing Programme A success story in cancer care Where integrated people centred care is a reality Terry Hanan October 6 th 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)

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 Outcomes Patient 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 supported Community 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 Dayward Donegal 69% decrease

Community Nursing Referrals Galway

Community Intervention Team Nurses 41% increase in oncology activity following completion of community oncology programme

Share knowledge and expertise Mutual RespectPatient 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

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 integrated approach. Br J Community Nurs. Aug 2; (8):382-7