Transcript 48/10 – Advancing Cancer Care for the Younger and Older Adult

48/10
Advancing Cancer Care for the Younger and Older Adult
Tracy L. Lust RN BSN MA Quality, Safety and Accreditation Leader PHSA/BCCA
BC Cancer Agency Interdisciplinary Team: Janice Dirksen Clinical Coordinator, Arlyn Heywood Education Resource Nurse, Karen Janes Nursing Professional Practice, Dr Don Cooper,
Dr Mike Mamacos , Winnie Cheng Pharmacy, Shirley Hobenshield Dietician, Rob Thayer Respiratory Therapist, Suzanne Butler Physiotherapist, Sarah Sample Patient and Family Councilor
Abstract:
Identification of the Intervention/Strategy for Change:
Context/Aim:
Sustainability of Compliance/Measurement:
The completion of Patient Assessment documents and care plans was measured from the Spring
While introducing the concept of the 48/6 Guidelines to the BC Cancer Agency, the interdisciplinary
The BC Cancer Agency identified the importance of a comprehensive risk assessment, nursing flow
team identified multiple assessment documents and processes during an environmental scan.
sheet and care plan in identifying and reducing patients’ functional difficulties and co-existing health
In addition, the need for assessing and documenting other key areas of patient functioning were
problems not only in the elderly cancer patient, but in all patients. The project aim was to
identified. This lead to the implementation of 48/10 guidelines at the BC Cancer Agency.
amalgamate all interdisciplinary documentation and create one risk/functional assessment, flow
Interdisciplinary Team involvement resulted in the creation of one comprehensive patient
sheet and care plan.
risk/functional assessment document, a 24 hour Patient Care Flow Sheet, as well as a Patient Care
2014 implementation through to Fall 2014.
Plan to cover all key areas of patient function:
Geriatric oncology is a growing specialty as just over half of the newly diagnosed patients are over 70
100%
BC Cancer Agency’s 48/10 Implementation:
% Completion of Risk Assessments
Problem/Issue:
BC Cancer Agency:
48/10 Document Audit
120%
years of age. Often the cancer is the least of their problems and cancer impacts these co-morbidities.
The BC Cancer Agency has adopted this interdisciplinary approach with patients of all ages to
ensure and early and appropriate assessment and care plan to address the effects of treatment of
cancer that may tip them over the edge.
Description of the Context/ Aim Statement:
Patient Symptom Self
Assessment
Document
Hospital Care for Seniors (48/6) was identified as a Provincial Clinical Care Management Guideline
in 2011. As a result, the Provincial Seniors Hospital Care working Group collaborated with
80%
60%
40%
20%
representatives from the Ministry of Health, BC Patient Safety & Quality Council and geriatric
0%
experts from each health authority with the goal of implementing 48/6 within all BC acute inpatient
Series1
June
0%
11-Jul
0%
18-Jul
58%
24-Jul
71%
1-Aug
0%
7-Aug
38%
14-Aug
38%
21-Aug
50%
28-Aug
75%
4-Sep
75%
11-Sep
38%
18-Sep
63%
25-Sep
63%
9-Oct
100%
16-Oct
50%
23-Oct
88%
settings by the Fall of 2014.
The Hospital Care for Seniors (48/6) guideline involves:
Screening and assessment of the patient including 6 key areas of patient functioning
and
Development of the patient’s individualized inter-professional care plan
To address identified issues within 48 hours of the decision to admit.
The 6 key areas of patient functioning are:
Cognition
Medication Management
Pain Management
Nutrition and Hydration
Bowel and Bladder Management
Functional Mobility
Audit results show a steady rise in the team involvement in ensuring completion of these documents
and processes of 20 – 86% during this time period.
Interdisciplinary Care Plan
Patient
Patient Assessment
Document
(10 Key Areas)
In addition to the completion rates of the new assessment forms, flow sheets and care plans, the
interdisciplinary team explored how the 48/10 implementation would impact the patient’s over all
experience.
A review of the Patient Safety Learning System shows a decrease in Patient Falls reports within the
inpatient population at the BC Cancer Agency during the 48/10 implementation.
