scholarly journals Applying the Synergy Model to inform the nursing model of care in an inpatient and an ambulatory care setting: The experience of two urban cancer institutions, Hamilton Health Sciences and Grand River Regional Cancer Centre

2021 ◽  
Vol 31 (2) ◽  
pp. 186-194
Author(s):  
Charissa Cordon ◽  
Jennifer Lounsbury ◽  
Delia Palmer ◽  
Cheryl Shoemaker
Keyword(s):  
Ambulatory Care ◽  
Care Setting ◽  
Surgical Oncology ◽  
Model Of Care ◽  
Ambulatory Care Setting ◽  
Care Needs ◽  
Cancer Society ◽  
Senior Nurse ◽  
Unscheduled Care ◽  
Regional Cancer Centre

The incidence and prevalence of cancer continues to rise throughout Canada. Approximately one in two Canadians are expected to develop cancer at some point in their lives (Canadian Cancer Society, 2021). As the complexity and acuity of individuals with cancer increases, there is increased necessity to define the ideal nurse-to-patient ratio and patient caseload for nurses in specialized oncology settings. Two senior nurse leaders, faced with the need to determine the most appropriate model to inform the nursing model of care within their respective care areas, collaborated and decided to implement the Synergy Model. The Synergy Model is a professional practice model developed by the American Association of Critical Care Nurses (AACN). In the Synergy Model, nursing care reflects the integration of nurses’ knowledge, skills, attitudes, competencies, and experience to meet the needs of patients and families (Curley, 2007). This model provides a framework for matching nursing resources based on patient care needs and has been adapted in various care settings. The model, however, has not been applied in a surgical oncology inpatient unit or in an oncology ambulatory care setting. Using a quality improvement methodology, the Synergy Model was piloted in these new areas and found to be effective. The Synergy Model can be utilized to determine the need for additional nursing resources with specialized oncology nurses and appropriate skill mix of intraprofessional nursing teams. It can also be used to assess adult oncology patients who present to the ambulatory systemic care suite for unscheduled care related to symptomatic concerns.

scholarly journals Developing Future Clinical Pharmacy Leaders in the Interprofessional Care of Children with Special Health Care Needs and Medical Complexity (CSHCN-CMC) in a Pediatric Pulmonary Center

Children ◽  
2019 ◽  
Vol 6 (12) ◽  
pp. 135
Author(s):  
Catherine B. Hobart ◽  
Cori L. Daines ◽  
Hanna Phan
Keyword(s):  
Health Care ◽  
Ambulatory Care ◽  
Care Setting ◽  
Medication Use ◽  
Special Health Care Needs ◽  
Health Care Needs ◽  
Ambulatory Care Setting ◽  
Care Needs ◽  
Special Health Care ◽  
Special Health

The health care needs of children with special health care needs and medical complexity (CSHCN-CMC) are multifaceted and often require the expertise of various disciplines. The medication-related needs of this population can be further complicated with off-label medication use, polypharmacy, and vulnerability to medication errors. Although clinical pharmacists are increasingly becoming a common part of inpatient, pediatric interprofessional patient care teams, their presence remains lacking in the outpatient or ambulatory care realm. Pediatric clinical pharmacists in the ambulatory care setting have the potential to help optimize medication use and safety through collaborative efforts as part of the interprofessional team. Since the late 1960s, Pediatric Pulmonary Centers (PPCs) provide training programs designed to develop interprofessional leaders who will improve the health status of CSHCN-CMC, specifically those with chronic respiratory and sleep-related conditions. The addition of pharmacists not only provides a more comprehensive care model for CSHCN-CMC, it creates an avenue to encourage the career paths of pediatric pharmacists in the ambulatory care setting. Here, we describe the addition of clinical pharmacy as part of an interprofessional patient care team and the development and implementation of a maternal child health (MCH) pharmacy discipline training model designed to mentor future pharmacist leaders in the care of CSHCN-CMC.

PDA-Based Documentation of Medication Interventions in an Ambulatory Care Setting

2007 ◽  
Vol 23 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Kathy E Fit ◽  
Jill S Burkiewicz ◽  
Brooke L Sweeney
Keyword(s):  
Ambulatory Care ◽  
Care Setting ◽  
Ambulatory Care Setting

Outpatient Parenteral Antimicrobial Treatment (OPAT)

2019 ◽  
Author(s):  
Mark Melzer
Keyword(s):  
Ambulatory Care ◽  
Lower Limb ◽  
Care Setting ◽  
Joint Infection ◽  
Multidrug Resistant ◽  
Antimicrobial Treatment ◽  
Ambulatory Care Setting ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Receive Treatment ◽  
The Uk

Outpatient parenteral antimicrobial therapy (OPAT) is the provision of intravenous (IV) antibiotics to patients in the community or an ambulatory care setting. It was first used to treat children with cystic fibrosis in the 1970s but did not become part of adult services in the UK until the 1990s. OPAT facilitates hospital admission avoidance and decreased lengths of inpatient stay. It is associated with high levels of patient satisfaction. Recent clinical guidelines on the provision of OPAT services in the UK and US have recently been published Skin and soft tissue infections (SSTIs), in particular lower limb cellulitis, are the commonest medical conditions referred to OPAT services. Patients are typically treated for three to five days with IV antibiotics but patients with lymphoedema or underlying skin conditions typically require longer courses. Increasingly, multidrug-resistant urinary tract infections (UTIs) may be treated in the community with IV antibiotics, although oral options such as fosfomycin are now available. Patients with bone and joint infection invariably require prolonged parenteral antibiotic courses, whether this be vertebral osteomyelitis or native or prosthetic joint infection. Other less common examples, where careful patient selection is required, include infected diabetic foot ulcers (with or without osteomyelitis), infective endocarditis, empyema, liver, and tubo-ovarian and brain abscesses. Patients are recruited on the basis of clinical syndromes (e.g. lower limb cellulitis) or laboratory referral (e.g. multidrug-resistant UTIs). Active recruitment (e.g. attendance at acute assessment unit board rounds or orthopaedic multidisciplinary teams, MDTs) compared to passive recruitment (waiting for clinical referrals) increases the yield of patients. The suitability of a patient to receive treatment out of hospital or in an ambulatory care setting needs careful assessment and is dependent upon age, comorbidities, and severity of infection. OPAT also requires patients to engage actively and reliably with therapy. Therefore, IV drug users and patients with serious mental health problems are generally not suitable. Commonly used antibiotics are those given once daily as these reduce nursing time, although some nursing teams can administer IV antibiotics up to three times per day. It is imperative to take a drug allergy history and seek an alternative class of antibiotics when a patient complains of severe penicillin allergy.

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