W9 NMP prescribing practice within Cancer Care (SH-Guest) 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
What is Non-medical prescribing (NMP)?
2 types?
Refers to prescribing in the UK by a healthcare professional other than by a doctor or dentist
- Independent NMPs can prescribe any medicines within their area of expertise utilising their diagnostic and clinical skills to benefit the patient
- Supplementary prescribers work with a doctor to prescribe medicines to patients using a pre-agreed clinical management plan.
What is SACT?
Systemic anti-cancer therapy (SACT) – any type of cancer treatment that can travel through the body eliminating cancer
cells.
Prescribing team/clinic set up – consultant led clinic
Consultant oncologist
Clinical Nurse Specialist
Pharmacist NMP
Clinic nurse support
Radiotherapy
- 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
Types of patients reviewed by NMPs?
- Less complex patients – experience dependent
- Different stages of disease
- Early stages of the disease – adjuvant/neo-adjuvant treatment
- Metastatic setting
- Stable patients
- Metastatic breast cancer Pharmacy led clinic pilot – JWP
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
*Treatment continues until CT scan review usually 3 monthly - Given CT results
-Stable – continue treatment
-Progressive disease – switch treatments
Aim of pharmacist prescriber role?
- Prescribing pharmacists not training to be doctors!
- To influence medicines use at the point of decision making
- Bring pharmacy expertise to the clinic
- To improve patient waiting times
- Provide rounded MDT approach to patient care and decision making
- Aid career progression
- Holistic patient approach
NMP pre-SACT clinical assessment review
What to consider?
- APPROPRIATE TO THE PATIENT GROUP/TREATMENT
- CONSENT HAEMATOLOGICAL
PARAMETERS - RADIOLOGY
- CLINICAL EXAMINATION
- PRESCRIBING SACT & SUPPORTIVE
MEDICINES - DO NOT PRESCRIBE CYCLE ONE
- REFER IF RED FLAGS
BOPA NMP guideline- what for?
Set key competencies for SACT NMPs within cancer care
others:
* RPS competency framework
for all prescribers
* HEIW competency project
* Organisation NMP guideline
Consultation skills?
- 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- which bloods are taken?
- FBC
- U&Es
- LFTs
- Bone profile
- Cancer marker e.g. Ca15-3, PSA, Ca125
- How often tested and how interpreted
Radiology
What types of scans?
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
Benefits of SACT NMPs?
Protocol driven treatments
Close MDT
Evidence based treatment
Established practice within oncology
Reduced patient waiting times
NMP professionals bringing their expertise to the clinic
Challenges of SACT NMPs?
- Aware of consultant team practice
1st rule – do no harm
SACT is rarely an emergency! - Prescribing in a safe and methodical manner –defending decisions
- Being left holding the baby! (left responsible in an unfair way)
- Aware of own limitations
- Use all resources available
- 1st rule – do no harm
