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Day 4 of the ACCC 37th [Virtual] National Oncology Conference gave participants the opportunity to connect directly with this year’s ACCC Innovator Award winners and their physician and/or administrative champions. These leaders shared with conference attendees what led them to support their innovations, how they procured the necessary buy-in and resources to implement those innovations, and what their plans are.
Miami Cancer Institute
Innovator Award recipients from Miami Cancer Institute explained that the imperative to adequately staff their newly built cancer institute with oncology nurses inspired them to develop their own solution. The nursing academy they created incorporates a dynamic, intensive curriculum in which experienced non-oncology nurses are trained in cancer care, graduate from the program, and join the cancer institute’s staff. “Miami Cancer Institute has succeeded in accelerating and capitalizing on the education of experienced nurses to speed up their path to specializing in oncology,” said Michele Ryder, MSN, MSHSA, RN, CENP, Cancer Program Administrator at Miami Cancer Institute.
When session participants were polled on whether their institutions have identified increasing oncology nurse retention and/or reducing nurse turnover as an organizational priority, 65% said “yes,” 12% said “no,” and 23% did not know. For those hoping to implement a similar program, Ryder said that having a solid business plan played a significant role in helping her obtain buy-in for the nursing academy. “It’s important to show that you have a sustainable program,” said Ryder. “Getting buy-in from our CMO and CEO wasn’t enough. We also needed the support of our finance department, HR department, recruiting, and clinical learning. We knew we couldn’t do it without all of them.”
A community cancer center based in Nashville, Tennessee Oncology was recognized with an ACCC Innovator Award for its creation of a customized patient portal and database (i.e., hospital event platform) that sends its providers real-time notifications when one of their patients presents at the emergency department (ED), is admitted to the hospital, and/or is discharged from the hospital. “This enables us to know how we are doing in real time” said Larry Bilbrey, Care Data Systems Manager at Tennessee Oncology. “Previously collected data was outdated by the time we saw it.”
“This tool enables us to determine why a patient went to the ED and find out the source of the problem,” added Johnetta Blakely, MD, MS, MMHC, Executive Director of Health Economics and Outcome Research at Tennessee Oncology. “Was the patient not adequately taught about side effects? Did someone give a patient poor direction? Was a physician unavailable? If we know what is happening, we will know how to counteract it.”
St. Luke’s Cancer Institute
During a session with pharmacists at St. Luke’s Cancer Institute, presenters said their award-winning innovation has drastically lowered their turnaround time for filling oncology prescriptions. Under a new oral oncolytic pharmacist collaborative practice agreement (CPA), oncology pharmacists at St. Luke’s are empowered to sign prescriptions on behalf of providers in several situations, including refill renewals, targeted dose adjustments, dose rounding, and adjustments for toxicities.
Julia Kerr, PharmD, Medically Integrated Pharmacy Program Coordinator at St. Luke’s, says that the change has significantly improved job satisfaction for both pharmacists, who no longer have to wait on physician approvals, and physicians, who now have fewer interruptions to their day. Key to the program’s success, said Dr. Kerr, was building on the strong provider/pharmacist relationships that already existed at St. Luke’s.
Amanda Wright, PharmD, Oncology Pharmacist at St. Luke’s, added that introducing the program with a small-scale pilot was very helpful. “It’s good to start small and test the waters first,” said Dr. Wright. “Figure out the best way to make it work, get support, and then expand it.”
Also key is education. When polled on their understanding of what a pharmacist collaborative practice agreement is, 32% of conference participants said they are unfamiliar with the concept, and 22% said their understanding needs improvement. “Look for opportunities to educate others about where you see potential workflow improvements,” advised Dr. Wright.
Maine Medical Center Cancer Institute
In an effort to help patients better understand diagnoses that may be unfamiliar to them, Theresa Roelke, MSN, RN, AGNP-C, a geriatric nurse practitioner at Maine Medical Center Cancer Institute, helped create a 3D lung nodule model to educate patients undergoing lung screening. After first putting her innovation in the hands of her patients, Roelke was impressed by how they well they responded to this visual learning tool. “When patients receive a new diagnosis, they need tools to understand the facts so they can make informed treatment decisions with their physicians,” said Roelke. “Before, our patients did not comprehend what [lung] nodules are and how big they are.”
Roelke worked with a local art student to refine the model and create it with a 3D printer. In addition to helping clinicians engage patients, she said the 3D model helps improve health literacy by bridging the communication gap that often exists between medical professionals and their patients. “Patients can physically hold and see the nodule that might be in their lung(s) rather than being spoken to with medical terminology that is difficult for them to understand,” said Gary Hochheiser, MD, Director of Thoracic Surgery at Maine Medical Center Cancer Institute, who championed the innovation.
Roelke said—and Dr. Hochheiser agreed—that one essential element to selling an innovative idea to leadership is passion. “You have to have passion for the project,” she affirmed. “If you have passion, it’s contagious, and other people will feel that energy and want to get involved.”
