1. The appointment of two new lead Acute Oncology Nurses (AON)

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1 Salisbury Foundation Trust Acute Oncology Service Annual Report Achievements We are pleased to report our achievements this year. This is reported to the departmental Haematology/oncology/palliative care departmental meeting on a monthly basis and feed back to executive leads by Dr Jonathan Cullis, Clinical Lead for Haematology and Oncology. 1. The appointment of two new lead Acute Oncology Nurses (AON) Following the resignation of Sr Rebecca Thomas last year we advertised for a new Acute Oncology Lead Nurse. In March 2015 we successfully appointed 2 lead Acute Oncology Nurses fulfilling 1.2 WTE. This has ensured we have two experienced oncology/haematology nurses delivering the acute oncology service during normal working hours (Mon-Fri 8-4pm). Their role includes triage and management of patients presenting with acute oncology problems (using our established assessment room), along with an outreach service to the wider hospital, and proactive telephone follow-up for those patients suitable for discharge. Out of hours, the acute oncology bleep is held by senior oncology nurses working on the Pembroke oncology ward. These nurses have been trained to use the UKONS triage system and are available to advise patients and staff regarding acute oncology problems. They have all completed the network acute oncology induction training and are aware of the relevant acute oncology pathways. 2. We have established the electronic flagging system SFT has sucessfully developed an electronic flagging system which was piloted in 2013 and then launched subsequently. It is now fully operational. Patients are added to the data warehouse by our AON s during preassessment for chemotherapy and then removed by the team around six weeks after completion of chemotherapy treatment. An alert flag is generated and sent to acute.oncology@salisbury.nhs.uk when a listed patient is admitted to Salisbury Foundation Trust. 3. The Service Specification policy for Malignant Spinal Cord The Network Acute Oncology Group (NAOG) have agreed a Service Specification Policy for Malignant Spinal Cord Compression including an agreed pathway and access points for Clinical Oncology input and Neurosurgical MDT opinion and access to neurosurgical input. This links with our local policy and cases of MSCC will be a subject for ongoing audit which will be presented at our Acute Oncology meetings. 4. Neutropaenic Sepsis Since March 2015 we have reestablished the Neutropaenic sepsis audit and the AON s are collating data on all cases of suspected neutropaenic sepsis. This is in accordance with the brief from the Network Acute Oncology Group and our data will be presented at the next NAOG meeting to be held September To date our limited data, identifies that we are meeting our target of delivering antibiotics to patients with suspected neutropaenic sepsis, within sixty minutes of arrival.

2 5. GP education Dr Harvey presented at the GP update conference held in September 2014 and Sr Angela Iveson presented again in April Feedback has been positive. Challenges Inevitably we have experienced some challenges particularly relating to changing staff and service requirements. 1. Lack of Medical Staff to support the Acute Oncology service The measures state that we must have 5 PAs of time/working week dedicated to delivering the AOS. Unfortunately we only have 1 session of time available and this covers DCC and managerial responsibilities for development of the service, including all the administrative work for peer review. 2. Poor Collation of data Due to changing staff and lack of administrative staff we have failed to reliably collate data relating to the AOS. Although, for neutropaenic sepsis and MSCC, we believe we have now resolved this problem. 3. No administrative support We have agreed job descriptions and roles and responsibilities for administrative staff contributing to the AOT. However, we have no personnel in place to deliver this role. Wendy Young was informed at the HOP meeting and is working to appoint new staff to the role. It is important to note that minutes from the last 3 AOT meetings have been dictated by Dr Harvey but not typed. This is a serious concern. 4. The acute oncology induction training We have raised awareness of the AOS throughout the hospital including local contact points. However, following the dissolution of the CSCCN Network no further Network wide training has been established. 5. Permanent contract for both AON s Sr Angela Iveson has only been appointed on a 6 month fixed term contract. This has 3 months remaining and will expire 1/9/2015. We require her services and in deed already the service is benefiting from her extensive oncology experience and capability. Sr Sarah Goulbourne has a permanent contract.

3 Patient numbers (due to incomplete data collection- figures below are from 1 st March to date) Number of oncology admissions MAU - (awaiting info from IT) Outlier (awaiting info from IT) ED - (Await info from IT) Pembroke - 36 Number of direct access AO calls answered = 207 Calls by speciality/consultant TJI (upper GI/colon) 28% AYB (Lung/prastate) 19% JB (Breast) 18% JOC (Haematology) 11% LF (Haematology) 8% MH (CUP/Gyni) 10% EG (Haematology) 4% CC (Breast) 1% TE ( ) 1% Number of calls resulting in admission = 36 Number of calls that did not result in admission = 171 Numbers of oncology patients attending pre-assessment clinics starting chemotherapy by speciality TJI 38 JB 16 AYB 13 MH 7 CC - 4 Number of patient s attending the assessment room = 24 Numbers discharged from the assessment room = 19 Numbers admitted from the assessment room = 5 Numbers of patients referred with MSCC = 1 Numbers transferred to a cancer centre for MSCC treatment =1 Number of patients receiving palliative DXT = (await IT to get info) Number of patients undergoing neurosurgery = (await IT to get info) CUP patients Total number = 19 6 of these had chemotherapy 2 received Radiotherapy 11 patients received best supportive care/palliative care Neutropaenic sepsis audit 9 cases of suspected Neutropenic sepsis (6 Haematology patients & 3 Oncology) 100% of suspected NS patient s received antibiotics within 1 hour door to needle time 88% of patients followed Neutropenic pathway

4 62% of patients had a completed NS sticker placed within their medical notes MSCC audit Only had 1 case of MSCC since March 2015 Patient seen in clinic, commenced on PPI/Dex immediately and referred to Southampton for urgent Radiotherapy. This was received within 24 hours of diagnosis therefore following the MSCC national guidelines.

