A PATIENT SURVEY OF A NURSE-LED OUTREACH SERVICE Jo Richardson, Charlotte Townsend and Debbie Holland, Ipswich Hospital

1. A PATIENT SURVEY OF A NURSE-LED OUTREACH SERVICE Jo Richardson, Charlotte Townsend and Debbie Holland, Ipswich Hospital Introduction Many cancer patients make frequent, time -consuming journeys to a Cancer Centre for chemotherapy. Much of this treatment could be delivered closer to home.In an outreach chemotherapy service, staff from a Cancer Centre, trained in patient assessment and chemotherapy administration, travel with the drugs to clinics sited in local hospitals or GP practices. A nurse-led outreach chemotherapy service in Ipswich was proposed in 2003 following a capacity-demand study by the Cancer Service Collaborative that showed the Centre could not cope with increasing numbers of patients. Developing community based chemotherapy was seen as a way to ease pressure on chemotherapy delivery at Ipswich. A survey on the views of patients treated at Ipswich showed that those living further from the Centre would prefer a local service. The success of the initial outreach at Aldeburgh led to expansion of the service to four sites in East Suffolk. Currently, two nurses on a six month rotation from the Ipswich chemotherapy unit work as a pair to deliver the outreach service four days a week at the four sites, providing a convenient local service that also eases demand on the busy chemotherapy unit at Ipswich Hospital. Stowmarket Aldeburgh Ipswich Hadleigh Felixtowe Aldeburgh Stowmarket Ipswich 14m 24m Aim To assess patient expectation and experience of the Ipswich Hospital Outreach Chemotherapy Service. Method A patient-completed questionnaire given to consecutive patients in attendance at each of the four outreach sites. 11m 12m Hadleigh Felixstowe Organisation 2 days before treatment Blood sample taken at local GP surgery 1 day before treatment Pharmacy at Ipswich prepare treatments. In addition to chemotherapy, the service provides pamidronate, immunoglobulins and blood transfusions Treatment day Nurses collect drugs and drive to clinic. Outreach clinic appts: 10.30am - 4.00pm (allows time for set up/clearing site) 8-10 patients treated Longer IV treatments given first, quicker oral agents at the end of the session • Results • 45 questionnaires were returned, from 60 distributed. • 87% (39/45) patients recalled being informed that it was a nurse-led service • When asked who they would like to see in the outreach clinic there was a preference for a routine nurse consultation and an occasional doctor consultation • All patients who responded felt able to ask questions and discuss treatment. • 89% (39/44) said explanations were always clear and understandable • 93% (41/44) reported that enough information was provided • 93% (39/42) felt that facilities at the outreach sites were adequate, but some patients commented on a lack of space, resulting in overcrowding and a lack of privacy • 89% (34/38) felt that they had access to other services whilst being treated in outreach • 76% (28/37) had a telephone assessment before treatment • All patients were satisfied with their care and all rated the service as ‘good’ or ‘excellent’ • The Ipswich Outreach service provides high quality local care that is appreciated by patients for its convenience and the relaxed and friendly atmosphere. In addition to routine nurse consultations, patients would occasionally like to see a doctor in the outreach. Space was the only issue. The outreach nurses report high job satisfaction due to increased responsibility and autonomy, and a clear structure to the day – some have been reluctant to return to normal duties at the end of the rotation! • Outreach is now an integral part of the chemotherapy service. As demand continues to grow, further outreach sites are being investigated. Conclusion Outreach chemotherapy provides a sustainable solution to growing demand that not only provides a more convenient and patient-friendly service but is also a great success with doctors and specialist nurses. The model established in Ipswich provides a validated template for the establishment of outreach chemotherapy services across the country.