Karina L. Black, Mark Belletrutti, Marcel Romanick, Jennifer Shepherd, Mary Anne Venner, Shirley Perry!

! The Pediatric Oncology/Hematology program at the Stollery Childrens Hospital is internationally afliated with the Children Oncology Group (COG). Childrens cancer and hematology disorders are rare and hence it is essential to collaborate in research and treatment plans (Pizzo & Poplak, 2001). As a COG institution, medical care is guided by COG protocols. In an effort to effectively and efciently address the clinical concerns, which arise during treatment and research, a multidisciplinary Clinical Concerns Committee (CCC) was formed. The multidisciplinary approach mirror COGs protocol teams. The purpose of this committee is to promote consistent and evidenced based (Titler, 2010) care of children and families under our care.! ! In the early 1990s an unofcial group consisting of a physician and 2-3 inpatient nurses began to meet to deal with inpatient concerns. A Preprint Committee then became the format to specically create protocol based preprint orders. At that time there was no other formal venue to address clinical issues. Problem solving methods tended to be reactionary. This method is often enticing because it offers immediate answers but tends to be short-lived (Sam et al, 2004). In 2009 our director decided to form a multidisciplinary team (Clof, 2010) inclusive of both the Oncology and Hematology programs, consisting of a physician, nurses, pharmacist and ad hoc members as needed. Each member was specically chosen as expert clinicians, passionate about innovation, committed to improving quality of care, and having a positive working relationship with other health professionals. Members circulate information, orientate staff, and encourage peers to adopt the new endeavors, all members are Champions of Change(Titler, 2010). !

! The main objectives of the Clinical Concerns Committee are:! ! To have a multidisciplinary committee of experts to provide a venue for submission of clinical questions.! ! To continue to receive clinical concerns. ! ! To address clinical questions in an effective and efcient manner.! ! To remain active in promoting consistent and evidence based care solutions to clinical concerns.! ! To develop increased expertise in knowledge translation. ! ! To encourage interrelationships with all staff within the Hematology/Oncology program that will promote a culture of learning, an appreciation of inquiry and a quest for solutions to sustain quality in our clinical practice and working environment. !

The CCC has been successful in the promotion of consistent care within our program. More than 54 concerns have been addressed since the committee formed. Concerns have come from a wide variety of Hematology/Oncology team members. Many patient care improvement strategies have been implemented.! ! Issues are dealt with efciently and effectively for the most part, because of the expert multidisciplinary and consistent membership. All CCC members are respected by their colleagues, are passionate and able to provide leadership.! ! Challenges:! ! Some concerns take longer than desired to resolve. The main reasons include the complexity of certain issues, institutional restrictions as well as the CCC members not having protected time to work on projects within a busy Hematology/ Oncology program.! ! Difculty in dissemination of information remains a challenge. ! ! Future Goals:! ! Continue as a vibrant, ever improving committee, meeting the needs of patients and families and promoting evidence based care. ! ! Improve methods of dissemination of information such as an easily accessible website. ! ! Form a research group as an off shoot of the committee, as we address evidence based solutions. !

The CCC has met once a month since 2009 and submissions have come from all disciplines in the program and have ranged from basic to complex care issues. On retrospective review of our minutes encompassing the rst 2 years of committee work, the CCC has received 54 submissions/concerns. Distribution of the types of submissions is shown in Figure 1. The committee discussed each concern and a lead person was assigned to address the concern based on their area of expertise or knowledge. Collaboration with outside medical, nursing and allied health professionals occurred on an individual basis depending on the specics of the concern.! Figure 1. Distribution of concerns received by he OOC
20! 15!

10! 5! 0! Simple! Moderate! Complex! Ongoing! Recurrent! Referred out!

! The CCC was established in June 2009 with a core membership including a Hematologist/Oncologist, pharmacist, clinical nurse educator, and advanced practice nurses (inpatient, outpatient oncology, and hematology), with ad hoc members attending when needed (e.g. Clinical Research Associates, Psychosocial / Child Life Specialists, other sub-specialty experts and physicians). Clinical concerns are submitted in writing, though verbal requests are accepted. The concerns received are categorized based the nature of the concern and the length of time needed for the concern to be resolved (Table 1). ! ! Meetings occur monthly, with additional meetings occurring if urgent concerns are submitted. The committee is responsible for disseminating information and practice changes back to the program. Outcomes and decisions are circulated by email, paper memos, at verbal education sessions, on an education bulletin board and kept in the CCC binder, available on the patient care unit. All minutes are stored on a shared hard drive assessable to all program members. Our website is public and can be retrieved at http://cccstollery.weebly.com. Secretarial support for recording of minutes and sharing of results is provided.! Table 1. Classification of Submitted Concerns Type of Submission / Concern Simple! Moderate! Complex! On Going! Recurrent! Referred Out! Description/Length of time to resolve Easily resolved in one meeting ! Takes one to three meetings and collaboration and specialize opinion! Difcult to resolve, might involve hospital policies! Concerns that need to be regularly addressed! Concerns that come up again or need to be revisited due to change! Issue not appropriate for the CCC and referred on to other committees or staff!

! Pizzo, P & Poplak, D (2001) Principles and Practice of Pediatric Oncology. Philadelphia, Lippincott Williams & Wilkins (Fourth edition). ! ! Titler, M (2010) Translation Science and Context. Research and Theory for Nursing Practice: An International Journal. 24 (1): 35-55.! ! Sams, L, Penn, BK, & Facteau, L (2004). The Challenge of Using Evidence Based Practice. Journal of Nursing Administration.34 (9): 407-414.! ! Clioff, J, Wilkes, L, Cummings, J, Warne, B, & Harrison, K (2010). Multidisciplinary teams caring for clients with chronic conditions: experiences of community nurses and allied health professionals. Contemporary Nurse. 36 (1-2): 61-70.! ! Perry, S (2011) http:///cccstollery.weebly.com! ! Black, K (2011) Figure 1.! ! ! ! !

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Dr Paul Grundy (program director at the time) for his insight and leadership in forming the Committee ! Dr Beverly Wilson (present program director) for her continued support, keen eye in choosing committee members and her desire to give us protected time ! Stollery Childrens Hospital! Ms. Cheryl Boulet, secretarial support