Cancer treatment is often invasive and can be associated with side effects, as well as benefits. Finalists demonstrated an ability to improve the safety of cancer services.
Safe seamless nursing care for cancer patients at home – a hospital/community initiative
National Cancer Control Programme, Health Service Executive (HSE)
Patients traditionally receive all systemic cancer therapy in hospital. The aim was to deliver safe, shared nursing care, between hospital and community health services, for patients undergoing systemic cancer therapy.
National and regional project management structures were set up to train community nurses, equipping them with the knowledge and skills to provide care safely and competently, at home, for patients undergoing systemic cancer therapy. Training was theoretical and skills based, and delivered over six months.
Safety features of the programme included:
• Examination of the community nurses’ knowledge and skills
• Development of a Community Oncology Resource Book to assist nurses in clinically assessing patients
• Development of a referral form
• Commitment from the medical oncologist that the patients remain his/her responsibility irrespective of where nursing care is provided
• Arrangement with the treating cancer unit to receive urgent phone calls and/or admissions from the community nurses.
Evaluation determined the programme’s impact on patients, community nursing services and hospital oncology activity.
During the survey period:
• There were no emergency admissions by patients in the programme
• No urgent phone calls to the hospital for assistance
• Activity in the oncology day ward for selected nursing interventions shows a downward trend; these are now conducted in the community
• Some hospital capacity is freed-up.
Patients expressed satisfaction with and confidence in the programme, and many avoided arduous journeys to the cancer treating unit for oncology nursing interventions, like CVAD management.
Thanks to the programme, community nurses expanded their scope of practice and became partners with the treating cancer unit in caring for these patients.
The UKONS Oncology/Haematology 24 Hour triage – rapid assessment and access tool kit
Greater Midlands Cancer Network
Central West and Wales UKONS members have developed, designed and piloted the UKONS Oncology/Haematology 24 Hour triage, rapid assessment and access tool kit.
The tool provides a robust framework for triage assessment, action and audit, and as a result leads to improved quality and safety in patient care by:
• Ensuring patients receive a robust, reliable assessment every time they contact a helpline for advice
• Ensuring assessments are of a consistently high quality through the use of an evidence-based assessment tool
• Advising on action and advice that is appropriate to the patients’ ‘level of risk’
• Ensuring patients who require urgent assessment in an acute area are identified and that action is taken
• Identifing and reassuring those who are at lower risk and may safely be managed by the Primary Care team or a planned clinical review and avoid unnecessary attendance
• Providing a framework for triage training and competency assessment for practitioners.
Feedback assured us that with regular use the whole assessment process improves in terms of quality, structure and time taken. The development process has been methodical, professional and democratic and is an excellent example of teamwork. The aims and objectives of the project were clearly agreed, and with the completion of the pilot and evaluation, have been achieved.
It is a risk assessment tool that, if used correctly, standardises and supports excellent practice, improving quality and safety and providing evidence of service provision.
Acute oncology service: implementation of a nurse-led, integrated service – Pan Birmingham Cancer Network and Sandwell and West Birmingham Hospitals NHS Trust
Pan Birmingham Cancer Network
Sandwell and Birmingham Hospitals NHS Trust is one of the largest teaching hospitals in the UK. The Trust provides services for a population of 500,000 across two hospital sites, both offering a full range of acute services. The Trust estimated there to be around 650 acute oncology related emergency admissions a year (approximately 3,189 bed days).
It employs its own haematology consultants but receives oncology services through a service level agreement with the local cancer centre. A review of the current service against the recommendations for acute oncology highlighted the need to provide an expert ‘in house’ service to meet the needs of local cancer patients, in particular, for those undergoing chemotherapy and/or radiotherapy treatment or with acute onset of complications due to a known cancer diagnosis.
As there was a limited opportunity to change the Oncology SLA without considerable investment, the Trust established a nurse-led AOS with access to oncologists. The service comprises:
Clinical Nurse Specialist Band 7
Specialist Nurse Band 6
Administrator Band 2 (3.5 WTE)
Oncology support is provided by two consultant oncologists with a total of four afternoon sessions a week at the City Hospital site in addition to telephone support. The oncologists also provide advice on strategy and operational management to the team.
In nine months, the service – launched in September 2011 – successfully delivered improvements in:
• Emergency presentations through triaging
• Neutropenic sepsis – hour door to needle
• Diagnosing and treating metastatic spinal cord compression patients
• Identifying and learning from mortality and morbidity incidents
• Improving the service through data analysis, audit and patient satisfaction.The service has made a significant impact on patient safety, experience and outcomes. As it matures the team will look to continually improve to meet the needs of patients, carers and colleagues.
FACTS (Fast Access to Cancer Treatment Support) – raising awareness of acute oncology emergencies for patients and healthcare professionals
Lancashire and South Cumbria Cancer Network
FACTS was developed across the Lancashire and South Cumbria Cancer Network (LSCCN) to raise awareness, among patients and healthcare professionals, of signs and symptoms of oncology emergencies.
Alongside the FACTS website, the message is being delivered using folders for professionals, which contains information sheets and protocols, and e-learning resources available on local Trust intranets; and folders for patients, which contain information and alert cards, and a pre-chemotherapy DVD which patients are shown before they start treatment.
Increasing numbers of cancer patients are benefiting from advances in the systemic treatment of cancer (chemotherapy). Unfortunately, such treatments are often associated with complications and potentially serious side effects. Recent national reports have highlighted the need to improve significantly the support offered to cancer patients who experience side effects as a consequence of treatment (NCEPOD – For Better for Worse, DH, 2009; NCAG, DH 2008).
The LSCCN chemotherapy network group has recognised the need to improve awareness and appropriately manage chemotherapy related toxicities in primary and unscheduled care services. Additionally, it has recognised that patients need appropriate support and resources to be empowered to self-manage and request assistance when appropriate and in a timely manner.
This approach from both angles will result in significant reductions in morbidity and mortality associated with such treatments and consequently will improve care outcomes and the overall patient experience.
The aim of this project is to develop a network-wide patient and health professional toolkit as a resource as well as a supporting education programme. This ensures that the right information, delivered in a timely manner, will improve patient safety and ultimately save lives.