NMP prescribing practice - cancer Flashcards
location of cancer care
Specialist cancer services (non-surgical)
Cancer units/wards in teaching/district general hospitals
Specialist palliative care centres
Private cancer clinics
Healthcare at home schemes
Define Non-medical prescribing (NMP)
refers to prescribing in the UK by a healthcare professional other than by a doctor or dentist
SACT
systemic anti-cancer therapy
what does a prescribing team look like
consultant oncologist
clinical nurse specialist
pharmacist NMP
clinic nurse support
What is the importance of radiotherapy in cancer care?
Measured in grays
Can be given alone or in combination with SACT
Prescribed by consultants and registrars
Can form a phase of aggressive treatment
Can be used for palliative pain
List the patient pathway within cancer care?
- Pt reviewed by consultant in new patient clinic and given PILs etc
- Pt reviewed and consented within pre- SACT assessment clinic and initiates treatment
- Pt reviewed within pre-SACT assessment clinic prior to each cycle of treatment and receives a further supply/prescribed further treatment
4.Treatment continues until CT scan review usually 3 monthly
- Given CT results - stable? cont treatment
Progressive disease - switch treatment
Aim of pharmacist prescriber role
holistic patient approach
support other prescribers
decrease the waiting lists for patients
What is included in the clinical assessment review NMP pre-SACT?
- consent, radiology, clinical examination
- do not prescribe cycle one, refer if any red flags
- appropriate treatment for patient
What is the training pathway fro oncology of NMPs?
- uni IP course
-NMP led training - professional indemnity insurance
- disease specific training
- in house training
4 points of governance around NMP?
RPS competency framework for all prescribers
HEIW competency project
BOPA NMP guideline
Organisation NMP guideline
consultation skills - cancer care patient based
Read the situation - anxiety
Patient opportunity to get their point/purpose across
Use mostly open questions
Discuss each issue in depth
Reassure where possible
Then end with a summary of actions
Speak clearly and concisely
Support colleagues decisions
Blood parameters
FBC
U&Es
LFTs
Bone profile
Cancer marker e.g. Ca15-3, PSA, Ca125
How often tested and how interpreted
Radiology
CT scans to assess response to treatment
Complete response
Partial response
Stable disease
Mixed response
Disease progression
X-rays
MRI scans
Bone scans
PET scans
Clinical examination with oncology
Related to the cancer care specialty area e.g. breast cancer
Training within IP training but extra training often needed
Accuracy needed within cancer care
Backed up by radiology where appropriate
Boundaries and ‘red flagging’
- set scope of practice
- gradulaly expand scope with experienvce
-red flagging know your limitations and when to refer
