JL527. Rural Infusion Centers Gaining Access to Expert Oncology and Infusion Support Through the Use of Telemedicine
Susan Halbritter, ANP-BC, AOCN®, Sanford Hematology and Oncology, Sioux Falls, South Dakota, Rachel Olson, MPA, Sanford Vermillion Medical Center, Vermillion, South Dakota, Jenna Kaiser, RN, BSN, OCN®, Sanford Hematology and Oncology, Sioux Falls, South Dakota, Janice McGuire, RN, MSN, Sanford Vermillion Medical Center, Vermillion, South Dakota, and Peggy Ann Dufek, RN, ADN, Douglas County Memorial Hospital, Armour, South Dakota
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JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017
The posters for the abstracts below can be found at:
Background: Telemedicine has been described in the literature as an effective way to provide real-time expert medical care for patients residing in rural communities. The oncology literature is bereft in models that describe the use of telemedicine services to provide expert oncology support for rural infusion centers administering oncology therapies. Although many rural facilities have infusion centers that administer chemotherapy, those facilities do not have direct oversight by an oncologist or oncology-trained advanced practice professional (APP). Due to the high risk associated with chemotherapy agents and the potential for infusion reactions, oncologists have a limited list of agents that they will allow to be administered off-site. Thus, patients are often forced to travel to the tertiary care setting to receive their treatment. The purpose of this project was to determine if certified nurse practitioners (CNP) based in a tertiary care infusion center can provide oversight to two rural infusion centers through the use of telemedicine technology and the electronic medical record (EMR).
Design: This project, funded through an HRSA FORHP grant, was a descriptive, observational trial, set at a tertiary care center and at two rural infusion centers, located in the Upper Midwest. A dedicated oncology CNP within the tertiary care infusion center provides direct oversight to patient care; RNs provide rural infusion services. The intent of the virtual infusion project was to extend the CNP oversight into two rural infusion centers, using real-time support through the EMR and telemedicine capabilities.
Results: Over the course of a year, patient care was successfully transitioned from the tertiary infusion center to a site closer to home. The oversight of the CNP increased the comfort level of the prescribing oncologists. Complex treatments, previously only administered in the tertiary setting were safely transitioned into the rural setting. Patient and provider satisfaction surveys were overwhelmingly positive. Due to the success of the program, the project is in the process of adding an additional site.
Conclusions: The virtual infusion project demonstrated that an oncology CNP can provide safe and effective support to nurses in rural infusion centers through telemedicine technology. Telemedicine technology, the EMR, nursing education, shared policies, procedures and workflows allow for a seamless care-delivery model between the tertiary care setting and two rural infusion centers.
Implications: Rural communities provide oncology infusions, but have limited access to oncology providers. Real-time support through an oncology APP allows patients to receive complex treatments safely closer to home.
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