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Oncology Nursing Collaborative Knocks Down Silos

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By Debra Wood, RN, contributor

June 20, 2014 - Patient care has always required handoffs and teamwork, but a new emphasis on improving safety and the patient experience while delivering services more efficiently has created a renewed focus on collaboration.

Nurses at Torrance Memorial Medical Center in Torrance, Calif., take collaboration seriously and have found it has boosted patient satisfaction scores. For the past six years, a core group of nurses from a variety of settings within the health system’s Donald and Priscilla Hunt Cancer Institute have met to streamline operations and ensure policies align across settings. Their efforts also ensure that patients receive the same messages at each level of care.

“The scope of oncology care is huge and crosses boundaries and buildings,” said Miriam Sleven, RN, MS, OCN, coordinator of the Cancer Survivorship Program at Torrance Memorial. “We wanted to start addressing the needs of cancer patients within our system.”

The Hunt Cancer Institute Nursing Collaborative originally began to evaluate the clinical, resource and psychosocial education needs nurses staffing a new inpatient oncology department would require before starting.

Once the team successfully identified and addressed those needs, and with the help of patient feedback, they realized other opportunities existed to improve patient care through greater interdepartmental communication.

The nurses from inpatient oncology, resource center nurses, survivorship, radiation oncology, the diagnostic center, palliative care and other settings meet monthly. They started out by assessing the role various departments played and how they contributed to the care experience and their concerns. Now they concentrate on addressing issues that come up.

“We started out as a clearinghouse for information,” Sleven said.

Depending on the project, the number of participants will increase or decrease. The collaborative has brought in policy experts, for instance a pharmacist when developing policies and procedures associated with medication administration.

The collaborative provides participants an agenda so they know what to expect at that meeting, along with consistent leadership, which has led to ongoing problem solving. Meetings often begin with a team building exercise or icebreaker to enhance communication.

“We do something a little fun but that also demonstrates whatever we were trying to implement at the time,” Sleven said. “It’s important that the group makes a commitment to each other, as they make to the patient.”

The nursing collaborative has completed about 14 projects, including some associated with navigation, rehabilitation and palliative care. The projects are reproducible and renewable.

“We’ve been very successful,” Sleven said. “In the inpatient unit, the HCAHPS [(Hospital Consumer Assessment of Healthcare Providers and Systems)] scores have gone up.”

One of the things the collaborative learned was that patient education differed across the campus, and policies did not outline which department should teach what information. The nurses developed a patient packet that both inpatient and outpatient nurses use. It explains the patient’s disease and resources available. Patients can use it to track reports, appointments and take it to their physician appointments.

The collaborative updated its Rituxan protocols with the inpatient team, which administers the drug working in conjunction with a pharmacist, to ensure they met national standards and protocols were in place to deal with reactions. The institute is accredited as a Comprehensive Community Cancer Program by the American College of Surgeons Commission on Cancer, and the collaborative ensures all standards are met.

The collaborative has set up a “think tank,” in which people can bring ideas to the team for discussion and to incubate ideas. Members also developed a community-based consortium to increase public and professional awareness of survivorship issues.

“We are committed to help each other be successful in our own area as well as as a team,” Sleven concluded.

Sleven and co-authors Mary Hersh, PhD, RN, FPCN, CHPN, and Charlene Cotrell, RN, all members of the nursing collaborative, presented a poster about their program at the Oncology Nursing Society conference and submitted it for display at the National Coalition of Oncology Nurse Navigators conferences this spring.


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Why All the Fuss About Improving the Patient Experience?
The Breast Cancer Journey: Nurse and Patient Perspectives 

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