Nurse prescribing in Cancer Care. Emma Sweeney MSc BSc (Hons) RN Macmillan Head of Cancer Nursing Colchester Hospital University Trust

Transcription

1 Nurse prescribing in Cancer Care Emma Sweeney MSc BSc (Hons) RN Macmillan Head of Cancer Nursing Colchester Hospital University Trust

2 Objectives Supporting non medical prescribers: discuss the infrastructure needed to support he safe and effective development and implementation of non medical prescribing Developing advanced role around non medical prescribing Developments in cancer care prescribing

3 National Strategy Over 230,000 people in England and Wales develop cancer each year, and cancer accounts for one quarter of all deaths. A diagnosis of cancer and its subsequent treatment can have a devastating impact on the quality of a person s life, as well as on the lives of families and other carers. Patients face new fears and uncertainties and may have to undergo unpleasant and debilitating treatments. They and their families and carers need access to support from the time that cancer is first suspected, through all stages of treatment to recovery or, in some cases, to death and into bereavement.

4 Cancer Pain Is caused by tumours pressing on bones, nerves or other organs in the body or the cancer treatment itself eg. Chemotherapy. There are different types of cancer pain: Nerve pain: neuropathic pain, pressure on nerves or spinal cord burning, tingling common after surgery Bone pain: Somatic pain. Metastatic disease, causing damage to the bone in one or multiple areas aching, dullness or throbbing

5 Cancer Pain Soft Tissue pain: Visceral pain. Pain from a body organ or muscle for example pain in back from kidney disease often described as sharp, cramping, aching and throbbing Phantom pain: Where part of the body has been removed (mastectomy) and experience pain the site that has been removed Referred pain: pain experienced in a different part of the body to where the tumour is situated eg: swollen liver right shoulder pain as presses on nerves in that area.

6 The role of the Cancer Clinical Nurse Specialist The roles undertaken by Clinical Nurse Specialists (CNSs) are many and varied; however, there are core clinical practice functions and a level of practice that could be reasonably expected of all CNSs in cancer care. CNS s in cancer care can be described as registered nurses, who have graduate level nursing preparation and who would usually be expected to be prepared at Master s level. They are clinical experts in evidence based nursing practice within a specialty area. The specialty may be focused on a population, type of care type of problem, type of treatment or tumour type

7 The role of the Cancer Clinical Nurse Specialist They are clinical experts in evidence based nursing practice within a specialty area. The specialty may be focused on a population, type of care type of problem, type of treatment or tumour type The specialist nature of the cancer CNS and their role as key worker to individual patients means that they can quickly identify emerging issues that might require medical attention, enabling care to be planned and emergency admissions averted.

8 The role of the Cancer Clinical Nurse Specialist CNS s also support enhanced recovery after surgery equipping patients to manage their recovery at home and reducing the need for lengthy hospital stays. These two important contributions help the NHS to improve patient experience and safety. CNS roles have developed to include technical elements, for example: physical examinations and diagnostic tests; and insertion of central venous lines for the delivery of chemotherapy or for nutritional purposes

9 Maintaining training & support fro NMP s NMC Standard set of education and training once you become a NMP 2. Ensures patient safety in accordance with non medical prescribing law 3. Acknowledges the risk that medicines can pose for patients which includes age 4. Ensure competence and confidence to utilise the NMP qualification to its full potential

10 The benefits of NMP 1. Immediate prescription of drugs to assist in cancer pain and associated symptoms following a holistic assessment 2. Reduction of delays for patient receiving symptom alleviating medication 3. Ability to re review and provide dose adjustments if patients symptoms dictate 4. Improved patient experience 5. Asking the question should you prescribe or not?

11 Case Study 1 55 year old lady attended the chemotherapy unit prior to next dose of Cituximab, following assessment with the Nurse Consultant the lady reported that the rash had been improving over the last 2 days - What do you think the NMP did?

12 Case study 2 Patient receiving chemotherapy attended pre chemotherapy clinic for their next cycle, on review of their blood profile it was noted that they remained neutropenic. How did a NMP improve the patient s safety and experience in this situation?

13 The benefits of NMP 1. Reduction in the delays for adjustments to the patients prescriptions 2. Alleviation of patients symptoms 3. Further assessment and review of symptoms and dose changes or medication change if indicated 4. Nurses feeling powered to manage patients symptoms appropriately.

14 Conclusion 1. Highlighted the key priorities for cancer patients 2. Discussion of the national policies and frameworks that underpin our practice 3. Literature highlights the benefits of NMP in this field 4. Better outcomes and experience for patients 5. However support and continuous education if required in particular around off licence medications

15 References 1. National Cancer Action Team (2010) Quality in Nursing: Excellence in cancer care: The contribution of the CNS 2. National Institute of Clinical Excellence (2004) Supportive and palliative care guidance 3.