6.5.2 POGO Satellite Clinic Partners’ Role in the POGO Satellite Program

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POGO Satellite Clinics and the community hospitals within which they are located will commit to meeting specific requirements, as summarized below.

Agreements

The POGO Satellite Clinic community hospital signs an agreement with POGO to declare its affiliation with the provincial partnership and carry out its role, as specified in the POGO Satellite Manual.

By virtue of entering into the POGO Provincial Pediatric Oncology Satellite Program partnership, it will be understood that:

1. The operation of the POGO Satellite Clinic cannot be altered without prior discussion and approval – i.e., because of budgetary or other constraints.
2. The appropriate staff will be designated to carry out the program (see POGO Satellite Clinic Staffing Requirements below) and authorized to participate in education events (initial and ongoing) to ensure delivery of state-of-the-art care.
3. The confidentiality of all information on children/families referred for pediatric oncology treatment will be maintained by the community hospital and POGO Satellite Clinic staff through appropriate arrangements for storage and access.
4. The community hospital staff/administration will oversee and ensure the local approval and accommodation of all aspects of the introduction and maintenance of the POGO Satellite Program, which will facilitate the integration of all aspects of pediatric oncology satellite activity (see Section 2.0 Scope of POGO Satellite Program), including: Appropriate facilities (see Facility Recommendations/Specifications below); any special policies that may be required; acceptance of required documentation formats; agreements between organizations – i.e., for timely delivery of specialized products (see Section 2.0 Scope of POGO Satellite Program); etc.
5. Designated community hospital staff/administration will support all information transfer requirements which occur chiefly via the initial referral data transfer documents, including physician referral notes.
6. The appropriate POGO Satellite Clinic community hospital administrator will provide an accounting of both the funds flowed from POGO and of the patient population served and nature of services delivered. This must be done in a timely fashion, in accordance with guidelines provided.
7. Specialized childhood cancer program tertiary hospitals will not underwrite the direct costs of the care of pediatric oncology patients but will continue to advocate where appropriate, through POGO, with the Ministry of Health (MOH) for the necessary financial support of the POGO Satellite Program.
8. Annual funding will flow to POGO Satellite Clinic community hospitals from POGO as specified in Sub-Section 6.4.2 Funding Support for Community Hospital Activity.

POGO Satellite Clinic Staffing Requirements

Standard Satellite Practice Setting: Essential, Designated Staff

Pediatricians

Each POGO Satellite Clinic requires a designated lead physician whose primary responsibility is implementation of practice and oversight of chemotherapy delivery. This individual is required to have ongoing education exposure and familiarity with pediatric oncology issues. There must also be an identified backup physician/Nurse Practitioner (NP) with an articulated interest in pediatric oncology who will also have the opportunity for educational exposure on an ongoing basis. An NP is a registered nurse with advanced university education who can assess, diagnose, treat, prescribe and monitor patients. NPs working at POGO Satellite Clinics should have completed the Association of Pediatric Hematology/Oncology Nurses (APHON) Pediatric Chemotherapy and Biotherapy Provider Program as well as obtained the Certified Pediatric Hematology Oncology Nurse (CPHON) designation.

These two individuals are primarily responsible for oversight of chemotherapy delivery. They will be required to meet the ethical and regulatory requirements for participation in clinical trials (see Section 7.0 Research). For after-hours and emergency care, other members of the community hospital pediatric practice will be involved and will therefore need to be familiar with the management of after-hours issues, particularly fever and neutropenia. The lead physician must accept responsibility to ensure the ongoing familiarity of all pediatricians with these protocols.

Nursing

Pediatric Nurses for Ambulatory Clinic

The POGO Satellite Clinic must have an experienced satellite nurse coordinator with specific training in pediatric oncology and APHON and CPHON certification. This individual will also have ongoing educational exposure and familiarity with pediatric oncology issues. In addition, this individual is primarily responsible for oversight of the delivery of nursing care in the satellite context. Optimally, there will be 1 or more backup nurses with an articulated interest in pediatric oncology who would also have the opportunity for education exposure on an ongoing basis.

Pediatric Inpatient Unit

In addition, a sufficient number of inpatient nurses with familiarity with pediatric oncology and the opportunity for ongoing education opportunities are required. These nurses are required to have sufficient expertise in basic procedures, including accessing central venous catheter (CVC) lines and ports, and to maintain sufficient knowledge of pediatric oncology issues to provide supportive care (i.e., management of fever and neutropenia) after hours. Ideally, a proportion of the inpatient nursing staff will have APHON or CPHON certification.

