Implementation of Supportive Care Screening: A guide to the Five Stage Implementation Checklist

Transcription

1 Care Screening Implementation Guide Implementation of Care Screening: A guide to the Five Stage Implementation Checklist Target: 50% of Newly Diagnosed Cancer Patients are Screened for Care Needs This package contains: Part A: A guide to the Five Stage Implementation Checklist. Part B: The Five Stage Implementation Checklist. ASupporting the Integrated Cancer Services to implement the Care Policy for

2 Care Screening Implementation Guide A guide to the Five Stage Checklist Stage 1: Assessing current practice/identifying the need for change First identify if screening is being undertaken at your facility and if it is, then consider the following: 1.1) for screening? More than one person should be responsible to promote sustainability. Screening tool should be patient completed. 1.2) Is screening part of routine practice or research projects? Generally screening should be part of routine practice. 1.3) Who manages and reviews the screening tool(s) process? Process should be reviewed regularly as part of quality management processes. 1.4) for documentation of the screening tool results? Processing of data needs to be easy to collate and maintain. 1.5) Are evidence-based referral pathways established and reviewed for patients with unmet supportive care needs? Clear pathways and criteria for referral need to be established and widely understood. 1.6) Who reviews / evaluates the proportion of new/returning patients screened? Regular auditing of data would indicate at least 50% of newly diagnosed cancer patients have completed a supportive care screening tool. Stage 2: Identify and involve key stakeholders 2.1) Identify the main stakeholders / people in the health service who will decide on the tool to use (eg. Org Exec, NUMs; Educators, People with cancer, IT, specialist nurses). Rationale: Involving key stakeholders from the start promotes ownership and support for implementation. DoH Care Policy and VCAP targets. 2.2) Form a steering committee inviting the key stakeholders to join. Rationale: Develop clear lines of communication and involve key stakeholders. Communication strategy template. 2.3) Gain organisational support for the implementation. Rationale: General recognition of the need for supportive care to provide quality cancer care. Hospital Organisational statement regarding supportive care template. Stage 3: Plan for the implementation 3.1) Identify/apply for any sources of funding to support the process (eg backfill for project workers). Rationale: Funding may be required to implement new software, pay for project workers etc. Consider applying for ICS, VCA, Department of Health funding opportunities. 3.2) Identify champions for the use of the tool from within current staff at the health service. Rationale: Utilising current staff increases sustainability, as project workers are only employed on a temporary basis. 1Supporting the Integrated Cancer Services to implement the Care Policy for Part A:1

3 Care Screening Implementation Guide 3.3) Document / list the Care Services currently available to people who attend your area of work (consider both internal and external providers). List health services including non-cancer specialist services. Rationale: Understanding the support services available and the referral criteria facilitates referrals. Services include physio, OT, social work, nutrition, psychology, psychiatry, pastoral care, music therapy, meditation, relaxation etc. Referral pathway summary template. 3.4) Decide on the supportive care needs screening tool to be implemented. Rationale: There are a number of screening tools available and some may suit different contexts. Suggested tools template. 3.5) Identify, and if needed, obtain permission to use the tool identify restrictions on adaptations of the tool. Rationale: The tool must have evidence of reliability and validity and permission granted for reproducing the tool provided if needed. Fact sheet regarding reliability and validity of tools. State permission gained for use of DT. 3.6) Identify which committee needs to approve use of the tool for inclusion in the medical record and allocate a medical record number. Rationale: Including the tool in the Medical Record system enables easier auditing. 3.7) Determine which practitioners will undertake screening and at which points in the patients treatment pathway. Rationale: Integrating screening into clinical practice involves identifying the most appropriate person and time for implementation. 3.8) Consider compatibility of tool with software for possible data entry or inclusion into the electronic medical record. Rationale: Easy to use software would allow ease of data collection. 3.9) Identify a process for making and documenting referrals made for supportive care. Rationale: Identified needs require follow up and documentation of such. Template for allied health referral. 3.10) Consider how screening data will be fed back to clinicians/used in practice (eg MDT meetings, paper medical record, electronic medical record). Rationale: Immediate results of screening enable a focused discussion on needs. 3.11) Determine process of how tools will be available and who is responsible for their supply. Rationale: The tool needs to readily accessible to clinicians to prompt completion. 3.12) Budget for supply/printing of screening tools. Rationale: Sustainability requires recognition of costs of printing. 3.13) Consider support needs of staff undertaking supportive care screening (eg will they require extra support or benefit from clinical supervision). Rationale: Discussion of supportive care needs can identify emotive situations that clinicians need to be prepared for. Some method of reflection may be beneficial. 2Supporting the Integrated Cancer Services to implement the Care Policy for Part A:2