In response to a polling question asked at the start of this session, only 22% of participants said their cancer programs have a process in place to proactively identify patients at risk of treatment-related cardio-toxicity. The session’s hosts, a cardiologist and a cardio-oncology nurse navigator who created the Franciscan Health Cardio-Oncology Clinic, said that their innovation emerged out of a need to help cancer patients manage potentially cardio-toxic therapies. They were joined by Peter Garrett, MD, FACR, Medical Director of Cancer Services and Radiation Oncology, who shared why he championed the creation of this interdisciplinary program.
Kerry Skurka, RN, BSN, Cardio-Oncology Nurse Navigator at Franciscan Health, said that one significant barrier to their clinic was pushback from cardiologists who were concerned that such a program would cause them to lose their patients to oncologists. “Communication with cardiologists was crucial,” said Skurka. “They must know they will not be losing their patients to cardio-oncologists; instead, cardio-oncologists will act as specialists and return patients to their cardiologists after treatment.”
Vijay Rao, MD, PhD, Director of Cardio-Oncology and Co-Director of the Heart Failure Program and Anticoagulation Clinic at Franciscan Health, said effective communication about a new service such as a cardio-oncology clinic can resemble a PR campaign. “Make speaking engagements, attend dinners, go to tumor boards, give grand rounds,” said Dr. Rao. “Word-of-mouth can be effective, and it gets around fast.”
Skurka and Dr. Rao agreed that essential to their clinic’s success was enthusiastic support from physicians and hospital administration. “I feel very privileged to be working with such a terrific team,” said Dr. Rao. “I appreciate being able to care for oncology patients. I am able to offer the type of multidisciplinary, patient-centered care that can help keep patients healthy and out of the hospital.”
Mercy Cancer Care
In an effort to get ahead of an upcoming CMS quality reporting measure that takes into account the rate of inpatient admissions and emergency department visits related to chemotherapy treatment, Mercy Cancer Care—part of Mercy Health in St. Louis, Missouri—created a predictive algorithm to identify patients at risk of a hospital admission or ED visit within 30 days of chemotherapy treatment. The cancer care team takes measures to proactively address these patients’ needs before more urgent care becomes necessary.
“Mercy Health did not have a model to identify patients as being at risk,” said Michelle Smith, DC, Director of Oncology Services at Mercy Health. “In some cases, patients had two or three ED visits before the cancer care team was made aware of it.” Dr. Smith told participants that key to the success of Mercy’s algorithm was leveraging the energy of clinical champions. Dr. Smith said that she has countered pushback to algorithm use by demonstrating to physicians the success of her outcomes and having physicians speak to their peers about benefits to patients, staff, and clinicians.
University of Arizona Cancer Center
In an effort to both reduce costs and enhance patient care, the University of Arizona Cancer Center at Banner University Medical Center in Tucson transitioned delivery of select chemotherapy regimens to the ambulatory clinic setting. In talking about this innovation, Ali McBride, PharmD, MS, BCOP, Clinical Coordinator of Hematology/Oncology at Banner, said that past justification for inpatient chemotherapies is dated. By offering chemo in an outpatient setting, said Dr. McBride, patients enjoy better quality of life and decreased costs.
Making the change involved many stakeholders, including nurses, pharmacists, and members of the finance team. For other organizations looking to make a similar change, said Dr. McBride, “Maintain constant communication. Cancer care is a matrix environment, so different team members may have different perspectives. It’s important to get buy-in from different members of the team.”
Contributing to the conversation was Dr. McBride’s colleague, Daniel Persky, MD, Associate Director of Clinical Investigators in the Therapeutic Development Program, who shared why he supported the innovation and how he obtained buy-in from the entire cancer care team.
To meet its need for physical therapists certified in oncology, Beaumont Health in 2018 became the first accredited physical therapy residency program in the U.S. for oncology rehabilitation. Christopher Wilson, PT, DPT, DScPT, Residency Director of Oncologic Rehabilitation at Beaumont, says he wants to get all oncology patients seen by a physical therapist when they enter the system, regardless of diagnosis. “Our cancer survivors want to be as healthy as possible for whatever remaining time they have,” said Dr. Wilson.
Key advice that Dr. Wilson and his physician champion, Jennifer Stromberg, MD—Medical Director of the Wilson Cancer Resource Center and Clinical Assistant Professor at the Oakland University William Beaumont School of Medicine—have for other programs seeking to implement a similar innovation is to weave your passion for your project into everything you do. “Bring with your passion data, guidelines, and research to show your administration and stakeholders that this can enhance the lives of your patients and your staff,” said Dr. Wilson. “Let them know that you will carry the project through to implementation if they invest in it.”
The ACCC 37th [Virtual] National Oncology Conference was held live September 14-18. If you missed this exciting educational event, you can register and hear all sessions online through October 16.