Development of the Autonomous Nurse Practitioner Role in an Outpatient Malignant Hematology Unit a Twenty-Year Odyssey

Abstract ASH 2022

Development of the autonomous Nurse Practitioner role in an Outpatient Malignant Hematology Unit: A Twenty-Year Odyssey

Murray, C., Rowland, S.

The Princess Margaret Cancer Centre in Toronto, Ontario is the largest cancer treatment facility in Canada. In 2020, Princess Margaret Cancer Centre received 222,825 clinic visits and treated 82,571 patients. During the year, it received 17,433 new patients, of which 72% required treatment for malignant cancers. These numbers continue to grow.

As bed capacity concerns and physician shortages began to create delays in patient care and treatment during the late 1990s a nurse practitioner (NP) was hired to manage the care of leukemia patients in an outpatient setting. The administration of consolidation chemotherapy and follow up monitoring of patients was relocated from the inpatient areas to an ambulatory setting. This initiative proved to be safe and feasible and 'outpatient consolidation' became the standard of care for patients with acute leukemia.

During the next 23 years, the Malignant Hematology Day Unit (MHDU) has evolved and now provides care for patients with multiple myeloma, lymphoma, myelodysplastic syndromes and early post transplant allogeneic transplant patients. There are currently 7 NPs working Monday through Friday, and 1 on Saturdays with a total of 15 NPs rotating through the unit. The unit is also staffed with 12 specialized oncology registered nurses, working with the NPs to provide complete patient centered care for 45-60 patients per day. This care includes but is not limited to ordering and administration of chemotherapy, immunotherapy and blood products. The team also manages treatment and transfusion related reactions, febrile neutropenia, infections, pain and end-of-life care.

The MHDU is truly 'nurse led'. The Ontario Provincial Legislation allows NPs to independently provide prescriptions to patients (including opioids and other controlled drugs), order and review diagnostic procedures and refer patients to other services such as Respirology or Infectious Diseases. This model of care that has evolved, remains collaborative with physician colleagues ensuring comprehensive patient care.

Studies have shown, the use of advanced practitioners, such as NPs, in oncology, is cost effective while continuing the delivery of safe, high quality, patient care. Additionally, with the rapidly evolving treatment options and complexities of these diseases, the utilization of the NPs to monitor and support patients, allows the hematologist time to focus on treatment decisions.

This presentation will describe the processes developed to allow for the safe transition of management of a complex patient population to a nurse-led outpatient setting. It will also examine and highlight the positive outcomes of establishing a specialized unit dedicated to the care and management of patients with malignant hematological diseases. These outcomes include, but are not limited to, fewer patients requiring assessment and care in the Emergency Department, less hospital admissions for infections and other complications and improved, seamless end-of-life care

No relevant conflicts of interest to declare.