Cancer Services Collaborative Process

PHASE 2

ROLL OUT PROGRAMME

BREAST CANCER PROJECT

"TOOLKIT"

 

Achievements in Phase 1 (2001)   follow link

 

 

 

We are now part of the National Cancer Services Collaborative, making innovations in cancer care and passing this onto other units

GOAL

To improve the experience and outcomes for patients with suspected of diagnosed cancer.

The principles for change are:

strategy A co-ordinating the patients journey

strategy B improving the patients experience

strategy C optimising care delivery

strategy D managing capacity and demand

This is a national project. Five cancers have been identified for this project, bowel, breast, lung ovarian and prostate.

The participating centres are:

· Mid Anglia Cancer Network (eastern region)

· South East London Cancer Network ( London region)

· West London Environs and Cancer network ( London region)

· Meryseyside and Cheshire Cancer network ( North West region)

· Northern Cancer network ( Northern and Yorkshire region)

· Kent Cancer network ( South East region)

· Avon and Somerset Cancer Services (South West region)

· Leicestershire Cancer centre (Trent region)

· Birmingham Hospitals Cancer network ( West Midlands region)

Each project team (43 hospitals) undertakes an action period working in their own environment creating improvements. Our project team is Salisbury and ourselves. We meet to discuss intended changes. The collaborative comes together as whole four times. The aim is to gain a better understanding of changes outside our environment and to integrate suitable improvements into our own workplace. The changes we make should be based on where we perceive a problem to be, which should be in relation to the 4 strategies. We are also expected to audit, in a small way, any potential or actual change.

There are 4 stages to a change cycle (PDSA) Plan - plan the change to be tested or implemented Do - carry out the test or change

Study - study data before and after the change and reflect on what was learnt Act - plan the next change cycle or plan implementation

Each PDSA cycle has to have an implementation date. At each meeting we feedback what we have done, what we are doing, and what our future plans are.

At the end of the 16 month programme, the project teams will share their achievements and lessons learnt with other cancer centres! networks and with the wider NHS by:

· a national reference guide to improving delivery of care to patients with suspected or diagnosed cancers

· a national seminar

· a programme of events for spreading new systems of care delivery

CHANGES IN PLACE AT PRESENT

· Summary of benefits table to GPs ( NPI per patient for information)

· Referral proforma for GPs

· Further development of MDI which will create a detailed post histology GP letter, a referral letter for the Oncologist and a copy for the patients record.

· Discharge of Family History patients to mammography screening only.

· Review of patient information packs

· Review of information for benign diagnosis

· Patient questionnaire on services provided

· Introduction of a planned appointment system for oncology referrals

· Creation of patient resource room with internet and computer information

· Development of a link nurse within the plastic surgery ward

· Training of the clinic nurses for the role of advocate at the time of diagnosis

NEXT CYCLES PLANNED

· Development of a training programme for nurse practitioners to work within follow up clinics

· Development of a planned programme for GPs (to raise awareness of appropriate referrals

· Internet review using patient volunteers

· Network with other centres Re development of IT Eg direct bookings (Salisbury)

· Reassess access of physiotherapy club

 

Achievements So Far

· GP training sessions to: raise awareness of referral guidelines

Gain an understanding of the clinic procedures

Raise awareness of advocacy

Understand role of the breast care nurse

· Nurse practitioner training programme set up. Two nurses who both work on the admitting ward and in the clinic have official training in order to undertake supervised follow up sessions in clinic, and to asses and aspirate seromas. In addition the two breast care nurses are also aspirating seromas routinely.

· Computer MDI letters for post operative patients generating letter to GP, referral letter to oncologist and information letter to patient with details of type and grade of cancer, and adjuvant treatment required.

· To notify district nurse on the day of diagnosis ensuring good communication.

· Electronic (fax) system of pre-booking oncology referrals following post-operative multidisciplinary meeting reducing delays in appointment booking.

· Setting up of Young Women’s Support Group

· Review of patient information pack including contact card for partner, updated leaflets on lymphoedema, support group information

· Opening of Patient Resource Room with library loan of books, videos, tapes, and unrestricted access to the internet with "favourite" sites and links.

· Development of link nurse on plastic surgery ward for continued care

· Agreement of follow up protocols - release from planned follow up at 5 years post surgery with long term open appointment and 2-yearly mammography

· Adoption of two week wait referral proforma, encouraging GPs to advise all urgently referred patients to ring the Centre the day after their GP appointment to obtain clinic appointment date, thus ensuring GPs refer within 24 hours and reducing DNAs

· Most recent development of an audit tool to monitor appropriate/inappropriate referrals

· Provision of hand held patient diary

· Breast Care Nurses preclerking patients for admission