The Role of an Upper GI Clinical

Nurse Specialist

At a District General Hospital

At Chesterfield Royal Hospital

Emma Waterfield & Jessica Rouse

Emma Waterfield

• I have worked at Chesterfield Royal Hospital since 1997

• I Started the role as the Upper GI CNS in 2008.

• A new role for the trust.

• For 5 years the service was covered with 30 hours of CNS

time, Currently the role is a job share of 22.5 hrs each.

Jessica Rouse

• I have worked for the trust for 6 years initially starting

as a health care assistant. I have been qualified for 3 Years.

• Spent 2.5 years on a General Surgical ward.

• I started my secondment in Upper GI in May 2018

• To give an overview of what we do in a District General

Hospital when patients are referred with a suspected

oesophageal and gastric malignancy and then following a

confirmed diagnosis.

• To outline the role of the Clinical Nurse Specialist.

• The role of the MDT at a local District General Hospital.

Objectives

District General Hospital

• Chesterfield Royal Hospital is part of the South Yorkshire and North Derbyshire Cancer

Alliance.

• Patients who present with specific alarm symptoms which could potentially represent an

oesophageal or gastric malignancy should be referred as a 2 week wait cancer target to

their local hospital via the GP.(dysphagia, weight loss, abdominal pain, dyspepsia, early

satiety)

• All the hospitals in the Cancer Alliance will complete all the staging investigations.

• The initial staging investigations include: Gastroscopy and staging CT Chest Abdominal

Pelvis.

• An overall assessment of the patients general health is also done including

Performance Status.

• Once all the investigations are completed, the patients have been reviewed in clinic

and their overall fitness has been assessed their case will be discussed at the local

Multi Disciplinary Team (MDT) meeting.

• CRH MDT is on a Monday

• Patients diagnosed with an oesopgheal cancer that is potentially operable on CT

imaging and are fit will require further staging in the form of a PET CT and EUS

(endoscopic ultra sound )

• Patients with a potential operable gastric malignancy will usually need a staging

laparoscopy at Sheffield.

• Following our discussion at the local MDT all patients are then discussed at the central

Sheffield MDT. Patients who are potentially operable are taken over by Sheffield to be

assessed. Patients that are inoperable are referred back locally where they will then

be referred on to either an oncologist or palliative care team.

• CNS provide ongoing support and assessment through out their treatment and act as

the patients key worker.

It is essential we have a good working relationship with the Sheffield team and the

Clinical Nurse Specialist.

We work closely together liaising about patients management and potential transfer

of care.

We regularly contact the CNS from Sheffield for updates on patients treatments and

progress.

Performance

status

Informative

Clinical

Info

Recent

Investigations

Palliative Care • At diagnosis the majority of patients

are for palliative oncology care or are

for best supportive care.

• Locally We do a lot of inpatient

referrals to our palliative care team for

patients who are symptomatic and also

community referrals.

• Dietetic referrals

• Admit patients from the community if

having significant problems with

dysphagia for stent insertion

• Complex discussion about preferred

place of death and discussions about

final wishes.

• HNA Assessments

• DS1500 forms

• Respect Forms DNAR

• Referral to community supportive

services: OT, physio, psychology,

welfare rights advisor, red cross ect

Summary

DGH complete all staging Investigations needed for patients with oesophageal

and gastric malignancy.

All patients should be discussed at a local MDT and at the central Sheffield MDT

for a management plan to be formulated.

We work closely with Sheffield to hopefully make the patients cancer journey as

timely as possible.

The CNS have a pivotal role to play in supporting patients and their families.

Thank you

Any Questions?