Planning, Verification and Clinical Responsibility (TGray) Flashcards
Why is National Planning necessary?
The huge costs involved have an impact on society and economy so important consideration is important. Variation in delivery of care, equity and outcome needs to be minimised throughout society. Growing cost 'Postcode' prescribing (areas of deprivation = poorer outcome) Financial challenge (NHS commissioners enforce pressure on prescribers to avoid expensive treatment)
What has been implemented to improve value in the National Planning?
Clinical Reference Group
Treatment Algorithms
SACT - systemic anti-cancer therapy dataset
What is a ‘typical’ cancer journey?
Breast Cancer example
Screening detects abnormality
Referred b screening service to breast surgeon for autopsy
Biopsy shows early stage breast cancer MDT - a treatment plan is agreed
Undergoes surgery (in this case, wide excision with axillary node sampling)
3/5 lymph nodes have cancer cells. Case reviewed at post op MDT and treatment plan amended.
Has FECT-T chemotherapy (6 cycles) every 3 weeks under care of an oncologist and starts Herceptin for a year
Referred for radiotherapy to the breast and axilla
Clinical oncologist starts anastrazole - continued for 5 years by GP
Yearly mammograms for 5 years - discharged
Who is part of a Cancer MDT?
General practitioner Histopathologists (biopsy) Radiologists (Tx) Surgeons Oncologists Pharmacists and AHPs (allied HPs) GP, Community Pharmacist The patient and their advocates Others; chaplain, psychologists, charity etc
What does ‘Pharmacy Capacity Planning’ mean?
Demand - patient flow/ referral, campaigning (important early diagnosis in older patients)
Resources - clinics, high staff demand, specialist equipment such as cytotoxic bins, outreach at home. Space
Product - dose banding (organised per drugs)
Vial sharing
Outsourcing
What is a ‘chemotherapy journey’ like?
Decision to treat with chemo by consultant with MDT
Consent from patient
Chemo prescribed electronically
Appointment made for nurse led counseling session and assessment
Chemo prescription screened by pharmacist once blood results available. Supply of supportive drugs arranged
Chemotherapy manufactured in aseptic unit and checked and released by production pharmacist
Chemotherapy administered on suite by nurses
Patient seen prior to next cycle of treatment, toxicities assessed and cycle repeated.
What roles are there for pharmacists in a Cancer Pharmacy Team?
Clinical; inpatient and outpatient, screening Rxs, patient counselling, supportive medication
Technical; aseptic manufacture, dispensing cytotoxic and supportive medication
Prescribing advice; Medicines Information, prescribing advice for new drugs and funding
Clinical trials
Consultant Pharmacist; focus on research and education,, funding and patient access, protocols and guidelines
Which campaigns are currently being publicised in primary care?
‘Be Clear on Cancer’ NHS
RPS health campaigns
‘Talk Cancer’ CRUK
What points are key in the counselling of patients taking chemotherapy?
Adherence, regimen Interactions (Emollients contain metal ions that can cause burns in patients receiving chemotherapy). Side effects Adverse effects (neutropenia (sepsis)) Safety alerts
What are needed in the safe prescribing of chemotherapy?
SOPs, SACT requirements, standardizes forms, push towards electronic prescribing
Why is there a push towards electronic prescribing?
Allow safe limits, ensures checks are done, helps with resources and flow, blood tests, book/schedule too
What are the criteria for the Verification of Prescriptions for Cancer?
- Check the prescription
- Check against the plan
- Check patient details
- Check administration
- Check calculations
- Check lab results
- Verify sign and date
What general responsibilities do pharmacists have?
To their employer and legally
What professional responsibilities do pharmacists have?
1-7 GPhC priniciples
What clinical responsibilities do pharmacists have?
Best practice standards
Within scope of their practice
Reflective practices (CPDs)
