Children s Community Nursing Team Chemotherapy Policy

Transcription

1 Children s Community Nursing Team Chemotherapy Policy 1

2 Policy : Children s Community Nursing Team Chemotherapy Policy Executive Summary The purpose of this document is to set out guidance for the safe prescribing and associated handling and administration of low risk chemotherapy for children and young documents: people up to 16 years of age (19 years of age for children with complex needs) within East Cheshire NHS Trust. This policy is intended to safeguard children and young people and staff by defining best practice for the Children s Community Nursing Team (CCNT) staff involved in the administration of low risk chemotherapy. This policy provides a framework of guidance which aims to minimise risks by promoting safe handling of cytotoxic drugs. Supersedes: Children s Community Nursing Team Chemotherapy Policy May 2015 Description of Amendment(s): Numerous grammatical and typographical updates, Addition of competencies, Reference to updated policies and guidelines This policy will impact on: All Children accessing the CCNT requiring chemotherapy Financial Implications: Policy Area: Acute & Integrated Community Care Document Reference: ECT Version Number: 2 Effective Date: May 2017 Issued By: Children s Ward Review Date: May 2019 Authors: Sr Joanne Doyle Impact Assessment Date: Jan 2015 APPROVAL RECORD Committees / Group Date Consultation: CCNT team members, Children s April 2017 Ward Manager, Head of Children s services, Paediatric Clinical lead, Paediatric Consultants, Paediatric Pharmacist, Approval Committee Paediatric SQS April 2017 Received for information: April

3 Contents 1. Introduction 2. Scope of Policy 3. Aims and objectives of the service 4. Referral pathway 5. Starting Chemotherapy in the Community 6. Prescribing information 7. Safe handling of cytotoxic drugs 8. Responsibilities of the CCN 9. Training 10. Record Keeping 11. Roles and Responsibilities 12. Implementation 13. Measuring performance & Audit 14. Review 15. References 16. Equality Analysis 3

4 1 Introduction The purpose of this document is to set out guidance for the safe handling and administration of low risk chemotherapy for children and young people up to 16 years of age (19 years of age for children with complex needs) within East Cheshire NHS Trust. This policy is intended to safeguard children and young people and staff by defining best practice for the Children s Community Nursing Team (CCNT) staff involved in the administration of low risk chemotherapy. This policy provides a framework of guidance which aims to minimise risks by promoting safe handling of cytotoxic drugs. 2 Scope of Policy The document is aimed at staff delivering low risk chemotherapy for children and young people with malignant and non-malignant disease. Specialist nursing care by the East Cheshire NHS Trust Children s Community Nursing Team (CCNT) will endorse the guiding principles of Care Closer to Home by offering safe and effective care at home. The CCNT will provide equitable and holistic care that embraces the child or young person s physical, social, emotional and cultural needs. If carers, children or young people understand little or no English and the member of staff does not speak their language, they will be offered the opportunity to discuss their treatment with the aid of an interpreter. The prescribing of chemotherapy drugs does not form part of this policy as the paediatric department does not diagnose malignant diseases nor does it commence chemotherapy treatments for malignant diseases. 3 Aims and objectives of the service Administration of intravenous and subcutaneous chemotherapy by the Children s Community Nursing Team is an essential component of the role. The East Cheshire NHS Trust Children s Community Nursing team will work in partnership with the Paediatric Outreach Oncology Nurse Specialist and the principle tertiary or specialist centres, Royal Manchester Children s Hospital, The Christie Hospital and Alder Hey Children s Hospital to provide clinical care that is seamlessly integrated with the specialist hospital services, to ensure a comprehensive range of care and support is offered in the community. Children with cancer want to lead ordinary lives like all other children; they have a right to achieve their potential both during their treatment and in laying the foundation for their future. As per the Children s Community Nursing Team Operational Policy (2016) the East Cheshire NHS Trust Children s Community Nursing Team aims to bring about lasting changes in the care of children with cancer by ensuring both clinical outcomes and the experiences of the children or young people and their families are positive. 4 Referral Pathway All children and young people referred to the Team will have diagnosis of malignant disease. Referrals will be accepted following a Multidisciplinary Discharge Planning Meeting held at the tertiary or specialist centre. CCNT staff members do not need attend this meeting. Initial telephone confirmation of referral acceptance is acceptable but CCNT must ensure that a written referral is received from the referring centre. Referrals will be taken for children and young people aged between 0 16 years (19 years for children with complex needs) who fit the admission criteria for the CCNT - see East Cheshire NHS Trust Children s Community Nursing Team Operation Policy (2016) 4

