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What is Acute Oncology?

Sue Gauntlett Macmillan Acute Oncology Project Lead. What is Acute Oncology?. South Bedfordshire Cancer & Palliative Care Service. 15/09/2014. 1. NCAG (2009). NCEPOD (2008). NCAT (2011). South Bedfordshire Cancer & Palliative Care Service. 15/09/2014. 2. NCEPOD: For Better, For worse?.

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What is Acute Oncology?

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  1. Sue Gauntlett Macmillan Acute Oncology Project Lead What is Acute Oncology? South Bedfordshire Cancer & Palliative Care Service 15/09/2014 1

  2. NCAG (2009) NCEPOD (2008) NCAT (2011) South Bedfordshire Cancer & Palliative Care Service 15/09/2014 2

  3. NCEPOD: For Better, For worse? South Bedfordshire Cancer & Palliative Care Service 15/09/2014 3 June – August 2006 47,050 chemotherapy treatments 55,710 deaths from any cause 1044 deaths <30 days of treatment Data provided on 546 patients

  4. Deaths Within 30 days of Chemotherapy South Bedfordshire Cancer & Palliative Care Service 15/09/2014 4 85% admitted to hospital 55% to cancer centre 18% to different hospital 42% under general medicine

  5. Quality of Care 57% 35% South Bedfordshire Cancer & Palliative Care Service 15/09/2014 5

  6. NCEPOD: Failures identified Organisational Clinical South Bedfordshire Cancer & Palliative Care Service 15/09/2014 6 Staffing Communication Clinical policies, Referral pathways Use of chemotherapy Communication Medical management End of life care

  7. NCEPOD: Time to Oncology Review South Bedfordshire Cancer & Palliative Care Service 15/09/2014 7

  8. NCEPOD: Place of Death South Bedfordshire Cancer & Palliative Care Service 15/09/2014 8

  9. NCAG: 19 Recommendations South Bedfordshire Cancer & Palliative Care Service 15/09/2014 9 1 Acute Oncology Emergency medicine, general medicine, oncology Emergency admissions of patients with cancer 18 Commissioning AOS are available in all hospitals with an ED

  10. Acute Oncology South Bedfordshire Cancer & Palliative Care Service 15/09/2014 10 Acute new presentations of cancer Complications of cancer Complications of cancer treatment

  11. Network Measures South Bedfordshire Cancer & Palliative Care Service 15/09/2014 11 Name, detail and level of hospitals Broad membership Coordinate AOS services Consultant on-call service AOS training MSCC services

  12. Hospital Measures South Bedfordshire Cancer & Palliative Care Service 15/09/2014 12 Acute hospitals Cancer centres Outreach chemotherapy units Community hospitals

  13. Hospital Measures South Bedfordshire Cancer & Palliative Care Service 15/09/2014 13 AOS board AOS staffing AOS training Referrals and clinical guidelines Flagging system Out of hours services MSCC and NS

  14. Oncology Emergencies South Bedfordshire Cancer & Palliative Care Service 15/09/2014 14 Neutropenic sepsis Uncontrolled nausea and vomiting Extravasation injury Acute hypersensitivity reactions including anaphylactic shock Complications associated with central venous access devices Uncontrolled diarrhoea Uncontrolled mucositis Hypomagnesaemia Radiotherapy associated skin reactions Acute cerebral / CNS oedema Radiation pneumontitis Pleural effusion Pericardial effusion Lymphangitis carcinomatosis Superior vena cava obstruction Ascites Hypercalcaemia of malignancy Metastatic spinal cord compression Cerebral space occupying lesions

  15. Acute Oncology and CUP South Bedfordshire Cancer & Palliative Care Service CUP Measures 2012 15

  16. Acute Oncology Team Specialist Nurse Admin Support Oncology/ Haematology Physio/OT Pharmacy Palliative Medicine South Bedfordshire Cancer & Palliative Care Service 15/09/2014 16

  17. What is expected of the AOS? South Bedfordshire Cancer & Palliative Care Service 15/09/2014 17 Patients should be seen assessed the same day as admission (or the next day if admitted after midday) by specialist nurse or consultant oncologist. All patients should be seen and assessed by a consultant oncologist within 24 hours of admission. If admitted during the weekend, seen and assessed by a consultant oncologist on Monday morning.

  18. Benefits of AOS South Bedfordshire Cancer & Palliative Care Service 15/09/2014 18 Reduction in length of stay Reduction in deaths in hospital Faster diagnosis and treatment of new cancers Reduction in unnecessary investigations Better and earlier palliative care input Cost Savings!

  19. Thank the following for sharing how they are developing there services which has helped us get to where we are South Bedfordshire Cancer & Palliative Care Service 15/09/2014 19 Claire Cancer Manager and Caroline AOS CNS Bedford Hospital Dr Tom Newson-Davis AOS Medical Oncologist Chelsea & Westminster Hospital Dr Pauline Leonard AOS Medical Oncologist Whittington Hospital Alex Gallagher AOS Project Lead Lister Hospital

  20. Education -Nurse -Junior Doctors -Consultant & significant other induction training CommunicationProtocol Active treatment database Rapid Access Clinics -Find a model -Design -Implement ICE Alerts -Neutropenic Alert System -Know Ca in F/up -Frontline Alert -Ptn on SACT -Known bone mets -E of L AOS News Letter ACUTE ONCOLOGY SERVICES Audits -Base line admission audit -MSCC Audit -Neutropenic Sepsis Audit Protocols -Allergy & Anaphylaxis -Ascites -Brain Mets -Central Venous Access Devices -diarrhoea (N) -Effusions pleural -Extravasation (MVC) -Malignant Hypercalcaemia (N) -Hypomagnasaemia (N) -lymphangitis Carcinomatosis(N) -MSCC -Mucositis (N) -Nausea & Vomiting (N) -Neutropenic Sepsis -Pericardial effusion -Radiation Pneumonitis (N) -SCVO -Tumour Lysis Syndrome (N) -Communication AOS Group Members Pathways from Acute Services -Known Active Ca on Active Treatment -CUP -Known Ca not on Active Treatment -Know Ca Cured/stable acute cancer related event -Palliative EofL Care -MSCC Mortality & Morbidity Meetings Cancer Services Icon Business Case -Oncologist -CNS -24 advise line -Admin support Peer review South Bedfordshire Cancer & Palliative Care Service 15/09/2014 20

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