Innovation in Acute Oncology Philippa Jones Macmillan Acute

Innovation in Acute Oncology? Philippa Jones Macmillan Acute Oncology Nurse Advisor UKONS Acute Oncology Members Interest Group Lead

We all have bright ideas ………. It’s the will to drive them forward that makes the difference !

Teams Across The UK v Scotland……… a number of acute oncology teams and projects. v Northern Ireland…. . national roll out of Acute Oncology. v Wales…………. AO projects/services being supported by the Cancer Network and Macmillan. v England…. 193 AO services according to peer review

UK leading the way – lots of interest from other countries now • Australia • Canada • New Zealand • Malta • Irish Republic • America • Jordon • Portugal

Community Acute Oncology v Community supportive therapies team in Stoke v Integrated acute and community team in Crewe v Dedicated Acute Oncology team in East Anglia

24 Hour Help Lines v Sometimes called advice lines or hot lines v Patients receiving systemic anti cancer treatment should be given a 24 hour help line number v The advice line should also provide advice to health care professionals

Help Line Triage v UKONS 24 hour triage tool used widely across the UK and also internationally v Standardised evidence based triage v No reports of incidents or adverse events linked to the correct use of the tool v Review and update in process – nearing completion. Launched in 2010

Help Line Innovation v National Cancer Treatment Help Line in Scotland – 24 hour help line service, sitting within the NHS 24 structure in Scotland, provides a service for the whole of Scotland v Pilot extremely well evaluated, service now well established v Shropshire Doctors Co-operative (Shropdoc) primary care team now provide the 24 hour helpline service for patients in Shropshire and Powys. Very well evaluated by patients and staff.

Collaborative project. Now available on the CCLG website Poster and presentation at SIOP conference 9

Hospice Helpline v Macmillan supported project v Now recruiting v Triage to assess priority of care and need for urgent assessment/visit v Will work in conjunction with the acute triage advice line

Primary Care Risk Assessment Tool v Pocket tool and poster v RCGP approval being sought v Is currently being updated to reflect the acute tool v Plan to develop an app for GP’s

10 Top Tips

Shrewsbury and Telford Vitrucare App. v. Charity funded project v. Tech company and trust collaboration v. Support for patient at all stages of care pathway v. Tailored to the individual v. Utelising UKONS triage tool guidelines v. Two pathways being developed at present- SACT and prostate v. Live pilot to commencing – 3 month initially v. Similar projects underway in Southampton and North London

Vitrucare App

Acute oncology website • National AO update • Links to key national AO docs and NICE • Forthcoming events • News and innovation • Forum • Recent articles- papers • Resources • Peer review

Acute Oncology Initial Management Guidelines v Revision of the UKONS initial management guidelines to include the management of immunotherapy related complications/toxicities v Algorithms to support the assessment and management acute oncology patients for the first 24 to 48 hours v UK wide multidisciplinary development group

Training and education The framework consists of: A skills ladder - the ladder lists all clinical staff/professional groups, who may be involved in the care of acute oncology patients and describes four levels of knowledge and skill Competency documents – these have been developed for each of the four skill levels Resources list – a list of suitable training resources for each of the skill levels Users would be expected to complete all levels of the training ladder applicable to their role and responsibilities and expected to have competency confirmed by an agreed mentor/assessor. The four levels are: Level 1 – Basic Level 2 – Intermediate Level 3 - Advanced Level 4 - Expert Training and competency for all involved in the patient pathway Multi disciplinary development and consultation group

A web based Generic Acute Oncology Induction Training Programme. Developed by Acute Oncology Nurses and Macmillan. Will be updated in 2017

Low Risk Neutropenic Sepsis v Multidisciplinary group developing low risk neutropenic sepsis guidelines v Planning to test in a number of centres and units v Looking at existing practice examples: Sheffield, Clatterbridge, Bath Leicester v Please forward any examples to me. Multinational Association of Supportive Care in Cancer =MASCC Clinical assessment MASCC score Oral antibiotics Observation period Home monitoring

Leicester v Leicester – oral antibiotics and early discharge with planned follow up

Patient held prescription • • • Patient specific direction cards – patient held Stickers are also placed in the patient's medical notes The cards and stickers essentially direct nursing staff to administer a specified antibiotic stat, before medical review, where patients have triggered for suspected NS , negating the need for specialist training unlike a patient group direction. • Musgrove Park • Warwick • Shrewsbury and Telford

Accelerate, Coordinate, Evaluate (ACE) Programme Vague symptoms clinics/diagnostics- Piloting new diagnostic pathways for patients with non-specific but concerning symptoms. http: //www. cancerresearchuk. org/healthprofessional/early-diagnosis-activities/aceprogramme

Chelsea and Westminster.

Ace Wave 2 links with GM Cancer Vanguard

An ambulatory diagnostic pathway for non-elective patients presenting with a new suspected diagnosis of Malignancy of Undefined primary Origin (MUO) or provisional Carcinoma of Unknown Primary (p. CUP) reducing hospital stays for suitable patients to under a day Pathway objective: Reduce the length of stay for medically fit patients without negatively impacting the diagnostic pathway

Past AMAU, acute medical assessment unit; MDT, multidisciplinary team

AOS nurse-led ambulatory MUO diagnostic pathway CT, computed tomography; MRI, magnetic resonance imaging; PPI, proton pump inhibitor

How it works Step 1 Step 2 Step 3 AMAU AOS/AMAU AOS MUO patient with a performance status of 0 -1 Meet, review patient & address any symptoms to optimise Qo. L Medically fit for discharge but need investigations Collaborate with specialists +/- MDTs - ensure imaging etc. ready for MDT & track results (ongoing) Answer all questions Review patient back in AMAU No virtual ward to discharge to Ensure only relevant blood tests & imaging ordered Symptom management & feedback any results +/- referrals to 2 WW Refer to AOS Reassure & give contact details Appropriate onwards referral Discharge home Qo. L, quality of life

Continuing developments Community/ emergency IVABS delivered by ambulance teams – Isle of White Nurse led day case paracentesis Rachel Simpson University Hospital of Morecambe Bay NHS Foundation Trust

Join in v Macmillan Acute Oncology Mailing List v UKONS Acute Oncology Forum v Email – philippajones@nhs. net

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