working across cancer networks steve williamson principal pharmacist cancer services northumbria...
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Working Across Cancer Networks
Steve Williamson
Principal Pharmacist Cancer Services Northumbria Health Care Trust
&Lead Pharmacist - Northern Cancer Network
A Pharmacists experience of working with the CSC and a
Cancer Network
Development of a Network Pharmacist role
Bringing togeather colleagues across the Network
-examples of what we can acheive
Multi-professional working
Chemotherapy Protocol Handbook
Chemotherapy service review and capacity
(Only a Tiny mention of Clinical Governance - phew!)
‘Up North’
Northern Cancer Network
Wide geographical area with a population of over 2 million.
Northumbria Healthcare Trust
Most northerly NHS Hospital Trust Geographically one of
the largest
Northern Cancer Network NCN
One of the first Cancer Networks Linked with CSC from first wave NCN covers 3 SHA’s, 12 PCT’s and 7 Hospital Trusts
City Hospitals Sunderland NHS Trust Gateshead Health NHS Trust Newcastle upon Tyne Hospitals NHS Trust North Cumbria Acute NHS Trust North Durham Acute NHS Trust Northumbria Healthcare NHS Trust South Tyneside Healthcare NHS Trust
Cancer Centre in Newcastle Cancer Units in Ashington, Carlisle, Durham,
Gateshead, Hexham, North & South Sheilds, Sunderland, Whitehaven
Northern Cancer Network NCN
Organised into various groups under direction of a
Strategy Board and Clinical Advisory Group Includes;
– Patient Panel, NCRN, Commissioners, Nursing, Tumour
Specific Groups, information, Non-Surgical Oncology,
Support Professions, Pharmacy, Systemic Therapies
(D&T).
Full time Lead Clinician /Network Manager
Well established full time support staff
Regular project/ secondment posts.
Development of a Network Pharmacist role
April 1999 Pharmacist involved forming in Network Clinical
Support Profession Group
July 2000 CSC arranged pharmacy meeting
NCN Pharmacists invited to CSC Blackpool conference
Dec 2001 CSC commissions chemotherapy project for NCN
Jan 2001 Project Pharmacist forms network pharmacy group
against initial reluctance from pharmacy managers
Network Pharmacist Role Providing accurate High Cost/ NICE Drug expenditure
reports for network commissioners & budgetary forecasting
Project work, looking at chemotherapy staffing and facilities in conjunction with seconded chemotherapy nurse
Promoting multi-professional working with CSP group
Part of Network’s D&T - Systemic Therapies Group
Maintaining Network Chemotherapy Handbook
General point of contact for network pharmaceutical issues
However - so far non permanent as funding only available for intermittent secondments (spend equivalent of two sessions a month on Role - supported by own Trust)
NCN Cancer Pharmacist Group
Representatives from all Trusts in NCN area Quarterly meetings Initially no clinical oncology pharmacy posts in NCN area Group facilitated gradual re-engineering/ expansion of
roles from pure aseptics (supply) roles to include clinical duties.
Expanded to include palliative care pharmacists
Groups Mission Statement ‘To ensure the safe, effective and economic delivery of chemotherapy and clinical pharmacy services to cancer
patients and meet the demands of the National Cancer Plan and Manual of Cancer Service Standards.’
NCN Cancer Pharmacist Group
AIMS
To raise the profile of pharmacy services in cancer care
To ensure there is sufficient pharmacy manpower and facilities within the NCN to provide services to cancer patients.
To promote the specialist role of pharmacists and pharmacy technicians in the delivery of cancer services.
To ensure cancer patients receive best pharmaceutical care.
To promote the best value use of cancer medicines.
Ccommunication and peer support.
To enable and co-ordinate the sharing of good practice
Promote continued professional development, training and educational opportunities in cancer services for pharmacy staff.
NCN Cancer Pharmacist Group
Achievements (so far)
Developed Chemotherapy Capacity Planning Tool
Developed standardised network pre-printed
prescriptions
Facilitated development of clinical pharmacist roles
Ensured funding made available to support
pharmacy staffing from NCRN initiatives
Programme of evening educational meetings.
Looking at contracting for high cost medicines.
NCN Chemotherapy Documents
Cancer Unit Chemotherapy Handbook
Prepared following Cancer Unit Chemotherapy Review
Approved and Launched April 2002
Published on the NCN Website (nww.cancernorth.nhs.uk)
Reviewed and updated Annually
Interim updates/ new regimens posted on NCN website
Why did we need a handbook? Manual of Cancer Services Standards-Standard 6/8 ‘..list
of acceptable chemotherapy regimens for the network’
Northern Region Haematologists Handbook need an
equivalent resource for solid tumours
MCSS Standard 6/14 ‘..written guidelines/protocols for prevention and treatment of complications’
Clinical Governance & Risk Management
Prevent unorthodox and unpredictably varying practice which is against the opinion of peers in the network
Benefits of the Chemotherapy Handbook
Time saving process - detailed regimen information
available to staff in each cancer unit
Standardisation of regimens across the network
Patient benefit - information readily available on
site
To support and facilitate consistent good practice
Use as a learning resource for chemotherapy staff
Limitations of the Chemotherapy Handbook
Not a recipe book for the use of chemotherapy
Not a proscriptive list
Not ‘policed’ by pharmacy and nursing staff
Does not include Cancer Centre only regimens
Does not include clinical trial regimens
Guidelines compliment, not replace local practice
Handbook Contents
Cancer unit/ cancer centre chemotherapy contact details Approved solid tumour chemotherapy regimens for
• Breast • Gastrointestinal• Gynaecological• Lung• Superficial Bladder
Network Guidance on Use of Anti-emetics Neutropenia Guidelines Extravasation Guidelines Appendices
Chemotherapy Capacity Project
Visited each NCN Cancer Unit & Cancer Centre
Visited day unit/ ward and pharmacy
Collaborative ‘style’ approach to assessment to
avoid audit overkill - (time of peer review visits)
Refernce standards• Manual of Cancer Service Standards
• JCCO ‘ Cancer Units’ Dec 2000
• RCN chemotherapy guidelines
• Aseptic Dispensing Standards
Project Methodology
Pilot Visits
Questionnaire
Informal discussion with Nursing and
Pharmacy Staff
Inspected facilities - ward and pharmacy
Written report prepared for each unit
Cancer Unit Visit Reports Profile of unit
Opening Hours Weekly work pattern Staffing
Facilities
Management Structure
Policies and ProceduresAdministration Line CareNeutropenia ExtravasationAnti-emetic Anaphylaxis
Emergency Admissions
Chemotherapy regimens used
Factors Affecting Capacity
Pattern of Work
Booking System
Writing of Scripts
Blood Monitoring
Receipt of Chemotherapy
Patient Numbers
Other Activities
Patient Review
Pharmacy Capacity Assessment
Current workload
Daily pattern of work
Timing of prescriptions
Preparation in
advance
Number of Isolators/
Clean Rooms
Staff Commitments
Pharmacy Chemotherapy Capacity
NCN pharmacy group developed formulae to allow accurate comparison of capacity in all NCN hospitals;
Items x (19P+21T+11A) + ( 52T x No of sessions) + (Adjusted items x 5T)
Where P=Pharmacist time;T=Technician time; A=ATO time (mins)
Formula based on bench markeing time taken to prepare each different chemotherapy type to give standard adjusted doses,
e.g.
5-FU syringes are simple to prepare, 1 item = 1 adjusted item, Paclitaxel
takes longer to prepare, 1 item = 5 adjusted items.
Formula must be adjusted to account for non-productive activity.