Episode 11: How Cancer Practices Are Adapting to COVID-19

Wendy Vogel, MSN, FNP, AOCNP

Robert Hall, MSN

Sandra Kurtin, PhD, ANP-C, AOCN®

The COVID-19 outbreak has necessitated cancer centers to rapidly develop screening protocols and explore telemedicine strategies to prevent infections. Advanced practitioners have been on the front lines of patient care and education, and we talk with two of them to see what their processes are and what other health-care providers can learn from their experiences.

Show Notes

What are the preparations you’ve been involved in?

• Created two teams to preserve provider capacity
• Working with Head of Infectious Diseases
• Actively screening all persons entering building
• Work pool created with NPs and MDs for offsite participation in screening
• Identified PPE stocks, using masks in initial screening

What is your screening procedure?

• Algorithms updated every morning
• Have to have different colored stickers to enter the building every day
• If screen failure, we direct them to a separate triage and treatment area
• Testing in cars unless patients need to come in for life-saving treatment
• We have assigned a COVID-19 provider of the day at the institution and one in home-based team
• Daily meeting to count swabs for patient testing, and priority testing of providers

If a patient needs to enter the building, what do you do?

• Escort them to a designated area, with full droplet protection
• Aggressive debulking of clinic, calling and rescheduling patients. If patients are not on active treatment, don’t have treatment-related toxicities, and don’t require frequent supportive care, we set up telephone visits with own billing code.

What are you instructing patients who aren’t sure whether they should come in or not?

• Triage them into secure area of building
• Having serious conversations about being mindful of danger of going into the hospital, but also of staying out
• Created criteria for admission
• For regimens considered inpatient, figuring out how to do in clinic by modifying regimen
• People getting admitted are getting treatment for curative intent and are on regimens requires inpatient admission

Where are your sources for education?

• Virtual huddles through skype
• Home-based huddling with in-based team
• Meeting with screening staff to tell them what’s new in screening and testing process
• Constant communication
• Dispelling myths - managers round regularly
• Central command set up in clinic - only this group will communicate, email sent every morning with update on who infield provider is, who home-based provider is, so staff know who to contact
• Chair of medicine, APP manager, Infectous disease, medical team, nurse managers, central supply

What is your biggest tip to give to APs facing preparation?

• Take it seriously
• Get your center or clinic to take it seriously
• If you don’t have anything in place now, start now
• There are models, algorithms, criteria for admission available
• Share information
• Assume everyone is infected and practice accordingly
• Sensible use of PPE