Posted on 21/09/2018 by
Macmillan Advanced Nurse Practitioner Emma Earnshaw describes the changes achieved at Buckinghamshire Healthcare Trust
Our acute oncology service (AOS) was established in March 2012 with initial funding from Macmillan. In 2015, the proposed National Service Specification for AOS prompted a review of the service. This highlighted several areas of development required to meet future recommendations and continually enhance safety and quality.
Within our trust this included:
- Create a single point of access
- Move from a five-day to a seven-day service
- Bring cancer of unknown primary service within acute oncology
- Provide specialist telephone triage service
- Enhance acute oncology across emergency settings
- Improve staff education and training
- Develop nurse-led follow-up opportunities
- Provide a metastatic spinal cord coordinator
- Strengthen further stakeholder relationships across the trust.
A new acute oncology team of five nurses plus medical and administrative support staff came together in January 2017. The team includes an acute oncology advanced nurse practitioner/ nurse lead, an acute oncology clinical nurse specialist and three acute oncology specialist nurses. All team members (except support staff) are chemotherapy, haematology and oncology trained at degree level and above.
In October 2017 the team showcased their objectives and achievements over the past six months to Macmillan and Buckinghamshire Healthcare Trust. The aim was to demonstrate our work throughout the trust to ensure seamless and enhanced patient care pathways within cancer settings, leading to better patient experiences. This was evidenced by statistical data and feedback from service users and patients.
The event highlighted that overall activity had increased by 43% in those six months compared with the same months in 2016. New patients had increased by 5%, follow-ups had increased significantly by 139% and new diagnosis by 37%. Of patients seen at weekends, 6% were newly diagnosed and cancer of the unknown primary had also shown a huge 200% increase in diagnoses.
In that period, we introduced new alert cards with pre-prescribed intravenous antibiotics and fluids to improve national ‘suspicion to needle’ time targets of one hour. We also set up a seven-day acute oncology service, (the first in the country for a district integrated general hospital), and a specific telephone triage line for all patients receiving systemic anti-cancer treatments. An improved audit trail and statistically-evidenced metastatic spinal cord compression pathway have enabled shortened length of stay.
The trust has a commitment to paperless IT systems, and so now the UK Oncology Nurses Society triage tool and an acute oncology nurse encounter form have been incorporated into the medical notes software. This provides the wider workforce access to live information, improving collaboration and communication throughout the trust and enhancing patient care by ensuring appropriate management is set in place.