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NOMINATED BY HEATHER MILLER BSN, RN-BC, CPON, CPN
The pediatric hematology oncology team has done a tremendous job exemplifying teamwork. Both inpatient and outpatient teams have merged seamlessly to enhance the patient experience and patient flow. Nurses from both of these areas are specialized and incorporate patient- and family-centered care values.
The pediatric hematology oncology inpatient unit was separated from our general pediatric unit 2 years ago and has proved to be a site of clinical excellence. In addition, we received a new pediatric cancer center this year through 100 percent of donated funds.
 Education & Certification
All RNs working in this area are trained through the Association of Pediatric Hematology Oncology Nurses' (APHON) Chemotherapy and Biotherapy Provider Course. Newer nurses are placed with more seasoned nurses and begin to give chemotherapy gradually, relying on the knowledge base of their mentors and educational foundations.
The nurse manager of the unit is an APHON chemotherapy and biotherapy instructor who offers the course biannually. In the past year, the team has taken it a level higher by including PICU staff in the courses.
In addition, four of our staff members hold national certification in either pediatric oncology or pediatrics. National certification is encouraged throughout the department; many outside educational offerings are given on a regular basis.
Eighty-two percent of the staff holds a BSN or higher, and 30 percent of the staff is currently enrolled in BSN and MSN programs.
For our new graduates, we have created an educational binder that they complete during their orientation to help enhance their overall knowledge and understanding of patients under their care.
Shared Governance
Stared 2 years ago and now run solely by staff members, a shared governance council is a collaborative effort of our nursing staff, child life, pediatric palliative care, physicians and other members of the healthcare team.
Council members created patient-flow sheets denoting the size of Mediport needles and whether patients need pre-medications for transfusions; reviewing customer service scores; and helping implement scripting and action plans to exceed national targets.
In addition, they have developed monthly gatherings for both the day and night shifts. Each month, the council showcases commendations from fellow staff members, patients and families.
Quality Improvement
One of the biggest accomplishments has been the implementation of "power ports" for all of our oncology patients. We identified a certain product could actually enhance the patients' quality of life and avoid the number of extra sticks they must endure when a PIV is needed for many tests.
We also have gathered data on neutropenic patients and first dose of antibiotic therapy from both the outpatient cancer center and the emergency department. After educating ED staff, we have been able to virtually eliminate the delay in antibiotics for this population.
Two staff members created a handoff communication tool for those patients who are receiving chemotherapy, helping us to eliminate discrepancies in administration errors.
In addition, signs were created to help remind all caregivers to wash their hands before entering a patient's room. Patients and families are also empowered to let caregivers know when this does not occur. We are at 98 percent compliance for hand hygiene.
Patient-/Family-Centered Care
During bedside rounds, the team elicits the feedback of the patient and family. We also developed a tool - distributed on admission and daily - that reminds parents they can document their child's care or call a rapid response if they feel there is a change in the child's condition.
Additionally, a multidisciplinary team does daily bedside rounds and encourages patients and families to participate. We also have nearly eliminated IV infiltrates because two RNs always check sites together. Doing bedside report also helps prevent "never events" like falls, failure to rescue and communication errors.
Positive Outcomes
Initiative has been one of our top priorities as we continue to enhance the pediatric hematology oncology and palliative-care programs. Additionally, because of our commitment to excellence, the community donated $1.2 million toward construction of a new pediatric cancer center.
The APHON chemotherapy and biotherapy program at the hospital has helped enhance clinical expertise and professional growth for all nurses on the unit.
Staff willingness to further their education also impacted patient care because we can provide a higher level of expertise to patients and families, as well as prepare for our Magnet journey.
Staff nurses' ability to create a shared governance council has led to improved staff morale, decrease in call-outs, higher employee satisfaction, improved customer service scores and practice enhancements on the unit.
The nurse's ability to be part of the quality indicator data collection has also led to new practices that affect them directly at the staff level. Successful implementation of patient- and family-centered care helped spark a movement within our healthcare facility that can be the model or "gold standard" of care. This team continually strives to exceed our targets and provide the most memorable patient experience for our patients.
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