Successful Development of a Hospital-Based Outpatient Apheresis - - PowerPoint PPT Presentation

|

Click icon to add picture

Successful Development of a Hospital-Based Outpatient Apheresis Program

Patricia Miles BSN, RN, OCN Delight Joslyn MSN, RN, OCN, CRNI, CPHON Shannon Jagger BSN, RN-BC

03/13/2019 Click icon to add picture

|

Therapeutic Apheresis

• Therapeutic apheresis is a treatment that

cycles patient blood to remove an offending substance from the body.

• Apheresis is used to treat many different

autoimmune, neurologic, and blood-related diseases

• Having the ability to perform emergent

apheresis can save lives.

03/1

|

Therapeutic Apheresis

• Apheresis is a service that has proudly

been performed at Northern Light Eastern Maine Medical Center (NL EMMC) for many years.

• Over the last several years, use of this

intensive treatment option has rapidly increased at the hospital.

• Despite the increasing numbers, in 2017

the service was on the brink of collapse for a variety of reasons.

03/1

|

Historical Perspective…

• Dated Equipment
• Training
• Treatments limited to TPE and

leukodepletion

• Space/room availability

constraints

• Per diem staffing model

03/1

|

Equipment Impacts

Prior to 2018, COBE Spectra was the machine of choice for apheresis treatments. EMMC had 2 COBE Spectra machines. 1 Spectra Optia machine was in use. New staff were being trained to Spectra Optia.

• In 2017, learned that COBE Spectra being “sun-

downed” by company in 2018

• Needed to get FDA approval for WBC depletion
• n Spectra Optia
• Staff turnover influenced pool of people able to

03/1

|

Training Impacts

New staff were being trained to Spectra Optia “on- the-job”

• No formal training process or documentation of

competency

• Voluntary participation
• Relied on staff report “feel” ready

03/1

|

Treatment Options

Treatment options were limited

• Therapeutic plasma exchange
• WBC depletion
• Limited to dialysis/plasmapheresis dual lumen

short or long-term catheters

10/2

|

Space Constraints

• Limited availability of bed
• Day to day challenges of bed management
• Frequently moved around
• Not patient conducive
• Limited resources and supplies available to

staff performing treatment

03/1

|

Development of Business Plan

03/1

|

Business Plan Leadership

Sponsor: Deborah Sanford MBA, MSN, RN, Vice President of Nursing and Patient Care Services Leadership Team:

• Tina Scott MSN, RN, Medical-Surgical Service Line Director
• Kael Mikesell DO, Director of Blood Management
• Patricia Miles BSN, RN, OCN, Nurse Manager
• Shannon Jagger BSN, RN-BC, Assistant Nurse Manager
• Delight Joslyn MSN, RN, OCN, CRNI, CPHON, Staff Nurse I
• Cheryl Levesque CPA, Director of Nursing and Clinical Finance
• Laurie Damon PMP, Process Improvement Specialist

03/1

|

Business Plan Leadership Apheresis Team:

• Angela Stanoch BSN RN OCN Staff Nurse I G6
• Sandy White BSN RN OCN Staff Nurse I G6
• Ashley Bradley BSN RN Staff Nurse G6
• Meghan Pardy BSN RN Staff Nurse G6
• Rebecca Julian BSN RN Staff Nurse G6
• Brianna Speed BSN RN Staff Nurse G6
• Victoria Hill BSN RN Staff Nurse G6
• Delight Joslyn MSN RN OCN, CRNI, CPHON BSN RN Staff Nurse I/Apheresis Coordinator G6

03/1

|

Review Process (BCOR-Business and Clinical Opportunity Review) Business QUAD development

• Opportunities
• Justification
• Schedule
• Finances

Business Plan development

• Business justification
• Clinical justification
• Financial assumptions
• Exit Strategy

03/1

Months of preparation (Weekly meetings with key stakeholders)

| 03/1

Hematology/Oncology Specialty Treatment Services

|

Business Justification

• Pediatric and Adult Apheresis treatments have increased at

EMMC over the last several years.

• Lack of dedicated space resulted in decreased bed availability for

inpatient admissions during the time of an outpatient treatment.

• It is important for EMMC to maintain a hospital run apheresis

program as it is the only hospital in central and northern Maine doing so.

• Maintaining a program in this geographic region enhances

alignment and continuity of care with the primary care community closer to home for patient and their families.

03/1

|

Clinical Justification

• Apheresis is used to treat many different potentially life-

threatening pediatric and adult diseases. Having the ability to perform emergent apheresis can, and does, save lives.

• Reliance on “off duty” staffing model put the urgency of

treatment at risk, affecting patient satisfaction, safety, and quality

• f care for patients.
• 2/3 apheresis machines at EMMC were retiring by June 1, 2018.

An additional apheresis machine was needed to continue treatments.

• Structured program for annual competency of nurses and

providers needed to be reviewed/developed.

• Increased demands and types of treatment required training of

additional staff .