5 The AOT meetings The acute oncology team meetings take place bimonthly on the fourth Thursday in the month. The attendance is recorded as below. Sample AOT minutes ABC= Acute Oncology Team Meeting Held on: 4th September 2014 Pembroke Seminar Room, Level 2 1. Attendance Dr Melanie Harvey (Chair) (Lead Clinician for AOS) Dr Catherine Thompson, Mr Jeremy Whiteley, Debra Robertson, Dr Hatice Gungor, Louise Arnett 2. Apologies Roy Dear, Carolyn Sawyer, Belinda Mills, Rebecca Thomas, Nickola Amin - ED, Steve Davies - who were both at a planned and significant Emergency Department meeting. Debbie Butler, Emma Adams ACTION 3. Previous Minutes This meeting was prior to CUP peer review process. The operational policy, work programme and annual reports were all completed and uploaded to the C- quins site. 4. Terms of Reference Roy Dear will no longer be able to attend the Acute Oncology/CUP Team meetings. I will ask Sister Carolyn Sawyer if she can take over his role and adjust this in the terms of reference if she is in agreement. 5. Acute Oncology/CUP Work Programme Is established and ongoing, there were no changes to the programme. 6. Operational Policies The operational policies for both acute oncology and CUP are up to date as of the beginning of 2014 for acute oncology and July 2014 for CUP. 7. CUP Peer Review Report Jeremy Whiteley reported a positive outcome from the

6 recent CUP Peer Review. However there was an acknowledgement that work is still to be done in this area and of course this will be ongoing through our work programme. However he noted the good work that has been done this year in completing and clarifying the protocols and pathways for this service. 8. MSCC Audit Was not presented in the absence of Rebecca Thomas. 9. Neutropenic Sepsis Audit Rebecca Thomas submitted a document containing data regarding the neutropenic sepsis audit. This was presented on a spreadsheet and it is her intention to convert this to a bar chart to draw out the specific measures relating to neutropenic sepsis for future reporting to the network acute oncology group. It was acknowledged that all spected cases of neutropenic sepsis must be included in the report. 10. Rapid Referral Pathway - CUP Was not further discussed due to lack of time. 11. CUP Keyworker Pathway Was discussed in depth but unfortunately in the absence of Debbie Butler. A planned meeting has been arranged between the Cancer Nurse Specialist and Rebecca Thomas. This will take place on the 17th September 2014 and will discuss the keyworker pathway and processes for cancer of uncertain primary. The acute oncology/ CUP team have suggested that the appropriate keyworker should be identified through the which MDT process. The keyworker can be changed if subsequently primary site is identified. In addition if there is no clear primary site or indeed treatable tumour syndrome identified and the patient appears to meet the criteria for a true cancer of unknown primary then the keyworker will be Rebecca Thomas. This item with be discussed again at the next meeting with an update from the meeting with the CNS's. 12. Acute Oncology Team Staffing Prior to this meeting Debbie Butler has confirmed that although the staffing of the acute oncology team falls short of the peer review reviewed measures the request for a deputy acute oncology nurse has been

7 declined. Jeremy Whiteley was not aware of this but he will discuss with Debbie Butler to clarify this. 13 Any Other Business Louise Arnett attended to run through the process of the e-referral system. There is concern about how this will work for oncology. Oncology inpatients are managed under the care of the Respiratory Physicians as most of the oncologists are visiting or part time. However any e-referrals should be sent to The acute oncology bleep holder will responsible for checking for e- referrals. This system does not take the place of bleeping the acute oncology nurse should there be an urgent referral. Catherine Thompson asked if we could ensure that all acute admissions coming from oncology are documented in the book on MAU. This is generally requested via the medical registrar. Stuart Henderson requested that wherever possible could acute oncology admissions during working hours be seen by a consultant oncologist or Dr Gungor. Jeremy Whiteley suggested that audits are now required to support both the acute oncology and CUP services. Dr Harvey noted that the team were not quorate. Please could all core members attend the acute oncology team meetings as often as possible and if they are unable to attend please could they ensure that their deputy comes in their place. Attendance is monitored through peer review. However apologies to the Emergency Department who were unable to attend on this occasion due to the late change in the meeting date. This was changed because of a lack of core members who could attend the August meeting. 14. Date of Next Meeting The next meeting will be held on THURSDAY 27th NOVEMBER 2014 at 11:00 PEMBROKE SEMINAR ROOM LEVEL 2

8 Conclusion In conclusion we have had a challenging year with significant changes in staff and periods without adequate clinical cover. However, we must thank Sr Sue Potter for her kindness and flexibility, stepping in to the AON role, at times of staffing difficulty and for her continuing support to the service. We believe this should be acknowledged and rewarded by the Trust. We have clearly made progress with our staffing, appointing 2 new lead nurses, but Angela Iveson s appointment needs to be made substantive. We strongly urge the Trust to formalise this arrangement by offering Sr Angela Iveson a substantive post in keeping with Sr Sarah Goulbourne. We are in need of regular and reliable administrative support for this service. A rapid appointment to the agreed job role is now essential. We feel the service will improve over the coming year following the appointment of a stronger Lead AO nursing team but the decision to admit is key for the acute oncology service and for this we believe Consultant or Senior Oncology Doctors are required. It is our priority to keep oncology patients with acute problems at home as much as possible. Clearly, on occasion admission is required but with adequate staffing and support services we feel admissions can be kept to a minimum and, for those admitted, length of staff minimised whilst still providing gold standard care..