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Regional Chemotherapy Network NCEPOD Self Assessment March 2009

Regional Chemotherapy Network NCEPOD Self Assessment March 2009. Presentation will. Set Context: Regional Chemotherapy Service Review Present the findings of a NICaN initiated NCEPOD self assessment Consider implications. Context. NICaN Regional Chemotherapy Workshop

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Regional Chemotherapy Network NCEPOD Self Assessment March 2009

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  1. Regional Chemotherapy Network NCEPOD Self Assessment March 2009

  2. Presentation will • Set Context: Regional Chemotherapy Service Review • Present the findings of a NICaN initiated NCEPOD self assessment • Consider implications

  3. Context • NICaN Regional Chemotherapy Workshop • identified the need for a regional review of chemotherapy services • Policy Direction • DHSSPS Cancer Control Programme • DHSSPS Cancer Service Framework Standards • Current Service • Capacity & Demand • Single handed practice

  4. Regional review • Endorsed by NICaN Board • Appointment of Chemotherapy Service Development Manager Jan 09 • Two Strands of work • Baseline current chemotherapy services • Service Developments • Baseline assessment • Using NCEPOD and NCAG as a framework

  5. NCEPOD • Self assessment initiated by NICaN Chemotherapy Group • Sent to Medical Directors and Lead Cancer Teams for completion • Responses collated

  6. Positive Findings Areas needing further action Results

  7. Consent taken by appropriate level medical staff (consultant or reg) The consent form is generic to all pts and procedures, not just chemotherapy In one area Haematologist did not use consent form - ACTIONED Consent

  8. Good discussions at first MDM and commencement of treatment No MDM for palliative chemo Discussed initially but not discussed if recurrence Performance Status not known therefore not recorded at MDTs MDT and decision to treat

  9. No one unauthorised is prescribing chemotherapy Few independent and supplementary prescribers Those that have their skills are not being utilised Bigger issues here is competency level & assessment of junior doctor prescribers Supplementary Prescribers

  10. Only registrars and consultants initiate chemotherapy Pharmacists verify and sign chemo prescriptions Pharmacists do not sign/verify chemo prescriptions for off site clinics Initiation and Verification

  11. All patients are assessed for toxicity A standardised toxicity grading tool and form not used SpR is beginning work on a proforma, this really awaits a new electronic system Toxicity assessment

  12. Consultants appear to follow good clinical practice and dose reduce as required Clinical Management Guidelines not available in all tumour groups to ensure consistent practice CMGs are a Cancer Service Framework Standard - being addressed Dose reduction

  13. Guidelines on neutropenic sepsis exist Areas for development Care pathways Updated policy Robust system to ensure staff appropriately trained A/E integrated service Acute Oncology

  14. 24 hour helpline (nurse led) available at cancer centre can be used to access specialist oncology advice (currently unfunded) Notes not always available and COIS not up to date At cancer units reliant on haematology on call service Specialist Oncology Advice

  15. Processes in place at centre and units for admission of chemo patients with complications Admitted to treating unit Room for improvement in robustness of systems / processes Arrangements for admissions

  16. Palliative Care Staff are core members of MDM Service available for all patients with malignant disease No consistent approach to ensuring advanced decisions discussed and recorded Specialist Palliative Care

  17. Protected time for clinical audit Every consultant has SPAs for this sort of activity Some Neutropenic Sepsis audits have been undertaken At one unit it is part of job plan but doesn’t meet SPA commitment Neutropenic sepsis audits patchy and non systematic Clinical Audit

  18. Some deaths discussed at various forum No formal mechanism to ensure all deaths within 30 days discussed at morbidity/mortality or governance meeting Deaths within 30 days

  19. Tumour response is recorded Treatment intent not always recorded Tumour response / treatmentintent

  20. Summary • Recognition of coordinated work to date • Safe regional chemotherapy service • Systems, processes, guidance in place • Commitment to collaborative working

  21. Key areas for action • Development of acute oncology arrangements • Integrated teams for admission & treatment • Neutropenic sepsis • Guidelines for management • Pathways • Staff Education • Out of hours advice • Regional audit • Prescriber competencies • Morbidity and Mortality meetings • CMGs

  22. Implications • Governance and Risk Management • Requires coordinated approach all levels • Engagement from trust executive teams, NICaN Board, DHSSPS • Requires Clinical Haematology Oncology Information System

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