QUALITY AND SAFETY IN ONCOLOGY: Is oncology specific ? Sandy - - PowerPoint PPT Presentation

QUALITY AND SAFETY IN ONCOLOGY:

Is oncology specific ?

Sandy Decosterd, Clinical nurse specialist in oncology Marie-José Roulin, Deputy Nursing Director

Auer et al. (2014) Journal of Nursing Administration

SAFETY IN NURSING IN SWITZERLAND: nurses’ perspective

HEALTHCARE PROFESSIONALS’ LIKELIHOOD OF SPEAKING UP ABOUT SAFETY CONCERNS: a Swiss vignette study

Schwappach & Gehring (2014) PloS One

• Development of quality in medicine and care through the

formulation of therapeutic guidelines or tools promoting integrated care.

• Participation and development of patients and families

competencies

SWISS NATIONAL STRATEGY AGAINST CANCER: TWO PRIORITIES ARE LINKED TO NURSING

OUR CHOICES FOR THIS PRESENTATION

• Focus on the patient-nurse interface
• A Swiss perspective

A general perspective An oncology perspective

Nurse

Interprofessionality: coordination, communication, sharing responsabilities Environment: staffing, legislation, structure, patient trajectory

Patient Person centered care

ETHICAL CARE: ICN code of ethics nursing and the individual

• Respect of rights, values, customs and beliefs
• Consent for care
• Respect of confidentiality
• Equity in access to health care
• Respectfulness, compassion, trustworthiness and

integrity

• Nursing professional responsibility is to the

patient

ICN code of ethics, 2012, Geneva

• Individual responsibility for maintaining competences
• Ensuring the use of up to date technology and scientific

advances

• Determining and implementing standards of clinical

nursing

• Taking action to safeguard individuals during sensitive

care. ETHICAL CARE: ICN code of ethics nursing and practice/profession

ICN code of ethics, 2012, Geneva

Nurse

Interprofessionality: coordination, communication, sharing responsabilities Environment: staffing, legislation, structure, patient trajectory

Patient Person centered care

KNOWLEDGE USE:

the right information, at the right place, at the right time

• Summarizing and structuring the pertinent

information for the context

• Translating for clinician and management
• Disseminating knowledge at the bedside

Nursing k nowledge brokers McCormack et al. (2013) Implementation Science Pool et al. (2015) International Journal of Nursing Studies

It implies

Estabrooks et al. (2005) Qualitative Health Research Gagnon et al. (2009) Infirmière Clinicienne Social interaction Unit based documents

SOURCES OF PRACTICE KNOWLEDGE FOR BEDSIDE NURSES:

the right information, at the right place, at the right time Coaching at the bedside Regular contacts Nursing rounds In-services Team case analysis Journal club Protocoles Information in computerised care charts Internet, Service blogs /Tweet/ WhatsApp Newsletters

Examples in oncology In-services educational intervention with individual coaching Guided protocoles for chemotherapy Oncology information flyers Flyers from the national cancer league SOS nursing standards

BARRIERS TO KNOWLEDGE USE

• 4 national languages

(french is a minority language)

• Few national

guidelines/standards in

• ncology nursing
• Strong cultural link with

neighboring countries

Nurse

Interprofessionality: coordination, communication, sharing responsabilities Environment: staffing, legislation, structure, patient trajectory

Patient Person centered care

COMPETENCIES :

technical, relational, reflexive

Therapy, surgery, radiotherapy, side effects, procedures,.. Technicity, precision Patient education, support , enabling self-care, giving bad news, palliative care Therapeutic communication, emotional support Developing practice Reflexive, formalizing knowledge

Bachelor Specialty Master (CNS)

NURSING COMPETENCIES IN SWITZERLAND

Ledergerber, C., Mondoux, J., Sottas, B. (2009) Projet de compétences finales pour les professions de la santé HES, disponible sur : http://www.swissuniversities.ch/fileadmin/swissuniversities/Dokumente/FR/FH/Best_practice/1_Competences_finales_pour _les_professions_de_la_sante_HES_rapport_final.pdf