5 Trust/policies/P/Paediatrics%20Childrens%20Community%20Nursing%20Team%20Operational%2 0Policy%20ECT2652.pdf The referring tertiary centre must ensure that appropriate consent has been gained for the patient to have Chemotherapy at home. Proof of consent should be forwarded to the CCNT. CCNT should also adhere to the Trust Consent to Examination or Treatment Policy (2016) Trust/policies/C/Consent%20to%20Examination%20or%20Treatment%20Policy%20ECT2477.pdf All referrals will have dedicated Consultant Oncology Specialist Paediatrician based at the tertiary centre who will provide expertise that will help facilitate clinical care in the local community. Referrals will be made by the tertiary centre into Adult Services for those young people who have required care during the transitional phase up to the age of 19 years. (CCNT accept up to 16 years) 5 Starting Chemotherapy in the Community The decision to treat a child or young person with chemotherapy should be made by the Paediatric Oncology Consultant at the tertiary centre and agreed at the Multidisciplinary Discharge Planning Meeting. Cytotoxic drugs must be prescribed on a recognised chemotherapy prescription sheet. Designated paediatric pharmacists at the tertiary centre should clinically check and authorise all chemotherapy prescriptions that will be used in the community. Individual CCNT staff members will be deemed clinically competent to carry out safe administration of low risk chemotherapy in the community, having completed the Royal Manchester Children s Hospital Chemotherapy Training and annual updates and practice competency. All CCNS undertaking administration of chemotherapy in the community will be IV trained and competent as per East Cheshire NHS Trust guidelines. 6 Prescribing information The tertiary centres are responsible for the provision of all drugs, saline flushes and Heparin flushes. Children will be discharged home with sufficient supplies of treatment for the Children s Community Nurses to administer over the duration of the treatment course. The tertiary centres are responsible for the provision of all consumables including syringes, gloves, aprons, alcohol wipes, needles, and colour specific sharps bins for all children discharged home who require support from the CCNT. Prescriptions for Cytotoxic drugs and all subsequent cycles of chemotherapy must contain the following information: Child/Young persons full name NHS number Date of birth Location of where treatment to be administered Weight, height and surface area if indicated Prescription regime course or cycle number Allergies Route of administration 5

6 Volume, dilutent and rate of administration Date and time dose to be given Signature of prescribing doctor and date The drugs commonly used in malignant and non-malignant disease and indicated for safe administration in the community are: Methotrexate Cytarabine Granulocyte Colony Stimulating Factor (G-CSF) On completion of cycles of treatment the signed prescription sheet in the CCNT records is retained and must be photocopied and sent back for amalgamation in tertiary centre records. In exceptional circumstances it may be necessary that a patient may require treatment not included on the above list of accepted chemotherapy drugs. CCNT should discuss this with the patient s Paediatric Oncology Consultant and a collaborative decision made as to the appropriateness and feasibility of carrying out further treatments in the community. CCNT Staff Members should never administer Cytotoxic drugs that they have not been trained to administer. 7 Safe handling of cytotoxic drugs The CCNT must adhere to local policy detailing the safe handling of cytotoxic drugs in addition to the guidelines provided by the referring centre. East Cheshire NHS Trust Dispensing and Storage of Medicines Policy %20Dispensing%20and%20Storage%20ECT2709.pdf East Cheshire NHS Trust Healthcare Waste Management Policy Trust/policies/W/Waste%20Management%20Policy%20ECT2714.pdf Central Manchester University Hospitals Cytotoxic Medicines Safe Handling Policy The Christie NHS Foundation Trust Cytotoxic Spillage and Contamination Policy Cytotoxic drugs interfere with cell division, but as this action is not specific to tumour cells, normal cells may also be damaged. As a result, they can produce significant side effects in treated patients, or others exposed. This, together with the increasing complexity of chemotherapy, has raised concerns about the risks to health care workers involved in the preparation and administration of chemotherapy and/or the caring of patients undergoing treatment. For healthcare personnel the potential of exposure exists during tasks such as drug reconstitution and preparation, administration and disposal of waste equipment or patient waste. Hence, all staff involved in the delivery of services to cancer patients must be aware of all health and safety procedures. The more common routes of exposure are contact with skin or mucous membranes (e.g. spillage and splashing), inhalation (over-pressurising vials), and ingestion (e.g. through eating, drinking in contaminated areas or from poor hygiene). Less likely routes of exposure include needle-stick injuries which can occur during the preparation or administration of these drugs. Some cytotoxic drugs can cause acute or short-term health effects including irritation to the skin, eyes, and mucous membranes. 6