4 Care Screening Implementation Guide 3.14) Develop a training program and identify resources that may be needed (eg training kit). Rationale: Training in the use of screening tools and supportive care provides clinicians with confidence to manage the communication. Training kit available. 3.15) Establish length of training session (may be a trade off between amount of information and time staff are permitted to leave ward). Rationale: Training needs to be provided at a time that enables clinicians to devote their time to learn. 3.16) Establish the kind of training required (eg self-directed learning; train-the trainer). Rationale: Training resources need to be adapted to local environment. Training kit able to be modified. 3.17) Review competencies and identify gaps in understanding and match training to gaps. Rationale: Targeted training will increase relevancy of training. Competencies available in Framework. 3.18) Identify optimal training times. Rationale: Training is more sustainable if able to fit into clinician s schedules. 3.19) Identify when the training can be implemented. Rationale: Planning for training enables staff to manage schedules. 3.20) Budget for the cost of training (eg printing of resources, backfill of staff). Rationale: Realistic costing of training increases sustainability. 3.21) Identify who will coordinate the training. Rationale: Training requires someone to take on the responsibility of coordination. 3.22) Identify who will facilitate the training. Rationale: Facilitators need to be skilled in the training and with the use of resources. Facilitator guide available. 3.23) Identify if the training be held locally. Rationale: Local training provides clinicians with a familiar surrounding and reduces their time spent travelling. 3.24) Identify who is approached to back fill. Rationale: Back filling of staff enables clinicians to direct their attention to the training rather than worrying about work being left to be completed. 3.25) Identify who will assess success of training/competencies and how? (eg education session feedback, ability to successfully screen/refer). Rationale: Feedback regarding progress towards competencies provides motivation and directs learning. 3.26) Determine if the person assessing the training is skilled in assessing clinical competency. Rationale: Skilled provision of feedback requires competency in assessment. 3.27) Determine if there will be a certificate for attendance. Rationale: Can be added to portfolio and recognised as CPD. Template for certificate. 3Supporting the Integrated Cancer Services to implement the Care Policy for Part A:3

5 Care Screening Implementation Guide 3.28) Determine if the training will be sustained / ongoing. Rationale: Changing staff requires ongoing education. Training resources available. 3.29) Detemine if updates will be provided to reinforce training. Rationale: Regular updates provide reminders to clinicians to continue to screen. Training resources available. 3.30) Identify what processes will be in place for future training/assessment of new staff. Rationale: Sustainability requires planning for ongoing training. Stage 4: Implement and evaluate the change 4.1) Publicise the implementation (eg staff newsletters, seminars). Rationale: Remind staff to attend to supportive care screening. Posters available. 4.2) Consult with staff to troubleshoot problems and identify solutions as well as to identify benefits to practice (eg staff interviews, discussion in group/team meetings). Rationale: Implementation requires adaptation to the local area, listening to staff enables adaptations to be made. 4.3) Assess skills in implementing change (eg assessing completed tools, referrals and documentation) and provide constructive feedback as part of the training/learning process. Rationale: Constant review and feedback are part of change management. 4.4) Assess proportion of patients who are being screened. Rationale: VCAP target is to have 50% of all newly diagnosed cancer patients screened for supportive care needs. 4.5) Assess proportion of patients not being screened and identify barriers and solutions to address this. Rationale: Change requires ongoing feedback and review to improve outcomes. Stage 5: Sustain the change 5.1) Include supportive care screening in staff KPIs. Rationale: Highlights the value the organisation puts on supportive care screening. Template professional development tool available. 5.2) Implement a train the trainer program to educate new staff. Rationale: Train the trainer adds to sustainability of training. 5.3) Establish key QA criteria for screening. Rationale: If required to report on screening the health service is more likely to allocate resources to screening. 5.4) Establish a users group/committee to oversee sustainability and establish that key QA are being met. Rationale: Ongoing review of the tool and the implementation processes improves sustainability. 5.5) Establish rewards for departments/clinical streams that exceed QA criteria. Rationale: Motivation to continue with screening encourages sustainability. 4Supporting the Integrated Cancer Services to implement the Care Policy for Part A:4

