regional chemotherapy network ncepod self assessment march 2009
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
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