Supporting Integrated Care through National Standardisation of Chemotherapy Protocols

Abstract

Patients with cancer transition through the different stages of the cancer care continuum, and into and out of the cancer system, and will see many care providers in many settings (1). These will include General Practitioners (GPs), Community Pharmacists and Nurses as well as consultant led hospital multi-disciplinary teams. These patients require care that is integrated around the patient's needs and seamlessly coordinated across different providers (2) to ensure patients receive the right care, in the right place, at the right time (3). Chemotherapy treatment can be complex and toxic with many potential side effects. It is initiated by specialist consultants in secondary care and is either hospital or home administered. It is described in chemotherapy treatment protocols which support safe, evidence-based and cost effective cancer treatment. These are key documents which inform all involved in the care of the patient regarding the correct drug, dose, route and appropriate adjustments required due to toxicity or side effects. Effective communication and transfer of this information across the interface between primary and secondary care is seen as vital in the integration of care (3, 4). In 2014, the NCCP recommended that each hospital providing cancer services had access to an agreed list of chemotherapy protocols. This followed from the finding of the Oncology Medication Safety Review Report (5) which found that only 8 out of 26 hospitals had specific chemotherapy protocols in place which were available only for use within the hospital. The NCCP proceeded to implement a systematic process for the development of nationally approved chemotherapy protocols to improve communication at transitions in care for patients as they move across settings and providers, particularly from the hospital back into the community in order to support safe, evidence-based, cost effective cancer treatment. This process involves a standardised development and approval process. The protocols are developed in a coordinated fashion under the guidance of Specialist Medical Consultants with input from nursing staff, pharmacists and other healthcare professionals (HCPs). Once approved they are published on the NCCP website (6) where they are available to clinicians, HCPs and the public. These protocols are reviewed every two years at a minimum or when any relevant updates are published. The benefits of national, standardised chemotherapy protocols in terms of integrated patient care are manifold. Primary care HCPs, patients, carers and their families may readily access these protocols from a trusted source irrespective of their location. This ensures that the relevant information is available if patients become unwell, have queries or need an OAM prescription dispensed. The implementation of nationally approved standardised chemotherapy protocols is a key step forward to ensure that care is person-centred, coordinated and continuous across all care settings.180 chemotherapy protocols covering up to 240 different indications have been launched on the NCCP website. Going forward, these protocols will form the chemotherapy protocol library to underpin the national Medical Oncology Clinical Information System, a core component of the eHealth strategy (7) which is in development and will be the next step in improving the integration of care for patients with cancer. [ABSTRACT FROM AUTHOR]