POGO

icon-facebook

Satellite Manual

8.0 Appendix 1: Communication Tools

8.1 Pediatric Oncology Shared Care Initial Data Transfer Sheet

Communication between satellite and tertiary centres is a crucial element for safe and comprehensive care.  The Initial Data Transfer Sheet is a tool that lays the foundation for a new satellite referral and to open the lines of communication.  

Click here to print a copy of the Initial Data Transfer Sheet.

Primary author Mr. Kaniska Young-Tai, The Hospital for Sick Children, Toronto.

8.2 Shuttle Sheet
Back to Top

In this Section

  • 1.1 History & Overview
  • 1.2 Acknowledgements
  • 1.3 Committees and Working Groups
  • 1.4 Satellite Manual Disclaimer
  • 2.1 Principles of Satellite Care
  • 2.2 Eligible Patients
    • 2.2.1 Children Eligible for Chemotherapy Administration in a Satellite Centre
    • 2.2.2 Children Not Eligible for Chemotherapy Administration in a Satellite Centre
    • 2.2.3 Children Eligible for the Management of Complications on a Satellite Centre
    • 2.2.4 Eligibility of Children Requiring Supportive Care
  • 2.3 Scope of Satellite Practice
    • 2.3.1 Implementation of Psychosocial Treatment Plan (Process for Communication)
    • 2.3.2 Limitations on Satellite Practice
  • 2.4 Advanced Satellite Practice
  • 3.1 Safe Handling, Administration and Disposal of Chemotherapy Agents
  • 3.2 Accidental Exposure/Spills
  • 3.3 Extravasation Management
    • 3.3.1 Sample Extravasation Documenting Tool
  • 3.4 Injecting SC Medication Via an Insuflon
  • 3.5 Chemotherapy Administration Reference List
  • 3.6 Central Venous Catheter Care
  • 3.7 Chemotherapy Quick Reference
    • 3.7.1 Rapid Hydration Document
    • 3.7.2 Provider Guide: Prevention and Management or Irinotecan induced Diarrhea
    • 3.7.3 Parent Handout: Prevention and Management of Irinotean induced diarrhea
    • 3.7.4 Capizzi Methotrexate
    • 3.7.5 Erwinia L-Asparaginase
  • 4.1 Management of Fever and Neutropenia
    • 4.1.1 Routine Order Sample Sheet
    • 4.1.2 Fever Cards (Sample)
    • 4.1.3 Criteria for low-risk designation. Risk categorization refers to risk of bacteremia and serious complications, including mortality.
  • 4.2 Pentamidine Administration
    • 4.2.1 Inhaled Pentamidine
    • 4.2.2 Intravenous Pentamidine
  • 4.3 Antiemetics
  • 4.4 Treatment of Varicella-Zoster Infections
  • 4.5 TPN Document
  • 4.6 Immunization of Children with Cancer
  • 4.7 Transfusion
  • 4.8 When to consult the Tertiary Centre
  • 5.1 Palliative Care Overview
  • 5.2 Communication
  • 5.3 Settings of Care
  • 5.4 Symptom Management
  • 5.5 End of Life
  • 5.6 When a Child Dies in the Satellite Centre
    • 5.6.1 Reconciling your grief
    • 5.6.2 Funeral arrangement checklist
    • 5.6.3 Helping Children who grieve
    • 5.6.4 Coping with the Holidays
    • 5.6.5 The grieve experience
  • 6.1 Goals and Objectives
  • 6.2 Participant Site Selection
    • 6.2.1 Tertiary Site Selection
    • 6.2.2 Community Site Selection
  • 6.3 POGO’s Roles
    • 6.3.1 PHIPA, Privacy and Research
  • 6.4 Funding
    • 6.4.1 Funding Support for Tertiary Activity
    • 6.4.2 Financial Support for Pediatric Oncology Community Activity
  • 6.5 Infrastructure and Formal Requirements
    • 6.5.1 Tertiary Partners’ Role in Provincial Pediatric Oncology Satellite Program
    • 6.5.2 Satellite Partners’ Role in Provincial Pediatric Oncology Satellite Program
  • 7.1 Preamble
  • 7.2 Investigator responsibilities
  • 7.3 Training Requirements
    • 7.3.1 General Training for Conduct of Research
    • 7.3.2 Protocol Specific Training
  • 7.4 Research Activites that may be completed in satellite centres under supervision of DSI
  • 7.5 Research Activities to be completed in Tertiary Centres Only
  • 7.6 Recognition and Reporting of Adverse Events (AEs)
  • 7.7 Data Transfer
  • 7.8 Pharmacy Drug Accountibility
  • 7.9 Site Inspections and Quality Assurance
  • 8.1 Pediatric Oncology Shared Care Initial Data Transfer Sheet
  • 8.2 Shuttle Sheet
  • 8.3 Psychosocial Communication Tool
  • 9.1 Satellite Readiness/ Preparedness Checklist
  • 9.2 Education Report for Tertiary Centres
  • 9.3 Education Report for Satellite Centres
  • 9.4 Vital Signs Report
  • 9.5 Self- Assessment
  • 9.6 Satellite Contact Form
  • 9.7 Annual Satellite Caseload Report
  • 9.8 POGO Provincial Satellite Program Annual Accounting Report
Back to table of contents
Search our Manual
Have a question?
Contact us at: satellite@pogo.ca
  • About Us
    • Childhood Cancer Care Plan
    • Our Mission and Vision
    • Our Board & Committees
    • Our Partners
    • Our Donors
    • Privacy
    • History & Milestones
    • Reports
    • Newsroom
    • Job Opportunities
    • Accessibility
    • Staff List
  • Programs & Support
    • Patient Care Programs
    • Financial Assistance
    • Survivor Care
    • Cancer Resources
    • Childhood Cancer Resource Guide
    • Inspiring Stories
  • Education
    • POGO Satellite Education Day
    • Synoptic Reporting
    • Symposium on Childhood Cancer
    • POGO AfterCare Education Day
    • All Education Events & Conferences
  • Healthcare Practice
    • Satellite Manual
    • Practice Guidelines
  • Research & Data
    • POGO Surveillance Report
    • POGO Research Unit
    • POGONIS – Childhood Cancer Database
    • Data Reports
    • Data Requests
  • Get Involved
    • Pajamas and Pancakes
    • Birthday Parties for POGO
    • Events
    • Volunteer
  • Ways to Give
    • Donate
    • Gifts of Stock and Securities
    • Become a Corporate Partner
    • Gifts in Honour/Memory
    • Shop Online/Earn Cash Back

©2018 Pediatric Oncology Group of Ontario

480 University Avenue, Suite 1014 | Toronto, Ontario, M5G 1V2, Canada | Charitable Registration Number: 871067245RR0001
1-855-FOR POGO (367-7646) | Website Privacy Policy | Website Disclaimer | Satellite Manual Disclaimer