Template - UHN Presentation - CANO-ACIO

Facing the FACT Together:
The nursing leadership team and staff oncology nurses join
forces in meeting the accreditation standards for the
lymphohematopoietic stem cell transplant program
Kalia, V., Cordon, C., Incekol, D., Simon, S., Pringle, N., Dean,
R., Robinson, S., Wright, J., Simpson, L., Harmon, P., Patel, B.,
Weekes, D., Eduard Cojocari Breen, D. & Willson, B.
Abstract
•
The Foundation for the Accreditation of Cellular Therapy (FACT) establishes
international standards for hematopoietic progenitor cells isolated from bone
marrow or peripheral blood including all phases of collection, processing, and
administration of these cells (The Foundation for the Accreditation of Cellular
Therapy, 2006). FACT requires all nurses working in the
lymphohematopoietic stem cell transplant (LSCT) program to have formal
initial training and continuous education with evidence of training related to
the nursing care of LSCT patients at any point in their treatment.
In one teaching hospital, nurses working within the LSCT program had varying
clinical experience ranging from novice to expert, which posed as a challenge
in meeting FACT requirements. It was difficult to identify the type of training
these nurses had received. Although they were all trained at some point in their
career, their training was not standardized, sometimes sporadic and not
properly documented. Several LSCT nurses in leadership roles and staff nurses
collaborated and identified strategies to address this challenge. In February
2010, the LSCT Program successfully received accreditation.
In this presentation we will discuss our journey, the different innovative
educational opportunities that surfaced out of this challenge, the lessons
learned and future plans to ensure that FACT requirements are continuously
met.
Overview
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•
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PMH BMT Program
FACT Accreditation
Requirements for nurses
The challenges
How we met our challenges
Lessons Learned
Celebrating our success
Look at me!
Look at me!
Look at me NOW!
It is fun to have fun
But you have to know
how
(Dr. Seuss, 1957)
The Bone Marrow Transplant program at PMH
• Established in 1971
• Has some of the longest surviving
bone marrow transplant recipients
in the world
• The first in Canada to perform
allogeneic transplants and
transplants between unrelated
donors.
• Perform about 70 allogeneic
transplants per year and about 190
autologous transplants per year (UHN, 2010)
The Bone Marrow Transplant program at PMH
• Outpatient clinics
– Ambulatory clinics
– Systemic Therapy (Chemotherapy outpatient and
Transfusion outpatient units)
• Inpatient units
– Allogeneic stem cell transplant unit
– Autologous stem cell transplant unit
• Apheresis
• Others (Coordinators, APNs, Managers, Clinical
Trials)
The Foundation for the Accreditation of Cellular
Therapy (FACT)
• FACT establishes international
standards for hematopoietic
progenitor cells isolated from bone
marrow or peripheral blood
including all phases of collection,
processing, and administration of
these cells
(The Foundation for the Accreditation
of Cellular Therapy, 2006).