7 Control of Substances Hazardous to Health (COSHH 2002) risk assessment must be undertaken by the Tertiary centre prior to the patient being referred to CCNT. The adoption of safe handling techniques reduces the potential for exposure to cytotoxic drugs significantly. Trust/policies/C/Control%20of%20Substances%20Hazardous%20to%20Health%20COSHH%20Policy%20 ECT2568.pdf 8 Responsibilities of the CCNT CCNT staff members involved in handling chemotherapy waste are aware of both local and tertiary policies and procedures for handling, disposal and spillage of cytotoxic drugs. The child or young person must be observed throughout the entire administration of chemotherapy. The CCN must check for fever and general health before administration of chemotherapy. If temperature is above 37.5 or the CCN, parent or carer has any other concerns treatment MUST NOT be started and the patient referred back to the referring centre for advice. The CCN must carry emergency adrenaline in case of anaphylaxis. The CCN is trained and competent at basic paediatric life support. The CCN incorporates Aseptic Non-touch Technique (ANTT) when administering all IV chemotherapy. This is to reduce the risk of infection and promote best practice.. %20Aseptic%20Non%20Touch%20Technique%20ANTT%20ECT2564.pdf The CCN will support the child/young person with care of IV or central venous access devices or ports throughout the duration of treatment. Ports will be flushed monthly and lines weekly in accordance with policies and procedures from the referring centre. The CCN must carry out a risk assessment of the environment to be used, prior to undertaking any administration of chemotherapy in the community or home. The risk assessment forms part of the admission process to the CCNT and should detail personal protective equipment required, e.g. gloves, aprons, gowns or eye protection all of which should be provided by the referring centre. In the event of a spillage or contamination the CCNT will complete the necessary online Datix Incident Form and document details accordingly. 9 Training Individual nurses will be deemed clinically competent to carry out safe administration of low risk chemotherapy in the community, having completed a full day training course at the Royal Manchester Children s Hospital followed by completion of set practice competencies. The Nurse must be signed off by a CCNT Team Leader see competency; All Children s Community Nurses will adhere to NMC Standards for Medicines Management. All Children s Community Nurses will be trained to use central venous access devices, peripheral lines and any complication that may arise with the lines. 7

8 All Children s Community Nurses to be able to recognise all common chemotherapy side effects such as nausea, vomiting, stomatitis, diarrhoea, phlebitis, alopecia. All Children s Community Nurses to recognise and report signs or complications of immunosuppression immediately. All Children s Community Nurses to know how to deal with extravasation, anaphylaxis and neutropenia and any Oncological emergencies. 10 Record Keeping All patients referred to the CCNT for chemotherapy in the home will have individual records and care plans recorded on the Trust electronic recording system EMIS. All records will include: Completed referral form from referring centre Discharge summary from referring centre Up to date risk assessment Consent to treatment from referring centre Individualised care plan based on guidelines from referring centre Information on treatment plans and drug cycles Observation and monitoring information Contact information for Oncology liaison nurses and Oncology Consultant from referring centre along with details of any other professionals involved Information on procedures for caring for Totally Implanted Venous Access Devices, Central Venous Access Devices or any other venous access line relevant to the patient. All home visits for treatment, clinical assessment, monitoring, support and advice will be documented in the patient electronic records. Prescriptions will remain in paper form. 11 Roles and Responsibilities Children s Services Manager o The role of the Children s Services Manager is to support and oversee the Ward Manager and CCNT staff members in the management of the service, act as advocate for the service in relation to the service development Children s Ward Clinical Matron o The role of the Children s Ward Manager is to oversee the supervision of the CCNT Team leaders in the day to day running of the service CCNT Sister/Team Leader o The role of the CCNT Team Leader is to maintain responsibility of the day to day management of the team, oversee activities undertaken, highlight training needs and support staff to access training, engage and the lead the service development plan taking a long term view of service need, provide supervision for the CCNT Nursing Team. CCNT Registered Nurses o The role of the CCNT Nursing Team is to assist the Team Leader(s) in the day to day management of the service, undertake nursing cares within staff members own competencies, highlight own training needs and make effort to access appropriate training, engage in service development and contribute positively this plan, cover shifts on the children s ward as and when requested and required. o All staff members have a duty to ensure the health and safety of themselves and others whilst at work. Safe working practices and health and safety precautions are a legal requirement 8

