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.