Stanton Chemotherapy Update (February 12, 2018) - Chemotherapy services have been suspended at Stanton Territorial Hospital since December 2017 due
to a proactive review identifying areas for program improvement. Initially services were estimated to resume in February, 2018. While progress has been made on making program improvements challenges have presented that will not allow us to meet the February timeline, some of the issues we are experiencing include:

• Coordination of schedules with CancerControl Alberta and availability of resources to allow for on-the-ground training of NWT nurses and doctors in Edmonton. This training is intensive and normally takes many months, we are working to complete this training as quickly as possible.
• Nursing schedules and responsibilities. The nurses requiring training have additional responsibilities outside of delivering chemotherapy services which require scheduling adjustments and backfill to ensure care and services continue while training is upgraded.
• Potential need for new equipment which needs to be ordered, received, commissioned, and then staff would require training to operate it.

When will services resume?

We will continue to provide information to impacted patients as we progress towards phasing in a resumption of services. Unfortunately this process is affected by external factors and at this time it is not possible to provide an accurate timeline for this work to be complete. What does this mean for patients who need chemotherapy treatment?

• Patients who are currently receiving, or have upcoming, chemotherapy treatments have been notified of the extended suspension of services.
• Patients will continue to work with their regular doctor/care team to coordinate treatment.
• Medical Travel will assist in coordinating travel for patients that need to go for treatment; most patients will be treated in Edmonton.
• The NTHSSA will continue to provide updates to patients receiving cancer treatment in the Northwest Territories as we make the improvements required to resume chemotherapy services. 

BACKGROUND

What Happened?
At the request of Stanton Territorial Hospital, Cancer Control Alberta has been engaged to review cancer care and chemotherapy services at Stanton Territorial Hospital.

• Recommendations for improvements to the chemotherapy program were raised as part of a program review. These improvements will help Stanton align with best practices.
• Specific areas for immediate improvement that were identified were policy and procedures, and ensuring appropriate training for staff regarding roles and responsibilities.
• This led to a decision in late December, 2017, to temporarily suspend chemotherapy services at Stanton, and to transfer all chemotherapy patients to Alberta’s Cross Cancer Institute.
• Cross Cancer Institute regularly provides care to NWT residents who require cancer care that cannot be provided in the NWT.
• In order to continue to provide care for patients receiving chemotherapy, we continue to work with Cross Cancer Institute to ensure a smooth transition for these patients.
• This review will lead to program improvements such as additional training and practice guidelines for staff delivering the chemotherapy program.

What started the review?

• The NTHSSA has been working collaboratively with the Department of Health and Social Services on the implementation of Charting our Course: NWT Cancer Strategy. As part of goal 3 of the strategy “Improving patient transitions between each stage of the cancer journey”, a review of the cancer services provided by Stanton Territorial Hospital was undertaken, as Stanton is an important part of the step in the cancer care journey for many NWT clients.
• Cancer Control Alberta is our key partner in the delivery of cancer services to NWT clients, particularly in the area of oncology and chemotherapy services.
• An onsite visit to Stanton was carried out by a team from CancerControl Alberta at the end of November, 2017.
• It is important to note that the team from Cancer Control Alberta did not suggest suspension of chemotherapy services at Stanton; however the leadership of NTHSSA felt that this was a necessary measure to ensure that patients have access to the highest quality care and services. 

What issues were identified that required the shift in program delivery?

Through the review a number of issues were examined which included:

• Process mapping of current referral and treatment process,
• Review of access and currency of current policy and procedures,
• A site safety audit,
• Review of documentation standards,
• Review of current patient education materials, including access to drug specific information,
• Review of current quality assurance program and approach,
• Review of current staff roles, responsibilities, and practice supports,
• Review of current communication patterns with CCI and potential for formalizing this,
• Discussion of potential new supports required in the NWT,
• Site presentations on approaches to model of care work and OPREP- Oncology staff education program.

Specific areas for improvement that were identified in the preliminary findings were policy and procedures, and ensuring appropriate training for staff regarding roles and responsibilities.

How were patients impacted? Has anyone been harmed?

We are not aware of any harm caused by the chemotherapy program as it was operating before suspension. Cancer care is constantly evolving and an examination of our practices has now led to these improvements which will bring Stanton’s chemotherapy services in line with the latest best practice.

How will patients be informed?
Informing patients is a high priority. Impacted patients will continue to be informed directly in advance of any public notices about program changes.

Who can people contact if they have questions or are concerned about their care?
Cancer patients or their families who are currently receiving services at Stanton can direct questions about their plan of care to the Stanton Cancer Coordinator at 867-669-4310. Anyone with questions or concerns about their care in the past can contact our Quality, Safety and Client Experience staff at 867-669-4101.