regional chemotherapy network ncepod self assessment march 2009

Regional Chemotherapy Network NCEPOD Self Assessment

March 2009

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Presentation will

Set Context: Regional Chemotherapy Service Review

Present the findings of a NICaN initiated NCEPOD self assessment

Consider implications

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

NCEPOD

Self assessment initiated by NICaN Chemotherapy Group

Sent to Medical Directors and Lead Cancer Teams for completion

Responses collated

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Results Positive Findings Areas needing

further action

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Consent 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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

MDT and decision to treat 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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Supplementary Prescribers 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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Initiation and Verification Only registrars

and consultants initiate chemotherapy

Pharmacists verify and sign chemo prescriptions

Pharmacists do not sign/verify chemo prescriptions for off site clinics

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Toxicity assessment 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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Dose reduction 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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Acute Oncology Guidelines on

neutropenic sepsis exist

Areas for development

Care pathways Updated policy Robust system to

ensure staff appropriately trained

A/E integrated service

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Specialist Oncology Advice 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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Arrangements for admissions 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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Specialist Palliative Care 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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Clinical Audit 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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Deaths within 30 days Some deaths

discussed at various forum

No formal mechanism to ensure all deaths within 30 days discussed at morbidity/mortality or governance meeting

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Tumour response / treatment intent

Tumour response is recorded

Treatment intent not always recorded

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Summary Recognition of coordinated work to

date Safe regional chemotherapy service Systems, processes, guidance in

place Commitment to collaborative

working

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

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

Working Towards the Continuous Improvement in the Quality of Cancer Care and Cancer Survival

Implications

Governance and Risk Management Requires coordinated approach all

levels Engagement from trust executive

teams, NICaN Board, DHSSPS Requires Clinical Haematology

Oncology Information System