Development of a Nurse-Led Lymphoma Long Term Review Clinic L. Croan; L. Houlihan; O.Sheehy.

Within Northern Ireland between 2010 and 2014: There were 1,973 new lymphoma patients. This is an increase of 233 patients or 13.3% new lymphoma cases since the 2005 to 2009 period, As prognoses for lymphoma are improving it was estimated there are over 2500 people in Northern Ireland living with, or in remission from Lymphoma (NI Cancer Registry, 2016).

Traditionally there were four Lymphoma Haematology Consultants in the Belfast Trust, supported by Specialist Registrars routinely reviewing and following up all Lymphoma patients. However due to the rising number of patients being diagnosed with this condition and improved outcomes there have been considerable delays in patients waiting for review which causes undue anxiety and a rise in patient complaints.

As such, patient needs will change and develop over time and patient care needs to be responsive to this.

Aim To develop new models of patient review to improve patient experience and prevent delays.

Developing a nurse-led clinic The potential of a nurse clinic was explored including : Collaboration of the wider MDT (management, medical, nursing) Outpatient capacity Administration resources Secretarial support Possibility of community blood tests Identify patients/referral system

Developing a nurse-led clinic A protocol and criteria was developed outlining patients suitable for nurse-led review and criteria for referral back to a consultant. Two trial ad hoc clinics were run to assess feasibility

Problems in establishing the clinic Outpatient capacity Secretarial support Getting consultants agreement on policy for the clinic Referral to the clinic Difficulty with Belfast GPs doing community blood tests initially Funding for administration support was unavailable though trust resources

Trouble-shooting when developing the clinic Negotiation with admin/secretaries Booking a room for clinic Sitting down with consultants and the policy Phlebotomy Local Enhanced Service Administration funding was secured via the charity Friends of the Cancer Centre who also fund the Lymphoma CNS role.

Lymphoma nurse-led clinic starts! Clinics commenced weekly from 6th November 2015. Comprise of patients with stable disease (NHL, HL, CLL) and those post stem cell transplant on long term follow up. 10-12 patients reviewed per clinic. 15-20 minute appointments to give patients plenty of time to discuss any concerns. Bloods are taken in the community prior to their appointment to reduce waiting times.

Positives & Negatives Clinic run alongside consultants clinics for questions/concerns Have Health Assessment course Able to prescribe and request radiology Advanced comm, more time and knowledge to signpost for discussion psychological concerns Worry I’ll miss something Lack of knowledge around co-morbidities Still learning about lymphoma!

Conclusions Over the first 10 months 315 patients have been reviewed. This equates to a saving of 52.5 consultant hours assuming clinic appointments of 10 minutes per patient. Excellent feedback has been given from patient surveys including: improved patient waiting times and patient experience, longer appointment slot to discuss concerns and continuity of care.

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