1. Improving the oncology patient’s journey within a Clinical Research Facility – using the National Chemotherapy Advisory Group (2009) Chemotherapy Pathway Authors: Jessy Varghese and Sarah Doggett Contact Details: jessy.varghese@addenbrookes.nhs.uk and sarah.doggett@addenbrookes.nhs.uk (tel: 01223 586713) Introduction and Purpose Method Results Discussion References Department of Health (Sept 2000) The NHS Cancer plan: a plan for investment, a plan for reform http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/ en/documents/digitalasset/dh_4014513.pdf, last accessed 06 May 2010 National Chemotherapy Advisory Group, Department of Health (Aug 2009) Chemotherapy Services; Ensuring Chemotherapy Services in England: Ensuring quality and safety http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/ digitalasset/dh_104501.pdf last accessed 06 May 2010 Department of Health (2005) Research Governance Framework for Health and Social Care (2 nd ed). London: Department of Heath http://www.dh.gov.uk/ prod_consum _dh/groups/dh _digitalassets/@dh/@en/documents/digitalasset/dh_4122427.pdf, last accessed 25 May 2010 The publication of the NHS Cancer Plan (Department of Health (DOH, 2000) aimed to improve cancer care, making it one of the NHS’s top priorities and asserting that, “research into all aspects of cancer is essential if the burden of the disease is to be reduced as quickly as possible and for the benefit of future generations” (p86). Over 56 such oncology studies are currently running within the Wellcome Trust Clinical Facility (WTCRF)/Clinical Investigation Ward (CIW). The National Advisory Group document, “Chemotherapy Services in England: Ensuring Quality and Safety” (DOH, 2009) proposed a chemotherapy pathway which has been implemented within the WTCRF/CIW. In terms of nursing practice our friendly, person-centred service was highlighted. However, the need for a more streamlined service with reference to consultant assessment and chemotherapy waiting times, was identified. As a result of these findings, root cause analysis and audits have been carried out and the bottlenecks identified.We are in the process of implementing new strategies, such as pharmacy preparing the medication the day before, so that the medication can be stored in the unit to reduce patient waiting times. Such new systems could significantly improve oncology patients’ journeys within our clinical research facility. Aim To strive consistently to improve the oncology patient experience within our specialist research facility. Through implementing a nationally recognised tool, and obtaining direct feedback from research participants, we hope to develop a high level of patient- centred care. Each relevant step of the chemotherapy pathway model has been explored and then used to promote the best possible person- centred care. Individuals undergoing chemotherapy/oncology medication treatment as part of a research clinical trial are assigned a specialist oncology research nurse, who collobrates with the CIW staff to ensure the patient follows the chemotherapy pathway CIW’s three station oncology bay Collaboration of oncology research team sister and CIW staff. The Chemotherapy Care Pathway Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 Step 9 Access and referral to an oncologist Assessment and decision to treat Prescribing first cycle Dispensing Delivery and treatment environment Patient and carer information, education support and advice Urgent assessment and management of complications Prescribing subsequent cycles End of treatment record and subsequent care plan Shaded area denotes the steps of the chemotherapy pathway relevant to the oncology clinical trials research team utilising the Clinical Investigation Ward for administration of chemotherapy. Taken from The National Advisory Group document “Chemotherapy Services in England: Ensuring Quality and Safety” p16 For example, the person is seen in an oncology day clinic by a consultant, where they are assessed for their suitability for the cancer treatment available to them. This includes obtaining informed consent for both the chemotherapy and trial participation. Their first chemotherapy cycle is prescribed, dispensed and administered. All clinical and research practice adheres to Research Governance Standards (DOH, 2005) and Good Clinical Practice Guidelines. To monitor the benefits of the patient experience, we have used exisiting patient surveys and feedback forms to identify the most effective aspects of our service and, importantly, those areas of our service that require improvement. Typical patient comments were: “All the staff have been really wonderful ” “The staff are welcoming, friendly and make you feel comfortable and positive through treatment” “had to wait for his chemotherapy coming from Pharmacy” Ensuring the patient is at the centre of our care. Staff preparing a new vaccine in one of oncology clinical trials. Improving the oncology patient’s journey within a Clinical Research Facility – using the National Chemotherapy Advisory Group (2009) Chemotherapy Pathway Jessy Varghese and Sarah Doggett Contact Details: Jessy.varghese@addenbrookes.nhs.uk and Sarah.doggett@addenbrookes.nhs.uk (tel: 01223 586713)