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Achieving safety and quality in MCCN chemotherapy services

Achieving safety and quality in MCCN chemotherapy services. Quality. Purpose designed treatment facilities Short waiting times Short travelling times Available (free) car parking Excellent outcomes Availability of clinical trials. Safety. Patient selection Prescribing

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Achieving safety and quality in MCCN chemotherapy services

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  1. Achieving safety and quality in MCCN chemotherapy services

  2. Quality Purpose designed treatment facilities Short waiting times Short travelling times Available (free) car parking Excellent outcomes Availability of clinical trials

  3. Safety Patient selection Prescribing Pharmacy prescription checking Experienced nursing staff Patient education Effective toxicity management – triage

  4. Two reports concerning chemotherapy services published NCEPOD NCAG November 08

  5. NCEPOD National Confidential Enquiry into PatientOutcomes and Death Establised 1982 maintain and improve the standards of medical and surgical care reviewing patient management undertaking confidential enquiries.

  6. NCEPOD • Ist enquiry was into post-operative deaths

  7. NCEPOD – Nov 08 Deaths within 30 days of Systemic Anti-Cancer Treatment (SACT)

  8. Deaths within 30 days of SACT Rationale A belief existed that the standard of care was not uniform across the country Aim Identify remedial factors in the care received by patients

  9. Inclusion criteria • Patients aged 16yrs + • Solid or haematological malignancies • Received SACT during the study period • June / July 07 • Died within 30 days of treatment • Total numbers receiving SACT not recorded

  10. CCO June/July 07 • 34 deaths within 30 days • 4000 cycles of SACT delivered • 1% pts

  11. Overall quality of care

  12. Room for improvement • Decision to treat • Consent and information • Prescribing and dispensing • Toxicity management

  13. Advisors opinion on the decision to treat

  14. Consent forms 310/546 cases STANDARD Written information should be provided on treatment intention and expected response rates acute and possible late side effects mortality rates

  15. Recommendations of the report • Management plan formulated at MDT • Consent taken by an experienced clinician • Prescribing by experienced clinicians • Circumspection in treating poor PS pts • Experienced pharmacists check • Specialist advice available where patients are admitted with toxicity • Regular audit - neutropenic sepsis - deaths within 30 days

  16. Management of neutropenic sepsis: standards Intravenous antibiotics should be commenced within 30 minutes in 100% of patients who have received recent chemotherapy and who are shocked. Chemotherapy Guidelines: COIN 2001

  17. NCAG Nov 08 • Decision to start Ctx by consultant • Consent forms: common and serious toxicities and expected benefit • Dispensing and prescription verification by appropriately trained staff • Electronic prescribing • Access to 24hr helpline • Pro-active telephoning post Ctx • Improved communication: DGHs Cancer Centre • Acute oncology

  18. MCCN • All Ctx is consultant prescribed • Proactive telephoning patients • Improve the triage service • Improved consent forms • Improved consent process • Purpose designed facilities across the network • Electronic prescribing • Facilitate audit • Develop acute oncology

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