9 o Registered Nurses must work cooperatively within teams and respect the skills, expertise and contributions of their colleagues (NMC, 2008). CCNT Health Care Assistant o The CCNT HCA should not be involved in the administration of Chemotherapy. Any telephone queries should be directed to CCHT staff nurse or Team Leader. 12 Implementation The policy should be implemented in its entirety by all staff members under the employment of the Children s Community Nursing Team and Children s Ward at East Cheshire NHS Trust. 13 Measuring performance & Audit The effectiveness and performance of the CCNT will be measured through regular staff meetings, feedback from patients and families, and all staff members engaging in the appraisal process. Regular audits will be undertaken to ensure documentation is in adherence with the East Cheshire NHS Trust Clinical Records Management Policy (2016) Trust/policies/C/Clinical%20Records%20Management%20Policy%20ECT2620.pdf 14 Review This policy will be reviewed every 2 years as the service continues to develop and expand. The policy will be reviewed by the authors (if applicable) and/or CCNT Team Leader before being passed for approval by the Clinical Matron and Children s Services Manager. The updated policy will then be subject to the usual ratification process through SQS. 15 References East Cheshire NHS Trust Children s Community Nursing Operational Policy (2016) East Cheshire NHS Trust Clinical Guidelines: Intravenous Access Care and Maintenance for Adult & Paediatric Patients (2016) Central Manchester University Hospitals NHS Foundation Trust Cytotoxic Medicines Safe Handling Policy (2015) The Christie NHS Foundation Trust Cytotoxic Spillage and Contamination Policy (2015) East Cheshire NHS Trust Dispensing and Storage of Medicines Policy (2017) East Cheshire NHS Trust Consent to Examination or Treatment Policy (2016) The Christie NHS Foundation Trust Chemotherapy: a guide for patients and carers (2017) 9

10 16 Equality Analysis Equality Analysis (Impact assessment) Please START this assessment BEFORE writing your policy, procedure, proposal, strategy or service so that you can identify any adverse impacts and include action to mitigate these in your finished policy, procedure, proposal, strategy or service. Use it to help you develop fair and equal services. Eg. If there is an impact on Deaf people, then include in the policy how Deaf people will have equal access. 1. What is being assessed? Children s Community Nursing Team Chemotherapy Policy Details of person responsible for completing the assessment: Name: Joanne Doyle Job Title: Sister Team: Children s Community Nursing Team State main purpose or aim of the policy, procedure, proposal, strategy or service: (usually the first paragraph of what you are writing. Also include details of legislation, guidance, regulations etc which have shaped or informed the document) The purpose of this document is to set out guidance for the safe prescribing handling and administration of low risk chemotherapy for children and young people up to 16 years of age within East Cheshire NHS Trust. National and regional standards have been adhered to in conjunction with the following: NHS Cancer reform strategy 2007 Manual for Cancer Services Standards 2014 Children s Cancer Measures More than My Illness delivering quality care for children with cancer 2009 Greater Manchester and Cheshire Cancer Network (GMCCN) Intravenous (IV) Policy Greater Manchester Network Children s Community Nursing Services Intravenous Cytarabine Chemotherapy Bolus Guidelines (2010) East Cheshire NHS Trust Clinical Guidelines: Intravenous Access Care and Maintenance for Adult & Paediatric Patients In Hospital and at Home (2014) This policy is intended to safeguard children and young people and staff by defining best practice for the Children s Community Nursing Team (CCNT) staff involved in the administration of low risk chemotherapy. This policy provides a framework of guidance which aims to minimise risks by promoting safe handling of cytotoxic drugs. Local policy is based on the principles of Greater Manchester CCN Network guidance; any deviation from that guidance must be specified and justified in addition to this guidance. 2. Consideration of Data and Research To carry out the equality analysis you will need to consider information about the people who use the service and the staff that provide it. Think about the information below how does this apply to your policy, procedure, proposal, strategy or service 2.1 Give details of RELEVANT information available that gives you an understanding of who will be affected by this document 10

