Purpose: To improve access to care for patients with cancer by identifying and implementing a process for nononcology nurses to provide regional care to remote cancer patients.
Background: The Cleveland VA Medical Center (CVAMC) provides yearly care to more than 105,000 veterans and diagnoses and treats nearly 800 new cancer patients each year. The CVAMC has 13 community-based outpatient clinics (CBOCs) covering 24 counties with only 3 located within 40 miles of the CVAMC. The average distance to this facility from all CBOCs is 66 miles.
Methods: A multidisciplinary group of 8 leaders gathered in 2014 to identify services that might be offered at regional CBOCs following the training of the nurses in accessing implanted ports, safely administering leuprolide, and disconnecting a chemotherapy ambulatory infusion pump. (During this time, a pilot was in progress of a disposable elastomeric ambulatory pump to replace the chemo bag/mechanical pump system.)
Data Analysis: In 2013, nurses identified a need for improved patient access when a small study was done (n = 71) looking at the distance traveled to have an implanted port flushed. It showed that 48% had traveled > 20 miles. In 2014, better defined by the Access to Care initiative, an expanded review was done, and 4 interspersed CBOCs were identified that might improve access to care for veterans living > 40 miles from the CVAMC.
Results: In 2014, nurses from 6 CBOCs were educated on the safe mixing, administering, and disposal of leuprolide. On June 1, 2015, mechanical ambulatory pumps were replaced by disposable elastomeric pumps. On June 10, 4 volunteers from each of the 4 CBOCs began clinical training on accessing implanted ports, doing central-line lab draws, flushing/ heparinizing implanted ports, disconnecting the elastomeric pump, and appropriate disposal. The completed training is projected for August 21, 2015, with full implementation of regional care to begin August 28, 2015.
Conclusions: A small nursing initiative, fueled by a national goal, can generate multidisciplinary interest and insights in effectively implementing an evidence-based process that offers cancer patients regional care. The full impact will be disclosed at the AVAHO annual meeting.
