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Group Chemotherapy Pre Assessment

Group Chemotherapy Pre Assessment Claire Marsh RN, ANP BSc (Hons) & Belinda Mills RN, BSc (Hons), NMP I/P – Chemotherapy Nurse Practitioners.

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Group Chemotherapy Pre Assessment

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  1. Group Chemotherapy Pre Assessment Claire Marsh RN, ANP BSc (Hons) & Belinda Mills RN, BSc (Hons), NMP I/P – Chemotherapy Nurse Practitioners BACKGROUND – Historically patients at Salisbury NHS Foundation Trust were seen prior to chemotherapy on an individual basis lasting 90 mins by a Chemotherapy Nurse Practitioner (CNP). This session was utilised to carry out Holistic Assessment (HA), information giving on their specific chemotherapy regimen, consent process, VTE & MRSA assessments, Ht & Wt, & psychological assessment. A local review of cancer service provision & a 0.8 WTE secondment opportunity for the CNP, meant that Pre Assessment needed to be delivered in an alternative way. Using a PDSA cycle an action plan was identified to ensure the service was maintained. Pre admission assessment of patients can be defined as the hospital attendance, on an out patient basis prior to an elective procedure e.g. chemotherapy. It is not about doing extra to or for the patient. It is about doing the same only earlier (Fellows et al 1998) HOLISTIC ASSESMENT – NICE (2004) Improving Supportive & Palliative Care For Patients With Cancer – Key Recommendation 2 – Assessment & discussion of patients needs for physical, psychological, social, spiritual & financial support should be undertaken at key points, such as diagnosis, commencement of treatment, during & end of treatment. Manual for Cancer Services: Chemotherapy Measures (2011) The National Chemotherapy Advisory Group have set a requirement that patients about to undergo a course of chemotherapy should be able to have a separate consultation with a health professional prior to starting their treatment & receive the associated patient information. Changes to the delivery of Pre Assessment included a group session for all patients to deliver generic information on chemotherapy side effects & an individual 30min session with the CNP. Patients received an invitation letter explaining the Pre Assessment process to them. More emphasis was put on patient involvement with completion of the Holistic Assessment, VTE assessment & MRSA swabs being carried out by the patient at home. Evaluation & Results – An experience questionnaire was used to evaluate the changes to the Chemotherapy Pre Assessment. After an initial pilot of the questionnaire it was approved by the local Patient & Public Partnership Group. Overall the responses to the changes are very positive. As the Group session was a new way of delivering the information, the feedback from patients was very important. As the individual patients time with the CNP had been dramatically reduced, it was essential to ascertain the patients perspective on this element of the whole process. The CNP 30 minute 1:1 session also ensured that 35% of patients had access to financial support via the MacMillan Benefits Officers. 43% were referred onto the Psychological Support Team & 30% of patients were referred onto other agencies e.g. Dietician, Diabetic Nurse support, Hair clinic. The experience element of the questionnaire explored how patients were feeling through out the whole Pre Assessment process. The results show that on arrival patients were feeling very nervous but this had reduced significantly when they left the appointment. During the CNP 30 minute 1:1 sessions patients felt safe, supported & comfortable. “Reassured especially with start date” “Bit overwhelmed by amount of data to observe but happy to put faith in Claire & her expertise” “I’m fully confident I’m in good hands” “Not sure the service/delivery could be improved” • References: • Fellows, H., Lucas, B.,Burgess, L., Abbott, D., Clare, A., Barton, K., (1998) Orthopaedic Pre Admission Assessment Clinics: Part 1. Journal of Orthopaedic Nursing, 2, 209-218. • National Cancer Peer Review Programme, Manual for Cancer Services: Chemotherapy Measures, Version 1.0 (2011) • National Institute for Clinical Excellence, (2004) Guidance On Cancer Services: Improving Supportive & Palliative Care For Adults With Cancer, The Manual. London: National Institute for Clinical Excellence. • Conclusion – • Changes to the delivery of the Pre Assessment has not impacted on the overall outcome. It has quantified the need for this essential service, to allow patients time to understand & process the information provided. • The delivery of this service has been maintained & improved during the secondment period. • Salisbury NHS Foundation Trust are achieving the NICE & NCAG recommendation for Oncology Patients. Chemotherapy Peer Review measure 11-3S-112. • Patients are feeling the benefit of this service & their feedback confirms they feel safe, supported & comfortable during this process. For further information please contact Claire Marsh or Belinda Mills. claire.marsh@salisbury.nhs.uk or belinda.mills@salisbury.nhs.uk

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