Expanding paediatric oncology care into the home: Building nursing competence and confidence to facilitate the administration of subcutaneous cytarabine at home.

Abstract

Objectives: A review of services provided by the "Monash Children's at Home " community nursing program indicated that many patients would benefit by expanding the nursing scope of practice to include the administration of subcutaneous cytarabine during treatment for acute lymphoblastic leukaemia (ALL). The general paediatric nurses indicated they lacked the confidence and competence to deliver this chemotherapy in the home. This project aimed to expand paediatric home-based outreach services to include the delivery of low complexity chemotherapy for paediatric ALL patients. Method(s): Staff attended the current foundations day offered for oncology nurses, as well as a 'fit for purpose' trainingmodule developed specifically to support this scope of practice This included training in chemotherapy safe handling, clinical trials and cell biology, and focused on the agent to be delivered. Nursing procedures for home administration of cytarabine were developed. Nurses were rostered to the oncology outpatient department for competency assessment. Result(s): Fourteen paediatric community nurses have completed the competency program, providing a sustainable level of care. Nineteen children have so far been able to have their cytarabine delivered in the home. This has resulted in 133 hospital bed days saved, reduced 85 day oncology admissions and negated 48 inpatient weekend ward admissions. Travel distance saved across all families is estimated at 1,752 km. Conclusion(s): This project illustrates the potential wide ranging benefits of implementing small, localised service improvement projects to families, staff and health services. By increasing the scope of practice and confidence of staff, the project has improved the care pathway for children and their families, with less hospital visits and more time at home. For the health services, it has freed up bed days and allowed the service to expand its level of care in the community. A fit for purpose model of training also encourages participation from services outside the oncology department.