03/1

|

Financial Considerations

• Dedicated space/construction cost
• Cost of machine
• Cost of annual maintenance
• Anticipated future volume
• Staffing
• Educational needs

03/1

|

Exit Strategy

• Movement of outpatient services off-site
• Impact on urgently needed inpatient

treatment

• Equipment availability
• Staff competency----”low volume, high

risk”

• Contracted services
• Transport to other facilities (i.e. out-of-

state)

03/1

|

Approval of Business Plan

• Dedicated room
• Acquisition of new equipment
• Daily staffing commitment
• Staff Education and Training

03/1

|

Space and Equipment

03/1

|

Dedicated Space/New Equipment

• Patient-friendly

environment

• Ease of access
• Enhanced

availability of resources and supplies

• Infection Control

Review/Risk Assessment

10/2

|

Staffing Model

03/1

|

Staffing Model

Prior to 2018, staffing for apheresis was done on a per diem/on call basis.

• Relied on staff to respond to text/calls to come in

as needed any day, any night

• Weekend scheduling challenging
• Difficult to coordinate with line placement
• Staff turnover influenced pool of people to be

available

03/1

|

Staffing Model: Current state

Apheresis nurse is assigned to treatment room 620 on a daily basis:

• An apheresis trained nurse is always assigned to room 620 – 7

days a week, 12 hours a day.

• The assigned Apheresis nurse is a staff nurse, and has the ability

to flex back into direct patient care staffing in the event no apheresis treatments are scheduled that day.

• This has allowed us to more quickly and efficiently schedule

patients.

• Provider awareness that if a patient needs treatment a nurse will

always be available

• Increase in staff desire to become apheresis trained
• Retention of apheresis nurses

03/1

|

Scheduling/Calendar Development: Transition to new model

Starting February 2018 treatments were scheduled via outlook Calendar

• Calendar was created via outlook

and Assistant Nurse Manager would enter all treatments and bill for all treatments

• Calendar was in read-only view for

all apheresis nurses

• Printed version was placed in

charge book every Friday Scheduling calendar current state:

• Apheresis nurses have read/write

access to scheduling calendar

• Daily apheresis nurse will update

calendar and schedule appointments

• Apheresis nurses bill for each

treatment same day and update “billing complete” on the calendar

03/1

|

Staff Development/Competency

03/1

|

Staff Development to support the new model

• On-site formal training of additional

staff during the fall of 2017 by Terumo

• Developed competency for

documentation of performed treatments/transition to independence

• Training provided by Terumo to perform

RBC Exchange on the Spectra Optia

• Staff trained to perform apheresis via

Vortex and PowerFlow Apheresis ports

• r peripheral access

03/1

|

Staff Development to support the new model

• On-site staff training on apheresis

adverse reactions by the Medical Director

• Skype training for leuko-reduction

in November 2018

• Policy development/revisions with

staff input regarding care and management of the patient undergoing apheresis treatment

• Development/documentation of

SOP’s for each type of treatment Apheresis Resource Manual created

03/1

|

Staff Development Impact Expanded treatment options

• Red blood cell exchanges
• Expanded options to provide

service to patients with port access

• Treatment also provided to

patient with triglycerides>5000

03/1

|

Community Outreach

• Enhanced collaboration with

Neurology, Adult Hematology and Oncology, Pediatric Hematology and Oncology

• EMMC Apheresis Program

“In the News”

• Website Development
• Dedicated Phone/Fax line

03/1

|

Outcomes What does it all mean?

• Increased patient

satisfaction

• Increased efficiency
• Increased treatment options
• Increased availability of

scheduling

• Increased volume
• FY 2019-Q1

102 Treatments!!!

03/1

|

On the horizon…

GROWTH

• Trained 3 additional RN’s in November bringing total

number of nurses on our Apheresis Team to 8!

• Training expanded treatment options to include WBC

depletion on the Spectra Optia Machine PATIENT SATISFACTION

• Gaming/entertainment system installed
• New treatment recliners (vs. bed)
• Increased vascular access options

STAFF SATISFACTION

• Professional development

03/1

Many new and exciting things continue to happen with the NL EMMC Apheresis Program…

TECHNOLOGY

• CPOE

QUALITY

• CLABSI Prevention/Vascular

Options

• “Time-Out”

METRICS

• In progress---for consideration: patient

experience, AABB standards, adverse event rates “BEST PRACTICE” GUIDELINES

• American Society for Apheresis

(ASFA)-”Choose Wisely”

|

Leadership Impact

• Nurse Manager:
• Recognition of importance of collaborative

multidisciplinary team for program development

• All nurses are leaders – everyone has something

to offer and it takes a village

• Formal title doesn’t make a leader
• Assistant Nurse Manager:
• Empowerment of apheresis nursing team
• Organizational skills
• Ensuring the staffing model met program

demands

• Communication is key
• Staff Nurse I:
• Accelerated “learning curve”---novice to

expert

• Coordinator responsibilities/leading a

“team”

• Collaboration among disciplines regarding

patient care

• Networking/establishment of a resource

base

• Navigating change

03/1

|

FINAL THOUGHTS

• Management of a therapeutic apheresis program “requires

balancing multiple resources and talents in a coordinated effort to support patient care in a highly specialized area of medicine”.1

• Limited resources/references are available to consult in the

management of a successful apheresis program.

• Key management strategies for the successful development of a

hospital-based outpatient apheresis program include executive leadership support, effective management of daily operations, development of highly trained apheresis staff, multidisciplinary collaboration, balancing of resources, and ensuring excellence in patient care.

03/1

|

References

• 1. Linz, W. et al. (2017). Principles of Apheresis Technology (6th ed.).

Vancouver, British Columbia: ASFA

03/1

|

QUESTIONS?? ?

10/2