Transcript Northern Cancer Network

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
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Development of a Network Pharmacist role
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Bringing togeather colleagues across the Network -
examples of what we can acheive
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Multi-professional working
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Chemotherapy Protocol Handbook
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Chemotherapy service review and capacity
(Only a Tiny mention of Clinical Governance - phew!)
‘Up North’
Northern Cancer Network
Northumbria Healthcare Trust
Wide geographical area with a
population of over 2 million.
Most northerly NHS Hospital Trust
Geographically one of the largest
Northern Cancer Network NCN
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One of the first Cancer Networks
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Linked with CSC from first wave
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NCN covers 3 SHA’s, 12 PCT’s and 7 Hospital Trusts
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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
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Northern Cancer Network NCN
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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).
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Full time Lead Clinician /Network Manager
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Well established full time support staff
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Regular project/ secondment posts.
Development of a Network Pharmacist role
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April 1999 Pharmacist involved forming in Network Clinical
Support Profession Group
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July 2000 CSC arranged pharmacy meeting
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NCN Pharmacists invited to CSC Blackpool conference
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Dec 2001 CSC commissions chemotherapy project for NCN
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Jan 2001 Project Pharmacist forms network pharmacy
group against initial reluctance from pharmacy managers
Network Pharmacist Role
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Providing accurate High Cost/ NICE Drug expenditure
reports for network commissioners & budgetary forecasting
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Project work, looking at chemotherapy staffing and facilities
in conjunction with seconded chemotherapy nurse
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Promoting multi-professional working with CSP group
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Part of Network’s D&T - Systemic Therapies Group
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Maintaining Network Chemotherapy Handbook
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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
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Representatives from all Trusts in NCN area
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Quarterly meetings
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Initially no clinical oncology pharmacy posts in NCN area
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Group facilitated gradual re-engineering/ expansion of roles
from pure aseptics (supply) roles to include clinical duties.
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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
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To raise the profile of pharmacy services in cancer care
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To ensure there is sufficient pharmacy manpower and facilities
within the NCN to provide services to cancer patients.
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To promote the specialist role of pharmacists and pharmacy
technicians in the delivery of cancer services.
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To ensure cancer patients receive best pharmaceutical care.
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To promote the best value use of cancer medicines.
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Ccommunication and peer support.
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To enable and co-ordinate the sharing of good practice
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Promote continued professional development, training and
educational opportunities in cancer services for pharmacy staff.
NCN Cancer Pharmacist Group
Achievements (so far)
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Developed Chemotherapy Capacity Planning Tool
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Developed standardised network pre-printed prescriptions
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Facilitated development of clinical pharmacist roles
Ensured funding made available to support pharmacy
staffing from NCRN initiatives
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Programme of evening educational meetings.
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Looking at contracting for high cost medicines.
NCN Chemotherapy Documents
Cancer Unit Chemotherapy Handbook
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Prepared following Cancer Unit Chemotherapy Review
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Approved and Launched April 2002
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Published on the NCN Website (nww.cancernorth.nhs.uk)
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Reviewed and updated Annually
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Interim updates/ new regimens posted on NCN website
Why did we need a handbook?
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Manual of Cancer Services Standards-Standard 6/8 ‘..list
of acceptable chemotherapy regimens for the network’
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Northern Region Haematologists Handbook
need an equivalent resource for solid tumours
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MCSS Standard 6/14 ‘..written guidelines/protocols for
prevention and treatment of complications’
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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
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Time saving process - detailed regimen information
available to staff in each cancer unit
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Standardisation of regimens across the network
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Patient benefit - information readily available on site
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To support and facilitate consistent good practice
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Use as a learning resource for chemotherapy staff
Limitations of the Chemotherapy Handbook
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Not a recipe book for the use of chemotherapy
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Not a proscriptive list
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Not ‘policed’ by pharmacy and nursing staff
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Does not include Cancer Centre only regimens
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Does not include clinical trial regimens
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Guidelines compliment, not replace local practice
Handbook Contents
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Cancer unit/ cancer centre chemotherapy contact details
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Approved solid tumour chemotherapy regimens for
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Breast
Gastrointestinal
Gynaecological
Lung
Superficial Bladder
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Network Guidance on Use of Anti-emetics
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Neutropenia Guidelines
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Extravasation Guidelines
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Appendices
Chemotherapy Capacity Project
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Visited each NCN Cancer Unit & Cancer Centre
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Visited day unit/ ward and pharmacy
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Collaborative ‘style’ approach to assessment to avoid
audit overkill - (time of peer review visits)
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Refernce standards
• Manual of Cancer Service Standards
• JCCO ‘ Cancer Units’ Dec 2000
• RCN chemotherapy guidelines
• Aseptic Dispensing Standards
Project Methodology
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Pilot Visits
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Questionnaire
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Informal discussion with Nursing and Pharmacy Staff
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Inspected facilities - ward and pharmacy
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Written report prepared for each unit
Cancer Unit Visit Reports
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Profile of unit
 Opening Hours
 Weekly work pattern
 Staffing
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Facilities
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Management Structure
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Policies and Procedures
Administration
Neutropenia
Anti-emetic
Line Care
Extravasation
Anaphylaxis
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Emergency Admissions
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Chemotherapy regimens used
Factors Affecting Capacity
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Pattern of Work
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Booking System
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Writing of Scripts
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Blood Monitoring
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Receipt of Chemotherapy
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Patient Numbers
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Other Activities
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Patient Review
Pharmacy Capacity Assessment
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Current workload
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Daily pattern of work
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Timing of prescriptions
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Preparation in advance
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Number of Isolators/
Clean Rooms
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Staff Commitments
Pharmacy Chemotherapy Capacity
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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)
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Where P=Pharmacist time;T=Technician time; A=ATO time (mins)
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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.
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Formula must be adjusted to account for non-productive activity.