11 Cheshire East (CE) covers Eastern Cheshire CCG and South Cheshire CCG. Cheshire West & Chester (CWAC) covers Vale Royal CCG and Cheshire West CCG. In 2011, 370,100 people resided in CE and 329,608 people resided in CWAC. Age: East Cheshire and South Cheshire CCG s serve a predominantly older population than the national average, with 19.3% aged over 65 (71,400 people) and 2.6% aged over 85 (9,700 people). Vale Royal CCGs registered population in general has a younger age profile compared to the CWAC average, with 14% aged over 65 (14,561 people) and 2% aged over 85 (2,111 people). Since the 2001 census the number of over 65s has increased by 26% compared with 20% nationally. The number of over 85s has increased by 35% compared with 24% nationally. Race: In 2011, 93.6% of CE residents, and 94.7% of CWAC residents were White British 5.1% of CE residents, and 4.9% of CWAC residents were born outside the UK Poland and India being the most common 3% of CE households have members for whom English is not the main language (11,103 people) and 1.2% of CWAC households have no people for whom English is their main language. Gypsies & travellers estimated 18,600 in England in Gender: In 2011, c. 49% of the population in both CE and CWAC were male and 51% female. For CE, the assumption from national figures is that 20 per 100,000 are likely to be transgender and for CWAC 1,500 transgender people will be living in the CWAC area. Disability: In 2011, 7.9% of the population in CE and 8.7% in CWAC had a long term health problem or disability In CE, there are c.4500 people aged 65+ with dementia, and c.1430 aged 65+ with dementia in CWAC. 1 in 20 people over 65 has a form of dementia Over 10 million (c. 1 in 6) people in the UK have a degree of hearing impairment or deafness. C. 2 million people in the UK have visual impairment, of these around 365,000 are registered as blind or partially sighted. In CE, it is estimated that around 7000 people have learning disabilities and 6500 people in CWAC. Mental health 1 in 4 will have mental health problems at some time in their lives. Sexual Orientation: CE - In 2011, the lesbian, gay, bisexual and transgender (LGBT) population in CE was estimated at18,700, based on assumptions that 5-7% of the population are likely to be lesbian, gay or bisexual and 20 per 100,000 are likely to be transgender (The Lesbian & Gay Foundation). CWAC - In 2011, the LGBT population in CWAC is unknown, but in 2010 there were c. 20,000 LGB people in the area and as many as 1,500 transgender people residing in CWAC. Religion/Belief: The proportion of CE people classing themselves as Christian has fallen from 80.3% in 2001 to 68.9% In 2011 and in CWAC a similar picture from 80.7% to 70.1%, the proportion saying they had no religion doubled in both areas from around 11%-22%. Christian: 68.9% of Cheshire East and 70.1% of Cheshire West & Chester Sikh: 0.07% of Cheshire East and 0.1% of Cheshire West & Chester 11

