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Trailblazers deliver nurse-led care in acute oncology unit

Nurse consultant Carole Conner tells Elaine Cole about the steps the award-winning Aylesford Unit’s nursing team has taken to deliver seven-day outpatient chemotherapy provision

Nurse consultant Carole Conner tells Elaine Cole about the steps the award-winning Aylesford Unit’s nursing team has taken to deliver seven-day outpatient chemotherapy provision

‘The care that I get from all my “chemo angels” in the Aylesford Unit is second to none and they turn what would probably be a frightening experience into fun. I almost look forward to my “days off” there as I call them.’

Tim Taylor had keyhole surgery for bowel cancer in April, but it has spread to his bones. He is receiving palliative FOLFOX and panitumumab.

‘I just could not begin to praise all the staff, doctors, pharmacy, porters and – most of all – the nurses, enough,’ he adds. ‘They are all so loving, professional and caring, and nothing is too much trouble.’

Click here for more information on the Nurse Awards and to enter

Such appreciation from a patient is reward enough, but the comprehensive and exemplary care delivered by nurses at the acute oncology unit at South Warwickshire NHS Foundation Trust has been recognised at the RCNi Nurse Awards 2016. The team, led by nurse consultant Carole Connor, won the Cancer Nursing category (see Cancer Nursing award finalist pane below).

The purpose-built unit, part of Warwick Hospital, was set up from scratch to address a gap in service provision and meet pressures from an ageing population. Historically, all oncology patients, including those with lung, bladder, breast and bowel cancer who needed chemotherapy, had to travel to other hospitals, primarily Coventry, to receive treatment. The 60-mile round trip was difficult on public transport. Furthermore, the area’s percentage of population aged over 65 far exceeded the national average and was growing, with implications for cancer service provision.

(Bottom picture) Some of the Aylesford Unit’s nursing team and winners of the Cancer Nursing award at the RCNi Nurse Awards 2016 with awards host Lucy Porter (far right). Team leader Carole Connor (second from right) is pictured in images at top of page with (clockwise from left): colleague Shirley Griffin; a patient on the unit; and other team members. Picture credit: Neil O’Connor / Barney Newman

Carole was employed with a remit to plan and deliver cancer treatments and supportive services in a purpose-built unit. She says: ‘Our philosophy is clear – to have a positive effect on patients’ and carers’ experience in their time with us.’

Since opening its doors in 2008, the service has developed into a high-quality, day-case and outpatient chemotherapy and support service, with most care being nurse-led. Crucially, there is a continuous focus on education and development for all staff (see staff education panel below).

There is no waiting list, and patients can expect to have treatment started within 15 minutes of their appointment time. The team has developed extensive partnerships with external organisations in health, social and voluntary sectors. For example, it is a pilot site for a Macmillan benefits adviser and is proud of the care environment it offers, having been awarded the Macmillan Quality Environment Mark.

‘It is safe and supports the delivery of care and wellbeing of patients, staff and carers,’ says Carole.

‘Grow our own’ approach to staff excellence

Staff development has been key to the Aylesford Unit’s success.

The unit’s lead nurse consultant Carole Connor explains: ‘The initial focus was recruiting and developing a team fit for purpose and empowered to deliver care – including roles previously undertaken by medical staff.

‘It has been a continuous period of change and evaluation, but I have developed a visionary team of nurses all committed to excellence in patient care.’

It proved difficult to recruit staff with pre-existing skills and knowledge, she says: ‘We have no choice but to grow our own.’

Staff undergo a tailored educational and development programme with Carole (pictured below) developing a fast-track, 18-month to two-year programme for budding band 7s.

Carole Connor

‘We fill our band 6 posts with our band 5s to keep them, and we are developing our band 7 nurses into cancer leaders for the future,’ says Carole. ‘They have to rotate through the different areas in the unit, spending 12 to 18 months in each, so we have a supply of band 8As.’

Rotation is also the foundation of the service’s sustainability in the face of year-on-year growth in patient numbers.

‘No man is an island,’ says Carole. ‘Ensuring our staff work through all our services protects against vulnerability through absence or leave. It also provides diversity to staff and supports their personal development and growth.

‘They go on secondment to acute oncology. This is replicated for our healthcare assistants and other staff such as phlebotomists and receptionists.’

The focus on staff development has helped mitigate against problems in recruiting and retaining medical staff. The unit boasts five senior nurses with advanced health assessment skills and prescribing qualifications. These nurses prescribe chemotherapy and lead outpatient clinics. Some undertake a variety of procedures such as peripherally inserted central catheter insertions, Hickman line removals, bone marrow aspiration and trephine biopsies.

Administrative co-ordinator posts have been developed to maximise direct clinical care from trained nurses.

Consultant oncologist Peter Correa says: ‘Carole has not only trained nurses in the safe delivery of chemotherapy, but has also encouraged our nurses to expand their clinical skills. Over the past few years, with the help of medical colleagues, she has encouraged and supported a number of nurses to gain competence as independent prescribers.’

The senior nurses now support consultant oncologists in clinics by reviewing patients independently before chemotherapy.

‘We have, as a unit, encouraged alternate appointments for patients between doctors and nurses while on treatment,’ says Dr Correa. ‘Patients report that this system improves their experience of treatment during a difficult period in their lives.

‘Our senior nurses also facilitate expeditious and appropriate treatment for patients with oncological emergencies, including emergency review on our unit and telephone advice.’

Patient-centred care

A patient information and support service and a complementary therapy service are embedded with the unit. An example of the drive to empower patients is the ‘just-in-case pack’.