6 Care Screening Implementation Guide Five Stage Implementation Checklist 1: Assessing current practice/identifying the need for change Identify if screening is being undertaken at your facility? ( Yes / No ) If YES then answer the following: 1.1. for screening? 1.2. Is screening part of routine practice or research projects? ( Yes / No ) 1.3. Who manages and reviews the screening tool(s) process? 1.4. for documentation of the screening tool results? 1.5. Are evidence-based referral pathways established and reviewed for patients with unmet supportive care needs? (Yes / No ) 1.6. Who reviews / evaluates the proportion of new/returning patients screened? 2: Identify and involve key stakeholders 2.1. Identify the main stakeholders / people in the health service who will decide on what tool to use (eg Org Exec, NUMs; Educators, People with cancer) Form a steering committee inviting the key stakeholders to join Gain organisational support for the implementation. Supporting the Integrated Cancer Services to implement the Care Policy for 1

7 Care Screening Implementation Guide Five Stage Implementation Checklist 3: Plan for the implementation 3.1. Identify/apply for any sources of funding to support the process (eg backfill for project workers) Identify champions for the use of the tool from within current staff at the health service Document / list the Care Services currently available to people who attend your area of work (consider both internal and external providers). List health services including non-cancer specialist services (e.g. physio, OT, social work, nutrition, psychology, psychiatry, pastoral care, music therapy, meditation, relaxation etc) Decide on the supportive care needs screening tool to be implemented Identify, and if needed, obtain permission to use the tool identify restrictions on adaptations of the tool Identify which committee needs to approve use of the tool for inclusion in the medical record and allocate a medical record number Determine which practitioners will undertake screening and at which points in the patients treatment pathway Consider compatibility of tool with software for possible data entry or inclusion into the electronic medical record Identify a process for making and documenting referrals made for supportive care Consider how screening data will be fed back to clinicians/used in practice (eg MDT meetings, paper medical record, electronic medical record) Determine process of how tools will be available and who is responsible for their supply Budget for supply/printing of screening tools Consider support needs of staff undertaking supportive care screening (eg will they require extra support or benefit from clinical supervision). Supporting the Integrated Cancer Services to implement the Care Policy for 2

8 Care Screening Implementation Guide Five Stage Implementation Checklist 3: Plan for the implementation Develop a training program and identify resources that may be needed (eg training kit) Establish length of training session (may be a trade off between amount of information and time staff are permitted to leave ward) Establish the kind of training required (eg self-directed learning; train-the trainer) Review competencies and identify gaps in understanding and match training to gaps Identify optimal training times Identify when the training can be implemented Budget for the cost of training (eg printing of resources, backfill of staff) Identify who will coordinate the training Identify who will facilitate the training Identify if the training be held locally Identify who is approached to back fill Identify who will assess success of training/competencies and how (eg education session feedback, ability to successfully screen/refer) Determine if the the person assessing the training is skilled in assessing clinical competency Determine if there will be a certificate for attendance Determine how or if the training will be sustained/ongoing Determine how or if updates will be provided to reinforce training Identify what processes will be in place for future training/assessment of new staff. Supporting the Integrated Cancer Services to implement the Care Policy for 3

9 Care Screening Implementation Guide Five Stage Implementation Checklist 4: Implement and evaluate the change 4.1. Publicise the implementation (eg staff newsletters, seminars) Consult with staff to troubleshoot problems and identify solutions as well as to identify benefits to practice (eg staff interviews, discussion in group/team meetings) Assess skills in implementing change (eg assessing completed tools, referrals and documentation) and provide constructive feedback as part of the training/learning process Assess proportion of patients who are being screened Assess proportion of patients not being screened and identify barriers and solutions to address this. 5: Sustain the change 5.1. Include supportive care screening in staff KPIs Implement a train the trainer program to educate new staff Establish key QA criteria for screening Establish a users group/committee to oversee sustainability and establish that key QA are being met Establish rewards for departments/clinical streams that exceed QA criteria. Supporting the Integrated Cancer Services to implement the Care Policy for 4