Based on the CANMED 2005 Framework Nursing expert

NURSES WITH A NURSING SCIENCES’ MASTER IN SWITZERLAND

349 nurses (mean age 40)

Somatic hospitals 53% Universities of Applied Sciences 27% Universities 12% Psychiatric hospitals 8% Long term care 5% Home care 3%

21% in

• ncology

Schwendimann R., Koch, R. (2013) Masterumfrage, ASI. Disponible sur: http://swiss-anp.ch/w/media/Akutelles/2013_05_20_Masterumfrage_2013_Bericht_4S_final.pdf

Nurse

Interprofessionality: coordination, communication, sharing responsabilities Environment: staffing, legislation, structure, patient trajectory

Patient Person centered care

PATIENTS’ CHARACTERISTICS: What are the patients’ characteristics that influence acuity ?

Pilot study in four hospital wards

• Oncology
• General Medicine
• Rehabilitation
• Psychiatry (crisis unit)
• 1. Evaluation of the importance of 6 characteristics in a convenience

sample of 184 patients

• 2. Identification of indicators for each characteristic

Ansel, Ducloux, Ferreira, Genoud, Gonzales, Hamache, Herrault, Roulin (2015) Preliminary results, pilot study HUG.

IMPORTANCE OF PATIENTS’ CHARACTERISTICS

STABILITY PARTICIPATION VULNERABILITY COMPLEXITY PREDICTABILITY RESOURCES N=184

• ncology (n=46)

Etude pilote HUG: Résultats préliminaires, 2015

VULNERABILITY

Ansel, Ducloux, Ferreira, Genoud, Gonzales, Hamache, Herrault, Roulin (2015) Preliminary results, pilot study HUG.

Susceptibilty to stressors that may affect outcomes such as comorbidities, cognitive problems,…....,

• Decosterd. Bavaux, Eicher, 2015 (Preliminary results)

SWISS ADAPTATION OF THE ONCOLOGY ACUITY TOOL FROM BRENNAN

P T

Nurse

Interprofessionality: coordination, communication, sharing responsabilities Environment: staffing, legislation, structure, patient trajectory

Patient Person centered care

ENVIRONNEMENT legislation, role, staffing, reimbursement

• No definition of scope of

practice.

• No recognition of nurses’

autonomy of practice

Federal law in preparation on health professions Change in the health insurance federal law in consultation

TODAY, counseling and teaching must be prescribed by a physician Counseling and targeted follow up of patients with oral anti-cancer medication must be prescribed by a physician

NURSES’ PER 1000 INHABITANTS

Panorama de la santé 2011, OCDE

NURSING STAFFING

Aiken et al. (2012) BMJ; 344.e1717

Nurse

Interprofessionality: coordination, communication, sharing responsabilities Environment: staffing, legislation, structure, patient trajectory

Patient Person centered care

INTERPROFESSIONALITY

Coordinated care, patient trajectory, chronicity

Multiprofessional Interprofessional

Other Nurse Physician Nurse Other Phys. Knowing the others’ Patient centered integrated care

DRIVING AND RESTRAINING FORCES

Interprofessional practice

Patient and family Complexity, vulnerability, autonomy Professions Competencies sharing, optimize expertise Politique Cost control, accountability Lack of expertise Communication, teamwork, sharing of responsabilities Cultural silos Values, perspective, systemic vision Infrastructure Schedules, rewards, levels, physician based financing Inspired from Heather et al. (2011) Nursing Outlook

INTERPROFESSIONALITY : Complexity indicators linked to interprofessionality

Ansel, Ducloux, Ferreira, Genoud, Gonzales, Hamache, Herrault, Roulin (2015) Résultats préliminaires, étude pilote HUG. Non defined therapeutic goals/ or in definition Professionals from different disciplines and services (coordination) Ethical questions Divergences or lack of dialogue between professionals Light patient Medium patient Heavy patient

TAKE HOME MESSAGE

Ethical nursing Quality and security Quality and security complex process

Nurse

Interprofessionality: coordination, communication, sharing responsabilities Environment: staffing, legislation, structure, patient trajectory

Patient Person centered care