Wednesday 3rd April 2013
An assessment tool is helping professionals assess and triage chemotherapy-related problems.
Central West and Wales UK Oncology Nursing Society (UKONS) members have developed and piloted an oncology/haematology 24-hour triage, rapid assessment and access toolkit. The toolkit is for staff who may be required to man a 24-hour helpline for adult patients who have:
- received chemotherapy/systemic anti-cancer therapy
- received any other type of anti-cancer treatment, including radiotherapy
- disease/treatment-related immunosuppression, ie, acute leukaemia or corticosteroids.
It’s a risk assessment tool that, if used correctly, standardises and supports excellent practice, improves quality and safety, and provides evidence of service provision. The tool provides a robust framework for triage assessment, action and audit, leading to improved quality and safety in patient care. It works by:
- ensuring patients receive a robust, reliable assessment
- ensuring assessments are of a consistently high quality by using an evidence-based assessment tool
- advising on action that is appropriate to the patient’s level of risk
- ensuring that patients who require urgent assessment in an acute area are identified and that action is taken
- identifying and reassuring those who are at lower risk and may safely be managed by the primary care team or through a planned clinical review to avoid unnecessary attendance
- providing a framework for triage training and competency assessment for practitioners.
Development began in December 2007. Oncology and haematology nurses from the central west region were invited to attend a series of meetings to discuss current practice, determine the project aims and objectives, and develop a project plan. The group were enthusiastic and keen to work together.
The triage process was discussed along with a comprehensive review of current pathways and guidelines. A steering/development group of Central West and Wales UKONS members designed and piloted the toolkit over a three-year period. The group met regularly during this period to review and refine the toolkit. At each stage, the members were asked to take the toolkit back to their clinical teams for discussion. The comments were then considered at the following meeting and the toolkit amended accordingly.
The UKONS chemotherapy leads and board members, and the cancer lead at the National Patient Safety Agency (NPSA), were also invited to review the toolkit at regular intervals. Everyone involved identified the toolkit as a positive step towards supporting patients by providing consistent, reliable advice and support for both patients and staff. The NPSA supported the design, printing and pilot of the toolkit.
The tool was intended for use nationally and has had a great impact on the provision of helpline care nationally. It is now being developed internationally.
The NPSA funded a multicentre pilot with 19 cancer centres and 17 cancer units from England, Wales and Northern Ireland. Each organisation sent pilot leads to pilot introduction and training days. They then assumed responsibility for the pilot at a local level. The pilot leads were assessed at the training day and acted as mentors and assessors to their trust teams. All staff using the toolkit received training and assessment of competency.
There was a two-step evaluation process, including a questionnaire and log sheets.
Helpline practitioners anonymously completed a questionnaire that gathered information regarding the use of the tool, design, ease of use and reliability. A total of 134 completed questionnaires were returned. All the information received was entered into a database for evaluation.
A review of completed log sheets provided data on reasons for calls, action taken and quality of assessment. A total of 1,899 forms were received and 500 correctly completed forms were randomly selected for review and evaluation.
The pilot ran for a two-month period, or until 100 log sheets were completed. Twenty-five of the 26 sites returned forms in time for evaluation.
The tool was released as a final version in October 2010 following the pilot and a very positive evaluation. The majority of the pilot sites have continued to use the tool. Project costs have been minimal.
The process has been adopted by at least 78 cancer centres/units across the UK, 20 cancer networks and four healthcare providers. This number is probably a conservative estimate, as many more areas are now implementing under their own steam. A number of trusts are using the data to report regularly about call admissions.
Northern Ireland has rolled the tool out nationally, and Scotland is planning to use it in a national acute oncology pilot.
The tool meets national recommendations as set out by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), the National Chemotherapy Advisory Group (NCAG), and acute oncology measures that aim to improve quality and safety for patients.
The Greater Midlands Cancer Network provided continuous support and allowed me time within my network role to develop the tool and roll it out nationally. UKONS have supported the development, pilot and distribution of this tool, and have fully endorsed its use in practice. The NPSA funded and supported the design and pilot of the tool and endorsed its use in practice. The National Cancer Action Team has promoted the tool as evidence of best practice in acute oncology.
The tool is being developed to support paediatric and primary care services, and the group has linked with the Royal College of Nursing and Macmillan. A UKONS survey is under way to identify sites using the toolkit. They will then be invited to complete a questionnaire about the use of the tool, with a view to extending its scope to cover people with cancer who are not on active treatment but are experiencing acute problems. It will also be added to the staff groups who could be trained to use the tool in the future. A comprehensive plan for regular review and evaluation will be developed and agreed upon completion of current developments.
The toolkit was developed by a group of hard-working nurses with the experience and vision to produce a nationally recognised tool. It required patience, determination and tenacity, all of which have been demonstrated in abundance.
Philippa Jones, Macmillan Network Lead Chemotherapy Nurse, Greater Midlands Cancer Network.