CNS/AHP LED CANCER FOLLOW-UP (INCLUDING POST TREATMENT FLEXIBLE NASENDOSCOPY EVALUATION)

Transcription

1 Macmillan Cancer support CNS/AHP LED CANCER FOLLOW-UP (INCLUDING POST TREATMENT FLEXIBLE NASENDOSCOPY EVALUATION) Chadwick, H. CNS Corfield, N. SLT George, C. RD Ross, L. CNS Macmillan Head & Neck Team

2 THE SERVICE 2011: Successful bid for Macmillan project funding to redesign H&N services in MYHT; Current team brought together, managed within H&N CNS/AHP team available to all H&N patients throughout their cancer pathway, including extremely successful input from alcohol and wellbeing nurse (community partner initiative) Highly specialist nature of core team enabled further redesign, now delivering RISK STRATIFIED CANCER FOLLOW UP allowing continuity for patients and consideration of ongoing holistic needs & treatment-related issues

3 What did we do?

4 BACKGROUND Nurse/AHP led clinics are in line with National Cancer Survivorship Initiative (NCSI) - a partnership between the Dept of Health and Macmillan Cancer Support Supported by NHS Improvement and the National Cancer Action Team Meet IOG and NICE recommendations

5 THE PROPOSAL To provide a clinically safe, risk stratified CNS/AHP-led screening assessment of post treatment H & N cancer patients: Oropharyngeal (tonsil and tongue base) 1yr post treatment Laryngectomy following first post treatment consultant review Successful bid to Macmillan - 1/2million Allowed the current team to be formed, managed in Head and Neck, and the clinics to be developed (with the support of ENT consultant Mrs H Cruickshank)

6 THE REASON An increase in the number of patients diagnosed with Head & Neck Cancer Consultant follow-up for 5 years posttreatment not sustainable Macmillan Team well placed to carry out some of these cancer follow ups Natural role progression following already successful joint AHP/CNS-led clinics Continuity for patients

7 THE PROCESS Consultant trained and assessed Neck palpation Examination of the oropharynx Nasendoscopy: Course at Derby Royal Infirmary; simulator; observed and practiced Stoma / speaking valve examination Cleaning and disinfecting the nasendoscope Competency documentation (available)

8 NASENDOSCOPY POLICY BASED ON: Fibreoptic Endoscopic Evaluation of Swallowing (FEES) (Hydes et al, 2007) Speech and Language Therapy, Endoscopy for Voice Disordered Patients (Carding et al, 2008) (RCSLT Position Paper) (Available)

9 THE NASENDOSCOPE High quality imaging; chip-on-a-tip High quality screen Compatibility with equipment already in place for recording purposes / AIDA Olympus met parameters With Narrow Band Imaging (NICE guideline NG36, 2016)

10 YOU CAN CALL ME BRIAN!

11 NASENDOSCOPY

12 THE CLINICS Risk stratified patients consented (form available) Max 6 pts at 1/2 hour intervals, now expanded 1 Nurse & 1 AHP at each clinic Assessment/correspondence Recording/cleaning Both CNSs non-medical prescribers 1 Nurse & 1 AHP still supporting consultant clinic All pts get holistic assessment/care First year all were double checked, now independent with peer assessment

13 LOGISTICAL ISSUES/CHALLENGES Support from professional bodies - All pro extended roles - Additional insurance for extended role - Altered job descriptions Capacity gaps; holidays Sub-diary (consultant leave; inappropriate patients) Clinic nurses not happy to clean our nasendoscope If you want a job doing..

14 What have we found?

15 AUDIT Clinical audit is a way to find out if healthcare is being provided in line with standards and lets providers and patients know their service is doing well, and where it could improve (NHS England, 2014) STANDARD: ENT H&N Consultant assessment

16 AUDIT PTFNE Assessment Report / Nasopharynx / Oropharynx/ Hypopharynx/ Larynx Patient Sticker: Date: Consent - Procedure Photos Diagnosis: Other relevant medical / surgical history: Outcome/Observations: ASSESSMENT: Agree Disagree Practitioner: Visual Inspection: Mouth: Assessor: Comments: Oropharynx: Neck: Nasendoscopy: Nasal Cavity: Post Nasal Space: Posterior Pharyngeal Wall: Oropharynx/Tongue Base: Valleculae: Larynx: Pyriform fossae: Summary of Assessment: Recommendations: Written patient info given: Macmillan Professional Review/Refer On: Consultant Review Images/Video: Date Date (Forms available)

17 DATA year 1 n = 121 all consented (35 patients) January 2014 February 2015 (first year/double checked) For each anatomical site - whether assessed (n=103) and observations/ descriptors CONCLUSION DOCUMENTED: no sign new primary or locoregional recurrence or referred back into consultant for investigation

18 RESULTS CONSENT 100% THOROUGH EXAMINATION CONSULTANT AGREEMENT 100% = COMPETENCE 3 recurrences detected; none missed = SAFETY 6months Storz nasendoscopes

19 DATA year 2 n = 214 all consented (50 patients) February 2015 end January 2016 For each anatomical site - whether assessed and observations/ descriptors CONCLUSION DOCUMENTED: no sign new primary or locoregional recurrence or referred back into consultant for investigation (several case reports)

20 RESULTS CONSENT 100% THOROUGH EXAMINATION PEER ASSESSED AGREEMENT 100% = COMPETENCE 1 new primary detected; no recurrences (none missed) = SAFETY

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22 Comparison of Contribution - Consultant Led Clinic v Macmillan H&N Clinic Description Income Consultant Led ( ) Macmillan H&N Clinic ( ) Direct Income 30,624 30,624 - Indirect Income 25,752 Total Income 30,624 56,376 Pay Costs Consultant 7,740 CNS B7 2,548 2,548 AHP - B7 (SLT/Dietician) 2,548 2,548 HCA B3 1,182 Total Pay Costs 14,018 5,096 Contribution 16,606 51,280 Contribution % 54% 91%

23 ACCOLADES 1 st Dietitian in UK scoping Presented at International Quality of life Conference (Liverpool, Nov 2016)

24 ACCOLADES Macmillan Team Excellence Award 2015

25 Where from here?

26 GOING FORWARDS Trust sign off established/embedded practice Expand ENT clinics to meet demands of service Maxillofacial service development Continue to audit good practice Continue to develop in role/new members Share our results and good practice

27 ACKNOWLEDGEMENTS Authors of original proposal/macmillan bid Mr David Mitchell Julie Hoole Mr Anastasios Kanatas Consultant lead ENT Mrs Helen Cruickshank Macmillan Development Manager/Project Lead Steve Edwards Abstract Editors Mr Michael Ho Mrs Helen Cruickshank Team Secretary Dawn Coomber BDA Professional Development and Education Lead Najia Qureshi

28 THANK YOU Any Questions?