Wednesday 3rd April 2013
Debbie Jordan shares how a new service is reducing unnecessary tests and admissions.
The acute oncology service at Doncaster and Bassetlaw Hospitals was launched in September 2011 following funding from the North Trent Cancer Network for a full-time acute oncology clinical nurse specialist (CNS). The aim was to pilot a new service, collect data to support a business case for a permanent service, and to learn from challenges and feedback.
The service is based on a nurse-led assessment and triage model for people who attend hospital with cancer-related emergencies. The service mainly covers accident and emergency and acute receiving areas in each hospital. We provide telephone advice to Montagu Hospital, Mexborough, which has a minor injuries unit. The service runs Monday to Friday, 9am to 5pm, and patients who present out of hours are reviewed the next working day.
I came into post in October 2011 on a secondment. I had a background of nursing people with haematological and gastroenterological malignancies, administering chemotherapy, and dealing with cancer-related emergencies such as neutropenic sepsis, hypocalcaemia and malignant bowel obstruction.
I spent time with the site-specific CNSs to learn more about their services, the different cancer diagnoses and the complications that can occur with each.
As the service runs across both Doncaster and Bassetlaw sites, the site-specific CNSs, lead cancer nurse and lead chemotherapy nurse all contributed to the rota during the pilot period.
Patient alert system
Prior to the service, the hospitals had an alert system in place known as the Patient Electronic Alert to Key-worker System (PEAKS). As soon as a patient is admitted to hospital in an emergency, a text message is sent to the site-specific CNS. While this was of benefit to the CNS teams, not every team could follow their patients up and review them on the same or next day.
The acute oncology service therefore uses the PEAKS system, so text messages for all tumour sites are sent to the service mobiles, and the acute oncology nurse will attend and review the patient. If the admission is cancer related, they will offer recommendations based on advice from the site-specific CNS or oncologist, or from treatment pathways in place. If the admission is not cancer related, the acute oncology team advises the site-specific CNS of the admission and they will follow up accordingly.
The wider service team includes oncologists, haematologists, lead clinicians from acute medicine and emergency departments, specialist nurses and the lead chemotherapy and cancer nurses. The team developed an acute oncology assessment form, which is used when assessing patients. We use a ‘red, amber, green’ system to assess toxicities and symptoms, which has been adapted from the triage tool developed by Philippa Jones, Macmillan Network Lead Chemotherapy Nurse, and members of UKONS. The form is also used as a data collection tool. Treatment pathways for the acute oncology presentations were also developed.
The pilot proved to be extremely successful, with an evaluation proving a reduction in length of stay by 2.5 days. Involvement of an acute oncology nurse also leads to a reduction in unnecessary tests and admissions. We have also seen an improvement in our treatment times for neutropenic sepsis.
We haven’t had the opportunity to conduct a patient experience survey. However, we have received positive feedback from the service verbally, with people expressing relief, for example, that someone has come to see them who knows about their cancer treatment.
The success of the pilot led to the appointment of two acute oncology nurses: myself at Doncaster and my colleague Nicky Godfrey at Bassetlaw. The pilot showed that the majority of acute oncology presentations occur at Doncaster, but it was still felt that an acute oncology nurse at Bassetlaw was essential. Nicky works with the specialist palliative care team. She follows up patients for the site-specific CNS while they are inpatients, so that their own CNS can be confident they are being reviewed regularly.
We plan to work with the network to gain access to electronic patient records to further improve the service. This will help during out-of-hours periods, when the team is not present. We would also like to work towards seven-day working, as our evaluation demonstrated that half of patients attend out of hours. We hope that continued audit and evaluation will support this.
Debbie Jordan, Macmillan Acute Oncology Clinical Nurse Specialist, Doncaster Royal Infirmary.
Macmillan’s Learn Zone has an out-of-hours toolkit and a video about managing neutropenic sepsis.