Accreditation Manual, 4th ed
Our journey…
http://www.solarnavigator.net/images/perfect_storm_big_wave.jpg
Image retrieved from: http://www.neophobic.ro/art_img/adeline/11122008212133/panic_attack.jpg
"This mess is too big and too deep
and too tall. We can't clean it up!
We can't clean it up at all!"
(Dr. Seuss, 1957)
Identifying the challenges
• Standard Operating Procedures
• Documentation of Training and Education for
Nursing Staff
– Development of standardized forms and tracking toolsto track Continuing Education Activities
– Compilation of certificates & documentation that
demonstrates participation in ongoing learning and
have met training competencies and requirements of
BMT program
– Submission of certificates and checklist
Collaborating and coming together
"I know, up on top you
are seeing great
sights, but down
here at the bottom
we, too, should have
rights."
(Dr. Seuss, 1958)
http://fazia.in2p3.fr/images/collaboration.gif
Using a Shared Governance approach on a
micro level
What is Shared governance?
• A dynamic process for achieving
organizational effectiveness by promoting
decision making and accountability for
practice through empowerment.
• It empowers nurses to contribute
collaboratively to the decision making
process related to nursing practice, practice
standards and procedures.
(Bednarski, 2009)
Shared Governance continued
• Theoretical underpinnings come from
various perspectives that includes
organizational, management, and
sociological theories.
• Used extensively in health care; with
evidence to suggest improved financial
status (cost savings or reductions), increase
nursing satisfaction, and improved work
environment
(Anthony, 2004)
Does shared governance work?
“most nurse researchers have concluded that shared
governance is good by its association with a
sparkling array of outcomes and correlations……”
(Hess, 2004)
Image from:
http://www.cartoonsto
ck.com/lowres/shr131
9l.jpg
Meeting FACT Requirements
“Think left and think
right
And think low and think
high
Oh! The thinks you can
think up if you only
try!”
(Dr. Seuss, 1975)
http://www.blindsociety.com/blindspot/wpcontent/uploads/2008/12/think_outside_the_box_by_neh
o.jpg
Innovative educational opportunities
Time
Full day Sessions
Topic
Presenter/fac
ilitator
0830-0840
Registration
Introductions
Charissa
Cordon
0840-0900
Pre-test
0900-0930
Overview of hematopoiesis
Cindy Murray
0930-1030
Leukemia (myeloid)
Disease pathophysiology, treatment, side
effects, symptom management, and nursing
care
Shanon Nixon
1045-1145
1145-1215
Leukemia (lymphoid)
Disease pathophysiology, treatment, side
effects, symptom management, and nursing
care
Case Study and discussion
Cindy Murray
1315-1415
Multiple Myeloma
Disease pathophysiology, treatment, side
effects, symptom management, and nursing
care
Case Study/Group discussion
Andrew
Winter
1415-1515
Lymphoma
Disease pathophysiology, treatment, side
effects, symptom management, and nursing
care
Case Study/Group discussion
1530-1630
Aplastic Anemia
Myelodysplastic Syndrome
1630-1700
Post-test, Evaluations and Wrap up
Kathy Trip
Time
Topic
Presenter
0800-0830
Pre-test
0830-0930
Comprehensive review of hematopoiesis and basic
concepts of transplantation

