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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

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Working across cancer networks l.jpg

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 l.jpg
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!)


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‘Up North’ Cancer Network

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


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Northern Cancer Network NCN Cancer Network

  • One of the first Cancer Networks

  • Linked with CSC from first wave

  • NCN covers 3SHA’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 ncn5 l.jpg
    Northern Cancer Network NCN Cancer Network

    • Organised intovarious 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 l.jpg
    Development of a Network Pharmacist role Cancer Network

    • 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


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    Network Pharmacist Role Cancer Network

    • 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)


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    NCN Cancer Pharmacist Group Cancer Network

    • 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.’


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    NCN Cancer Pharmacist Group Cancer Network

    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.


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    NCN Cancer Pharmacist Group Cancer Network

    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.



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    Cancer Unit Chemotherapy Handbook Cancer Network

    • 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


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    Why did we need a handbook? Cancer Network

    • 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


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    Benefits of the Chemotherapy Handbook Cancer Network

    • 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


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    Limitations of the Chemotherapy Handbook Cancer Network

    • 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


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    Cancer unit/ cancer centre chemotherapy contact details Cancer Network

    Approved solid tumourchemotherapy regimens for

    Breast

    Gastrointestinal

    Gynaecological

    Lung

    Superficial Bladder

    Network Guidance on Use of Anti-emetics

    Neutropenia Guidelines

    Extravasation Guidelines

    Appendices

    Handbook Contents


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    Chemotherapy Capacity Project Cancer Network

    • 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


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    Project Methodology Cancer Network

    • Pilot Visits

    • Questionnaire

    • Informal discussion with Nursing and Pharmacy Staff

    • Inspected facilities - ward and pharmacy

    • Written report prepared for each unit


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    Cancer Unit Visit Reports Cancer Network

    • Profile of unit

      • Opening Hours

      • Weekly work pattern

      • Staffing

    • Facilities

    • Management Structure

    • Policies and Procedures

      Administration Line Care

      Neutropenia Extravasation

      Anti-emetic Anaphylaxis

    • Emergency Admissions

    • Chemotherapy regimens used


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    Pattern of Work Cancer Network

    Booking System

    Writing of Scripts

    Blood Monitoring

    Receipt of Chemotherapy

    Patient Numbers

    Other Activities

    Patient Review

    Factors Affecting Capacity


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    Current workload Cancer Network

    Daily pattern of work

    Timing of prescriptions

    Preparation in advance

    Number of Isolators/ Clean Rooms

    Staff Commitments

    Pharmacy Capacity Assessment


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    Pharmacy Chemotherapy Capacity Cancer Network

    • 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.


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