12 Buddhist: 0.24% of Cheshire East and 0.2% of Cheshire West & Chester Hindu: 0.36% of Cheshire East and 0.2% of Cheshire West & Chester Jewish: 0.16% of Cheshire East and 0.1% of Cheshire West & Chester Muslim: 0.66% of Cheshire East and 0.5% of Cheshire West & Chester Other: 0.29% of Cheshire East and 0.3% of Cheshire West & Chester None: 22.69%of Cheshire East and 22.0% of Cheshire West & Chester Not stated: 6.66% of Cheshire East and 6.5% of Cheshire West & Chester Carers: In 2011, nearly 11% (40,000) of the population in CE are unpaid carers and just over 11% (37,000) of the population in CWAC. 2.2 Evidence of complaints on grounds of discrimination: (Are there any complaints or concerns raised either from patients or staff (grievance) relating to the policy, procedure, proposal, strategy or service or its effects on different groups?) Nil 2.3 Does the information gathered from indicate any negative impact as a result of this document? Nil 3. Assessment of Impact Now that you have looked at the purpose, etc. of the policy, procedure, proposal, strategy or service (part 1) and looked at the data and research you have (part 2), this section asks you to assess the impact of the policy, procedure, proposal, strategy or service on each of the strands listed below. RACE: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, racial groups differently? Yes No X Explain your response: This document offers guidance for the management of children being accepted onto the Children s Community Nursing Team for Chemotherapy in the community. All patients will be considered fairly for acceptance by the CCNT regardless of race. Any explanations to parents and children whose first language is not English will be carried out using the Trust s interpretation and translation policy and/or the picture communications book in the ward communications aids box. GENDER (INCLUDING TRANSGENDER): From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, different gender groups differently? Yes No X Explain your response: This document offers guidance for the management of children being accepted onto the Children s Community Nursing Team for Chemotherapy in the community. All patients will be considered fairly for acceptance by the CCNT regardless of gender. DISABILITY 12

13 From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, disabled people differently? Yes No X Explain your response: This document offers guidance for the management of children being accepted onto the Children s Community Nursing Team for Chemotherapy in the community. All patients will be considered fairly for acceptance by the CCNT regardless of disability. If necessary the Trust s interpretation and translation policy and/or the picture communications aids box can be utilised. For parents with learning disabilities, the health facilitator from CWP can be involved. AGE: From the evidence available does the policy, procedure, proposal, strategy or service, affect, or have the potential to affect, age groups differently? Yes No X Explain your response: These guidelines are designed to be applicable for children of all ages up to 16. LESBIAN, GAY, BISEXUAL: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, lesbian, gay or bisexual groups differently? Yes No X Explain your response: This document offers guidance for the management of children being accepted onto the Children s Community Nursing Team for Chemotherapy in the community. All patients will be considered fairly for acceptance by the CCNT regardless of orientation. RELIGION/BELIEF: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, religious belief groups differently? Yes No X Explain your response: This document offers guidance for the management of children being accepted onto the Children s Community Nursing Team for Chemotherapy in the community. All patients will be considered fairly for acceptance by the CCNT regardless of religion/belief. For families wehose beliefs prohibit the use of medication containing porcine products a full and open discussion will be held with that family to aid decision making. CARERS: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, carers differently? Yes No X Explain your response: This document offers guidance for the management of children being accepted onto the Children s Community Nursing Team for Chemotherapy in the community. If any children have carers for whatever reason, the rationale behind these procedures will be explained to them. OTHER: EG Pregnant women, people in civil partnerships, human rights issues. From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect any other groups differently? Yes No X Explain your response: No other impacts identified. 13

14 4. Safeguarding Assessment - CHILDREN a. Is there a direct or indirect impact upon children? Yes X No b. If yes please describe the nature and level of the impact (consideration to be given to all children; children in a specific group or area, or individual children. As well as consideration of impact now or in the future; competing / conflicting impact between different groups of children and young people: These guidelines are designed to be used for all children up to age 16 and will therefore impact on all these children. c. If no please describe why there is considered to be no impact / significant impact on children 5. Relevant consultation Having identified key groups, how have you consulted with them to find out their views and that the made sure that the policy, procedure, proposal, strategy or service will affect them in the way that you intend? Have you spoken to staff groups, charities, national organisations etc? Groups identified for consultation: Community Service Managers Children s Services Manager Children s Ward Matron Children s Community Nursing Team Children s Ward Sisters/Charge Nurse Paediatric Consultants 6. Date completed: May 2017 Review Date: May Any actions identified: Have you identified any work which you will need to do in the future to ensure that the document has no adverse impact? Action Lead Date to be Achieved 8. Approval At this point, you should forward the template to the Trust Equality and Diversity Lead lynbailey@nhs.net Approved by Trust Equality and Diversity Lead: Date: May