Hematopoiesis and immunology

HSCT as a treatment option

History of transplantation

Types of transplantation

Indications for a transplant

Predictive factors for acute GVHD

Ethical Considerations in HSC
0930-1015
Donor Identification and Stem Cell Collection

Evaluation of allogeneic donors for
collection (related, unrelated and
mismatched donors)

Blood stem cell collection

Mobilization

Apheresis

Stem cell processing.
Michelle Dougan,
RN
1030-1115
Conditioning Regimens in HSCT

Myeloablative vs. non-myeloablative

Total body irradiation
Sarah D’Angelo,
APNE
1115-1200
Infusions of Cryopreserved and Fresh
Hematopoietic Stem Cells:
Implications for Inpatient RNs

Baseline and ongoing assessments

Complications

FACT Accreditation
Vandana Kalia, RN
Allogeneic
1300-1400
Hematologic effects
Charissa Cordon
1400-1500
Graft vs. Host Disease

Classification and grading

Prevention and treatment

Gastrointestinal, hepatorenal,
cardiopulmonary, skin and neurological
complications of HSCT
Janice Wright,
1515-1600
Post treatment follow-up

Survivorship

Relapse and secondary malignancies post
HSCT

Quality of Life issues
Janice Wright,
Full day Sessions
Charissa Cordon
Administration of
Growth Factors
Presented by: Charissa Cordon, APNE
This learning activity has been
generously sponsored by:
When: Wednesday, May 20, 2009
Time: 1300-1345 & 1400-1445 (45 min of CE hours )
Location: PMH Nursing Center, (3-613)
At the end of this presentation, participants will be able to:
–
List the hematopoietic growth factors available for clinical use at PMH
–
Identify the therapeutic effect of each growth factor
–
Enumerate the side effects of growth factors
–
List the clinical indications for each growth factor
This learning activity meets one of the requirements for FACT Accreditation
For further information, please contact: Charissa Cordon x 16-5928
Conditioning Regimens for
Hematopoietic Stem Cell
Transplantation
Presented by: Sarah D’Angelo, APNE
This learning activity has been
generously sponsored by:
When:
Time:
Location:
Wednesday, April 29, 2009
1215-1300 & 1315-1400 (45 min of CE hours)
PMH 14th Floor Classroom (14-742)
Otsuka Pharmaceutical Group
At the end of this presentation, participants will be able to:
1.
Define the goals for Blood and Marrow Transplantation (BMT) conditioning regimes
2.
Differentiate between allogeneic & autologous conditioning regimes
3.
Discuss factors important for determining the type of conditioning regimen
4.
Understand nursing management during conditioning
5.
Discuss side effects of conditioning regimes and the associated nursing care
**Lunch will be served. This learning activity meets one of the
requirements for FACT Accreditation**
For further information, please contact: Charissa Cordon x 16-5928
Snack and Learn:
Beyond Survival: Managing Late Effect
Complications of Allogenic Stem Cell
Transplantation
Presented by: Janice Wright, NP
eLearning Courses
Competency Validation Checklist:
• A peer reviewed system that promotes professional
accountability for the delivery of quality nursing care
• An example of Shared Governance and enhanced
professional accountability
(Green & Jordan, 2004)
Did Shared Governance work for us?
….because shared governance demands
energy and attention from its participants,
some nurses may decide to follow BUT not
participate…..
(Hess, 2004)
Common deficiencies during on-site
inspections for FACT Accreditation
In clinical programs:
– Inadequate data management *
– Inadequate quality management plan*
– Incomplete or absent SOPs*
In collection facilities
– Incomplete or absent SOPs*
– Inadequate management of the results of donor evaluation findings and
test results
– Lack of documentation of adverse reaction reactions
– Deficiencies in label applied to the product at the end of collection*
In the lab services
–
–
–
–
–
Validation procedures/or records missing *
Inappropriate labels
HPC infusion documents
HPC storage P&P incomplete
Engraftment not tracked by laboratory
(Warkentin et al, 2000)
We GOT ACCREDITED!!
"You'll be on your way up!
You'll be seeing great
sights!
You'll join the high fliers
who soar to high
heights."
(Dr. Seuss, 1990)
Lessons Learned
• Need to standardize approach to education,
and training
• Consistently reinforce SOPs and P&Ps
• Consistently track education hours and
training activities
– Learner accountability
Future plans
• Continue with standardized approach
• Continue to brain storm and find more
effective ways to engage all staff on deeper
level
• Continue to work with foundation created
with initial FACT work
References
Anthony, M. (2004). Shared Governance Models: The theory, practice and evidence. The
Online Journal of Issues in Nurisng. 9(1)..
Bednardski, D. (2009). Shared governance: enhancing nursing practice. Nephrology Nursing
Journal. 36 (6).
Dr. Seuss. (1957). The Cat in the Hat. New York: Random House Books
Dr. Seuss. (1958). Yertle the Turtle and Other Stories. New York: Random House Books
Dr. Seuss. (1975). Oh, The Thinks you can Think!. New York: Random House Books
Dr. Seuss. (1990). Oh, The Places You’ll Go!. New York: Random House Books
Green, A. & Jordan, C. (2004). Common denominators: Shared governance and work place
advocacy- strategies for nurses to gain contraol over their practice. Online Journal of
Issues in Nursing. 9(1).
Hess, R. (2004). From bedside to boardroom- nursing shared governance. The Online
Journal of Issues in Nursing. 9(1).
University Health Network. (2010). Princess Margaret Hospital at a Glance. Website:
www.uhn.on.ca
Warkentin, P., Nick, L. & Shpall. E. (2000). FAHCT accreditation: common deficiencies
during on-site inspections. Cryotherapy. 3(2), 213-220