Day Oncology: a growing service. Improving patient and staff experience.

Abstract

Background: Ballarat Regional Integrated Cancer Centres (BRICC) Day Oncology department is subject to increasing patient numbers and service demand. Increased anti- cancer treatments, supportive therapies and an increase in clinical trial protocols is significantly affecting service demand. This nurse-led quality improvement project reports on changes to patient education, care and scheduling. Aim: This 18-month project sought to improve both patient experience and staff workflow to cater for increased service demand. Methodology: Four specific elements were undertaken. 1. The introduction of a fast track chair for patients requiring Central Venous Access Device (CVAD) Management and subcutaneous/intramuscular injections. 2. Patient education was changed to a pre-treatment education session instead of same day in chair. 3. Review and streamlining of scheduling processes to create efficiencies. 4. In conjunction with the Regional Cancer Nurse Educator (CNE), generalist staff in smaller regional hospitals were upskilled in CVAD management to improve care close to home. Results: Patient experience surveys compared data between those who received pre-treatment education versus same day in chair. Response rates were 55% and 45% respectively. Domains explored included treatment expectations, other support and keeping well, active involvement in care and patient understanding. The supportive care screening rates improved from 72% to 100%. Referral uptake to exercise physiology, psychology, cancer support services and the prostate cancer specialist nurse also increased. Staff reported improved workloads and achieving breaks as an impact of the changing work flow. Patient flow has improved and capacity has increased. Scheduling and visibility of availability is significantly clearer. Twelve CVAD workshops/in-services have been held involving 158 participants (of whom 13 have attended our Day Oncology unit to consolidate their skills). An additional five CVAD training workshops have been held in outer regional areas involving 42 participants. Conclusion: This nurse-led quality improvement initiative has been of benefit to patients, staff and the health service.