6.5.2 Satellite Partners’ Role in Provincial Pediatric Oncology Satellite Program
Satellite programs and the hospitals within which they are located will commit to meeting specified requirements, as summarized below.
The pediatric oncology satellite program and hospital sign an agreement with POGO, to declare affiliation with the provincial organization to carry out its role as specified in this document.
By virtue of entering into the Provincial Pediatric Oncology Program partnership, it will be understood that:
- The operation of the program cannot be altered without prior discussion and approval – i.e. because of budgetary or other constraints.
- The appropriate staff will be designated to carry out the program (see Satellite Clinic Staffing Requirements below) and authorized to participate in education events (initial and ongoing) to ensure state-of-the-art delivery of care.
- The confidentiality of all information on children/families referred for pediatric oncology treatment will be maintained by the hospital and staff through appropriate arrangements for storage and access.
- The community hospital staff/administration will oversee and ensure the local approval and accommodation of all aspects of the introduction and maintenance of the program, which will facilitate the integration of all aspects of pediatric oncology satellite activity (Section 2.0 Scope of Satellite Program), including: appropriate facilities (see Facility Recommendation/ Specification below); any special policies that may be required; acceptance of required documentation formats; agreements between organizations – i.e. for timely delivery of specialized products (Section 2.0 Scope of Satellite Program); etc.
- Designated community hospital staff/administration will support all information transfer requirements which occur chiefly via the initial data transfer documents including physician referral notes and the Shuttle Sheet.
- The appropriate satellite 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 (Satellite Program Annual Accounting Report).
- 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 MOHLTC, for the necessary financial support of the provincial program.
- Annual funding will flow to satellite sites from POGO as specified in Section 6.4.2 Financial Support for Pediatric Oncology Community Activity.
Satellite Clinic Staffing Requirements
Standard Satellite Practice Setting: Essential, Designated Staff
Each centre 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 indentified backup physician with an articulated interest in pediatric oncology who will also have the opportunity for educational exposure on an ongoing basis. These two individuals are primarily responsible for oversight of chemotherapy delivery. They will be required to meet the ethical and regulatory requirements for the participation in clinical trials ( hyperlink).For after hours and emergencies, other members of the pediatric practice will be involved, and will 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.
Pediatric Nurses for Ambulatory Clinic
The clinic must have an experienced satellite nurse coordinator with specific training in pediatric oncology who has 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 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
c. Pharmacy: It is recommended that the designated pharmacist:
- Is accountable to, and the primary liaison with, the tertiary hospital pharmacy;
- Is accountable for the correct handling of pharmaceuticals from receipt to distribution, etc;
- Is able to understand and execute study group defined requirements (i.e. recording, identifying batch numbers, checking calculations, ensuring the drugs are stored properly, etc);
- Is trained/has experience in pediatrics and/or oncology;
d. 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
- 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 satellite centres.
- 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 tertiary professional is recommended.
Satellite Hospital Staffing Commitment
Pediatric Oncology Satellite staff designated as part of the satellite program is asked to make the following commitment:
- Continuing involvement in the pediatric oncology satellite program.
- Provision of specialized care to shared care patients, in compliance with all aspects of the protocols of the parent institution/cancer study group.
- Delivery of clinical care according to the specifications and guidelines provided in this document (hyperlink).
- Commitment to maintain the program availability as specified in Section 2.3 -i.e. 24-hour basis.
- 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).
- Maintenance of a complete and accurate record of services delivered.
- Supply of all data required in accordance with commitments made by the tertiary centres to collaborative children’s study groups (clinical trials participation), and to convey, within 24 hours, to the tertiary-based case coordinator, all information regarding each satellite contact with the patient/family.
- Willingness to participate in program evaluation (see Participation in Program Evaluation/Submission of an Expanded Data below).
- Participation in education events, as specified by POGO, based on cross-centre consultation with experts in all essential disciplines.
- Provision of protected time for nurse coordinator to allow for program specific documentation and reporting e.g. routine utilization and data reporting requirements of POGO and the MOHLTC as detailed in Clinical Communications, Data Transfer and Technological Support section below.
The following are the recommended requirements for pediatric oncology satellite programs:
- Designated pediatric oncology clinic space.
- Designated pediatric, in-patient ward with connections to pediatric oncology ambulatory satellite staff.
- Provision for secure data storage and secure data communication.
Clinical Communications, Data Transfer, and Technological Support
The exchange of clinical information by both parties should occur by fax or electronically. Facsimile machines should be located in a secure area that ensures confidentiality and accessibility to care givers 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.
The following types of data are required for all jointly managed cases:
- Clinical information collected at each point of contact.
- 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.
- Other information related to POGO’s program evaluation of the satellite program.
- Information requirements arise 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 satellite program and included in electronic communication methods.
Participation in Program Evaluation/Submission of an Expanded Data Set
The scope and specific requirements of the evaluation of this program will be communicated to all partners upon completion of the research design. Full participation in this evaluation will be essential.