In Canada, 30% of seniors admitted to acute care will be discharged at a significantly reduced level
of functional ability and most will never recover to their previous level of independence
(BC Patient Safety and Quality Council, 2013)
BC Cancer Agency # of In-patient Falls - Jan 2011 - 2015
Research has shown that: the 6 key care areas have interrelated effects on health which, when
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Patient Care
Flow Sheet
addressed, reduce functional decline and improve patient outcomes.
Although the 48/6 guideline for care was developed to address the specific needs of the frail elderly,
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the BC Cancer Agency, believing that the guidelines are basic care applicable to all patients, adapted
the guideline for patients of all ages admitted to the inpatient unit for longer than 24 hours.
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As a result, the BC Cancer Agency aimed to amalgamate interdisciplinary documentation and create
Description of the Problem/Issue:
While Geriatric Oncology is a growing specialty, the effects of cancer and it’s treatment has effect on
1. Patient Risk/Assessment Document:
the key areas of functioning in patients of all ages:
The Patient Assessment Document was created to ensure the complete assessment of admitted
Hospitalized patients with cancer have higher fall frequencies and higher fall injury rates among
patients of all ages within 48 hours of the patient’s admission. In addition to the 6 Key areas of
hospitalized patients. Falls may be related to pathophysiclogical or behavioural effects of
Patient Functioning (Cognition, Medications, Pain, Nutrition/Hydration, Bowel/Bladder, and
chemotherapy or radiation as well as disease manifestations. One study shows that more than one-
Functional Mobility), four other key areas of function are also assessed.
half of patient falls are related to elimination needs, regardless of patient age, and impaired gait.
These include: Falls Prevention, Pressure Ulcer, Infection and Medication Reconciliation.
(Capone et al, 2010)
The patient’s involvement in the assessment is crucial to the interdisciplinary team’s overall
The BC Cancer Agency, recognizing that many oncology patients have pre-existing co-morbidities
understanding of the patient’s condition. To meet this need, the Patient Assessment Document
as well as the effects of oncology disease/treatment, has adopted the 48/6 Guidelines to ensure
also includes a Patient Symptom Self Assessment.
# of Falls
one Risk/Assessment Document in addition to a 24 hour Patient Care Flow Sheet and Care Plan.
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2
1
0
early assessment and care planning for admitted patients of all ages,
2. 24 Hour Patient Care Flow Sheet:
The Patient Care Flow Sheet is an amalgamation of multiple patient assessment and care
documents. The Flow Sheet ensures that a head to toe patient assessment is documented on an
Outcome data shows that inpatient falls have decreased to one every two months.
ongoing basis (day and night – once per shift),in addition to any daily care provided within 24
hours. The Flow Sheet allows any team member to add information or see at a glance what has
Effects of the Changes/Lessons Learned:
occurred with the patient within a 24 hour period.
With the introduction of the 48/6 guidelines, BC Cancer Agency team members identified that they
3. Interdisciplinary Patient Care Plan:
were proud of their cohesive team communication and interdisciplinary approach to patient care.
Interdisciplinary Team Members identified that they were cohesive in their communication but
needed to find a method to document the communication in one place that could be easily
accessed. An interdisciplinary Care Plan with a checklist of the key areas of patient functioning is
utilized during patient rounds.
As the team members explored their existing processes and documents, they discovered replication
and assumptions about documentation and communication of patient care issues. There was initial
reluctance from team members to offer suggestions for change until they came to realize their ability
to create documents and processes that had meaning to an oncology patient’s care.
Implementation of these documents and processes involved engagement of the Interdisciplinary
team. Feedback huddles, group meetings , education sessions and one on one conversations
were held to assist in the change process toward a new, comprehensive method to identify,
communicate and mitigate patient concerns. Interdisciplinary education consisted of sessions to
address Delirium and Pain Assessment, recognition of Cognitive Changes, as well as Falls
Prevention measures.
Including the patient and keeping them at the centre of communication, the interdisciplinary team
developed new methods to assess, document and communicate patient care concerns.
The 48/6 guidelines at the BC Cancer Agency have become 48/10 guidelines…with the capacity to
grow as more key areas of patient care are being identified by the team.