Nurses, Staff Members Adapt to Provide Uninterrupted Treatment to All Patients

Nurse Supervisor Emily Hernandez, BSN, RN, helps a patient in the infusion clinic where treatment continued during the pandemic.

Mays Cancer Center Annual Report

Jeremy Viles, DNP, MBA, RN, chief nursing officer for the Mays Cancer Center, sums up 2020 for those who provide lifesaving cancer treatment.

“Cancer doesn’t take any days off so we couldn’t either. Like everyone else, we had our share of challenges during the COVID-19 pandemic, but we did not miss one day of providing care to our patients,” he said.

During this difficult year, the biggest constant for Mays Cancer Center nurses and care team members was change. “In the early months of 2020, we were planning for a normal year. Then, the pandemic started coming, and we started planning for those ‘what-if’ scenarios.

“And then abruptly the entire world changed. We had to assess our status multiple times daily to determine current precautions, workflow logistics, and the types of needed personal protective equipment for optimal safety. The uncertainty was the most difficult piece,” he added.

Dr. Viles said the positive part of this experience was the responsiveness of the staff. “They all reacted so well to the quick transitions. In a little over a week, we all worked together to create and implement a plan. We had to see what work could be done from home. This meant that one third of the work force wasn’t here because we had to reduce the number of people coming to the center.”

For those patients who did not have to come in for appointments, Cristina Mora, director of practice operations, and her patient access team members worked with each patient who needed assistance to be able to video or teleconference with health care providers. Virtual and phone appointments made up 30 percent of total visits. Mora and her team helped patients to be able to do virtual appointments on their smart phones if they did not have other means.

For those who had to come for treatment, there were a lot of complex changes that came along operationally. “Roles of personnel had to be changed. For example, our transportation drivers had to change their duties. Previously, we had a van full of people being picked up for their care. We had to change how we did this. We had to make sure that we minimized exposure to our patients and our staff,” he explained.

Dr. Viles said because his team works with cancer patients who are an immunocompromised population at even greater risk than the general public to COVID-19, the center asked team members, who may have been in the same role for many years, to change to new duties. “We needed them to screen the patients who are coming into our buildings. We educated them so they could monitor patients for COVID-19 symptoms. They had to deal with the push back at first from patients who didn’t want to wear masks. These team members had to learn how to deal with all of that while being on the front line and wearing PPE. They did such a tremendous job during this entire time,” he said.

In addition, care team members started sharing suggestions on how to get patients safely into the building. One idea they had was to implement a virtual waiting room with patients waiting in their cars for radiation oncology. “We communicated with them via text message on their cell phones. Patients did not enter the building until it was time for their appointment, and then they were escorted in. This was developed because our staff saw the need.”

If patients were positive for COVID-19 but their physicians believed they needed to continue their infusion or radiation therapy, these patients were seen at the end of the day when there were fewer patients present. The staff wore full PPE while caring for them and extensively disinfected treatment rooms before and after each patient, he said.

Another challenge for the staff is that patients battling cancer often have neutropenic fever as a complication of cancer and treatment. Many of the symptoms of neutropenic fever are similar to those of COVID-19.

“We had to create a process to diagnosis each patient. During this time, the fourth floor Hematology Clinic had been renovated, but we hadn’t moved into it yet. We decided to close the Zeller building elevators to only patients who were coming for treatment who were being ruled out for neutropenic fever. These patients were escorted to the fourth floor by a nurse or medical assistant who was wearing full PPE. Then in a safe area with no other patients around, we could do testing for COVID and draw labs.

“By only using the one elevator, we could have patients come in and be moved immediately to that isolation area. As time went on, we learned we didn’t need to be that aggressive. We were able to modify the process and moved the screening area to the second floor near the Zeller elevator. This is an example of how the entire process continued to evolve,” Dr. Viles said.

Another key piece was promoting social distancing throughout the building since patients cannot sit within six feet of each other, and everyone in the building must wear a mask at all times. “We ensured that all staff had a medical-grade masks for staff, and we provided them to patients if they did not have an appropriate mask,” he said.

Because the entire team worked so well together, the Mays Cancer Center remained open the entire time. During the pandemic, the clinics experienced a 4 percent increase in the number of new patients and an 8 percent increase for total patient visits compared to the previous year. The center had “zero employee-to-employee, patient-to-employee, or patient-to-patient transmissions of COVID-19 during this period,” Dr. Viles added.