The individually tailored pack gives patients some control and healthcare professionals advice.

For patients it has clear instructions on how to recognise potential infections and advice on what to do if they encounter them. The pack gives healthcare professionals a summary of the patient’s condition and the agreed management plan. The pack includes a prescription for intravenous antibiotics. This ensures that they are appropriate for the patient and that the ‘door to needle time’ of 60 minutes is met.

Consultant oncologist Peter Correa has been working with the team for more than six years.

‘Its focus is high-quality, patient-centred care and it has been a privilege and pleasure to work with this group of dedicated, caring and professional nurses,’ he says. ‘It has a fantastic leader in Carole Connor who, with senior management support, has developed a world-class outpatient chemotherapy unit.’

Nurse-led clinics dovetail with consultant clinics to improve efficiency. This has been welcomed by patients. In his blog, patient Ian Charters writes: ‘The set-up here is unique in alternating between seeing the consultant and nurse specialist. The consultant’s prime interest is what the treatment is doing to the cancer, while the nurse wants to know what effect the treatment is having on me.’

There have been challenges. Within a year of the unit opening, it was at 125% capacity. As a result it began opening six days a week to meet demand, with extended hours Monday to Friday, and now offers a seven-day service.

Another potential difficulty was that none of the initial start-up team, including Carole, had experience in oncology nursing. ‘But this meant none of us had any preconceived ideology of how a day-case oncology chemotherapy service should work,’ says Carole. ‘This helped us develop innovative models of care and ways of working.’

Director of nursing Helen Lancaster says the trust is ‘extremely proud’ of the team. She adds: ‘We are proud of all they have achieved and the great care they provide to patients. Carole’s leadership and dedication to the service have ensured that the care we give to patients is of the highest standard.’

The RCNi Nurse Awards judges agreed on both counts. They called the unit ‘a great model of care’ and praised Carole’s leadership. The judges attributed part of the unit’s success to the clear drive to protect and develop the role of the clinical nurse specialist and put them in charge. As one put it: ‘It feels like something big is going on here.’

Judge Jan Baptiste-Grant was impressed by the focus on patients and the team ethos. She says: ‘This service has no silos; its nurses seek partnerships and engage their patients in this seven-day service. The drive to develop staff is impressive.’

The continuous strive to improve is ‘built on the foundations of communication with patients/carers, audit and evaluation’, says Carole.

As well as national and local audits by qualified and non-qualified staff, there is a patient forum and focus groups consider specific issues such as chemotherapy pump removal. This helps the unit to continue to grow. It is diversifying into other specialties, offering chemotherapy to non-cancer patients. It has been so successful that the trust is investing in a new unit to be managed by the same team due to open in Stratford early next year.

Carole says: ‘Simplicity keeps us on course. We are committed to providing an excellent service and making a difference to our patients and carers. We have achieved this through strong leadership, focused teamwork, developing and evaluating innovative ways of working and never forgetting that the patient and carer is at the centre of all we do.’

Cancer Nursing award finalists

Chemotherapy information team, Gloucestershire Hospitals NHS Foundation Trust

Alison
Peett

Training and development nurse Alison Peett led the transformation of care for patients about to embark on chemotherapy at Cheltenham General Hospital.

Previously, patients had to wait for a one-to-one session, but now up to eight patients at a time attend an information morning and are able to bring a carer. There is a 20-minute presentation about the treatment and its side effects, and a ten-minute private nurse assessment. Patients receive tailored, written information and signposting to support services. Patient and carer feedback has been positive.

Christine Talboys, advanced nurse specialist, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

Christine
Talboys

A new approach to giving patients histology results and a tailored care plan is improving the experience of patients with non-muscleinvasive bladder cancer. Christine Talboys standardised the pathway so that newly diagnosed patients are booked directly into a nurse-led results clinic. The personalised care plan she developed gives patients a clear explanation of their condition and follow up.

Previously, 33% of patients knew their cancer’s grade, and 72% were aware of its stage. Now all patients know their grade and 94% can recall the stage. The time from histology to the patient being informed has reduced from 17 to 13 days, and other trusts are adopting the care plan.

CAT trial team, University of Central Lancashire and Lancashire Teaching Hospitals NHS Foundation Trust

Kinta
Beaver

A team of clinical nurse specialists has improved the experience of women treated for endometrial cancer by providing a telephone follow-up service. The nurses ask specific questions and address concerns, enabling patients to build a trusting relationship with their nurse. Patients value the convenience and continuity of care.

An evaluation of the project, which has been led by University of Central Lancashire professor of cancer care Kinta Beaver, found that compared with those attending clinics, women in the telephone group were no more anxious, and were highly satisfied with the service. It did not take longer to have recurrences detected in the telephone group.

Gillian Al-Kadhimi, hepatocellular carcinoma clinical nurse specialist, King’s College Hospital NHS Foundation Trust

Gillian
Al-Kadhimi

Gillian Al-Kadhimi has introduced a Skype clinic in the hepatocellular carcinoma liver cancer unit, allowing patients to access specialist care from the comfort of their home. There are only seven liver centres in the UK, so patients were making long, exhausting and expensive trips to hospital.

As well as improving patient experience and quality of life, the Skype clinic has been valuable for patients undergoing a new type of oral chemotherapy that requires close and frequent monitoring. The ability to see patients has improved assessment, enabling early intervention when needed. It has also improved timing for access to palliative care. Patient feedback has been excellent.


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