The Challenge Patients arrive early and undergo a number of tests particularly relating to pathology. After about an hour or two the results are available and the chemotherapy prescription is, or in some cases is not, confirmed.
There is then a wait for the patients and their carers whilst the chemotherapy is prepared in the pharmacy department.
The pharmacy department receives the majority of its chemotherapy orders within a small time frame with little or no indication of priority and is under pressure to complete the workload as quickly as possible.
Patients and ward staff become frustrated with delays to Chemotherapy and this is reflected in communications between teams.
To help manage the expected pressure the pharmacy department prepares as much chemotherapy as possible in advance of prescriptions being confirmed, however where chemotherapy doesn’t go ahead these drugs are wasted.
Waiting patients occupy clinical space for longer than is necessary and this creates capacity pressures.
Opportunity A project with an indefinite lifespan was commenced in order to address the multiple system deficiencies which had arisen.
The project began in a small way and the approach taken was organic. The project would progress at a rate relative to the capacity for change amongst the affected staff and services.
At all stages the project was informed by, and kept informed, all staff involved in the preparation and administration of chemotherapy. Although patients were not directly involved in the project they were the primary concern of the project board and nothing was implemented which would have a negative impact on patients or their experience of care.
Action
• A small multi-disciplinary team of enthusiastic and motivated staff were brought together.
• Headed by a senior nurse whose role enabled activities which were focused on service redesign.
The following key changes were implemented by the team:
• A designated staff-link between ward and pharmacy aseptic services was created.
• Specific software was introduced which integrated with existing chemotherapy prescribing software.
• Awareness of the process of chemotherapy aseptic preparation and the extent and value of unused chemotherapy was increased amongst ward staff and prescribers.
• Relationships between ward staff and pharmacy staff improved.
• Use of dose-banding, agreed between clinical pharmacists and prescribers, was optimised.
• Prescribing practice was changed so that all chemotherapy prescriptions were required to be confirmed with the pharmacy department at least 24 hours in advance of the scheduled delivery slot.
For further information, please contact Wendy Anderson, Macmillan Nurse Consultant, Chemotherapy at South Tees Hospitals NHS Trust at [email protected].