Pharmacy

It is recommended that the designated pharmacist is:

• Accountable to, and the primary liaison with, the specialized childhood cancer program tertiary hospital pharmacy;
• Accountable for the correct handling of pharmaceuticals from receipt to distribution, etc.;
• Able to understand and execute study group-defined requirements (i.e., recording, identifying batch numbers, checking calculations, ensuring the drugs are stored properly, etc.);
• Trained/has experience in pediatrics and/or oncology.

Laboratory and Blood Bank

It is recommended that the designated laboratory (including blood bank) staff will participate in the requisite education and provision of care.

Additional Staff to be Considered

1. Social Workers, Dietitians and Child Life Specialists are deemed both essential and efficient uses of staffing resources. In the pediatric oncology context, these professionals provide unique and often preventative interventions for children with cancer and their families. Their work serves to complement and contain the physician staffing requirements. A dietician with appropriate training in pediatric parenteral nutrition should be available in the POGO Satellite Clinics.
2. Psychologist/Psychiatrist: Psychologist/psychiatric assessment and/or intervention may be sought locally, in the event of a crisis or for ongoing management of identified issues. Where this is related to an oncology issue, consultation with the specialized childhood cancer program psychologist/psychiatrist counterpart is recommended.

POGO Satellite Clinic Staffing Commitment

POGO Satellite Clinic staff, designated as part of the POGO Satellite Program, are asked to make the following commitments:

1. Continuing involvement in the POGO Satellite Program.
2. Provision of specialized care to shared care patients, in compliance with all aspects of the protocols of the parent institution/cancer study group.
3. Delivery of clinical care according to the specifications and guidance documents provided in the POGO Satellite Manual.
4. Commitment to maintain the program availability as specified in Sub-Section 2.3 Scope of Satellite Practice – i.e., 24-hour basis.
5. Education of emergency room staff if appropriate (including, perhaps, distribution of a pamphlet summarizing a standardized set of instructions for handling visits by shared care patients).
6. Maintenance of a complete and accurate record of services delivered.
7. Supply of all data required in accordance with commitments made by the specialized childhood cancer program tertiary hospitals to collaborative children’s study groups (clinical trials participation) and to convey, within 24 hours, to the specialized childhood cancer program case coordinator all information regarding each POGO Satellite Clinic contact with the patient/family.
8. Willingness to participate in program evaluation (see Participation in Program Evaluation/Submission of an Expanded Data Set below).
9. Participation in education events, as specified by POGO, based on cross-centre consultation with experts in all essential disciplines.
10. Provision of protected time for the satellite nurse coordinator to allow for program-specific documentation and reporting (e.g., routine utilization and data reporting requirements of POGO and the MOH, as detailed in the Clinical Communications, Data Transfer and Technological Support section below).

Facility Recommendations/Specifications

The following are the recommended requirements for POGO Satellite Clinics:

1. Designated pediatric oncology clinic space.
2. Designated pediatric inpatient ward with connections to POGO Satellite Clinic ambulatory staff.
3. Provision for secure data storage and secure data communication.

Clinical Communications, Data Transfer and Technological Support

The exchange of clinical information by both specialized childhood cancer program and POGO Satellite Clinic partners should occur by fax or electronically. Facsimile machines should be located in a secure area that ensures confidentiality and accessibility by caregivers at all times; 24-hour access to records is important in light of the stringent requirements for prompt service delivery. Electronic transmission of clinical information will be designed to meet all appropriate security related to sharing of Personal Health Information (PHI).

The following types of data are required for all jointly managed cases:

1. Clinical information collected at each point of contact.
2. Service delivery tracking, such as: The number of children seen, number and kind of services provided to individual cases, the disease status of the child.
3. Other information related to POGO’s evaluation of the POGO Satellite Program.
4. Information requirements arising from the child’s entry into clinical trial(s) and/or the surveillance of childhood cancer services to be carried out by POGO. Data requirements and submission deadlines will be clearly specified for the staff of the POGO Satellite Clinic and transmitted via electronic communication methods.

Participation in Program Evaluation/Submission of an Expanded Data Set

The scope and specific requirements of any evaluation of the POGO Provincial Pediatric Oncology Satellite Program will be communicated to all partners upon completion of the research design. Full participation in this evaluation will be essential.

Disclaimer: Source Accuracy

You are welcome to download and save a local copy of this document in the Word and/or PDF formats provided. As the POGO Satellite Manual is subject to ongoing revisions and updates by POGO, we recommend you regularly check the online version posted at https://www.pogo.ca/satellite-manual/ to ensure you have the most up-to-date content. In the event of any inconsistency between the content of a local copy and the online version of the POGO Satellite Manual, the content of the online version shall be considered correct. Please see also the POGO Satellite Manual Disclaimer.

Record of Updates

Version Number	Date of Effect	Summary of Revisions
1	7/27/2021	Original version posted.