Lung Cancer Peer Review Documentation 2011 East Kent Hospitals NHS Trust

Transcription

1 Lung Cancer Peer Review Documentation 2011 East Kent Hospitals NHS Trust Lung Peer Review Documentation Operational Policy KCH 2011 Page 1

2 Document 1 Operational Policy East Kent Hospitals NHS Trust KCH Lung Cancer MDM Lung Peer Review Documentation Operational Policy KCH 2011 Page 2

3 Contents Page Index to evidence 5-7 Operational policy sign off 8 MDT Operational Policy agreement sheet 9 Introduction 10 Lead Clinician 11 Letter from Clinical Director Lung Cancer Core Team Members 14 Separate pre-diagnostic MDM 15 The MDT meeting Cover arrangements 18 Policy for communication to GP 19 Fax form to GP Key worker / CNS policy 23 Histopathology and EQA 24 Nurse specialist study 25 Agreed responsibilities for nurse members 26 Agreed list of additional responsibilities Lung CNS job description Extended team members Permanent Consultation record policy 39 Information offered to patients 40 Recording MDT decisions 41 Example of MDT record Treatment guidelines 47 Referral guidelines 48 Diagnostic services radiology guidelines 49 Diagnostic services pathology guidelines 50 Data Collection 51 Electronic Collection of MDS 52 Additional policies attached at end of document 1. Bronchoscopy operational policy CT guided biopsy policy 55 Endobronchial US biopsy guidance 56 Surgical biopsy policy 57 Breaking Bad News policy 58 Oncology referral form 59 Mesothelioma policy 60 Individual Team Member Responsibilities Thoracic surgery referral forms Lung Peer Review Documentation Operational Policy KCH 2011 Page 3

4 Appendices Appendix A. EQA certificates for pathology 70 Appendix B. Copy of CNS certificates Appendix C. Examples of permanent consultation records Appendix D. Patient information leaflets 76 Appendix E. New Measures to be added to next policy 78 Lung Peer Review Documentation Operational Policy KCH 2011 Page 4

5 Index to Evidence Measure 08-2C-101 Single Named Lead Clinician (Measure 11-2C-101) Document 1 Page 11 Measure 08-2C-102 Named Core Team Members (Measure 11-2C-101) Document 1 Page 14 Measure 08-2C-103 Attendance at NSSG meetings (Measure 11-2C-104) Document 2 Page 6 Measure 08-2C-104 (not in new measures) Separate pre-diagnostic MDM Not applicable Document 1 Page 15 Measure 08-2C-105 Meet fortnightly and referral to next meeting (Measure 11-2C-105) Document 1 Page Record attendance Document 2 Page 7 Measure 08-2C-106 MDT agreed arrangement for cover (Measure 11-2C-106) Document 1 Page 18 Measure 08-2C-107 Core member present for 2 /3 rds of meetings (Measure 11-2C-107) Document 2 Page 7 Measure 08-2C-108 Annual meeting to discuss operational policy (Measure 11-2C-108) Document 2 Page 8-10 Measure 08-2C-109 Policy for all new patients to be reviewed by MDT (Measure 11-2C-109) Document 1 Page Measure 08-2C-110 Policy for communication to GP (Measure 11-2C-110) Document 1 Page Document 2 Page 11 (Audit) Measure 08-2C-111 Operational policy for named key worker (Measure 11-2C-111) Document 1 Page 23 Measure 08-2C-112 Histopathology member takes part in EQA (Measure 11-2C-112) Document 1 Page 24 Certificates uploaded Document 1. Appendix A Page 70 Measure 08-2C-113 Core nurse member completed specialist study (Measure 11-2C-113) Document 1 Page 25 Certificates uploaded Document 1. Appendix B Page 71 Measure 08-2C-114 Measure 08-2C-115 Document 1 Page (Measure 08-2C-114 ) Agreed responsibility and list for core nurse member Lung Peer Review Documentation Operational Policy KCH 2011 Page 5

6 Measure 08-2C-116 Attendance at National Communication Programme (Measure 11-2C-115) Document 2 Page 12 Cerificates uploaded Document 2. Appendix A Page 51 Measure 08-2C-117 Extended membership of MDT (Measure 11-2C-116) Document 1 Page Measure 08-2C-118 Permanent patient consultation record (Measure 11-2C-117) Document 1 Page 39 Examples of letters Document 1 Appendix C Page 73 Measure 08-2C-119 Patient experience exercise (Measure 11-2C-118) Document 2 Page Measure 08-2C-120 Presentation and discussion of patient experience survey (Measure 11-2C-118) Document 2 Page 25 Measure 08-2C-121 Provision of written patient information (Measure 11-2C-119) Document 1 Page 40 Examples of leaflets Document 1 Appendix D Page 76 Measure 08-2C-122 Agree and record individual patient treatment plans (Measure 11-2C-120) Document 1 Page Measure 08-2C-123 NSSG agreed clinical guidelines (Measure 11-2C-103c) Document 1 Page 47 (Measure 11-2C-121) Measure 08-2C-124 NSSG agreed referral guidelines (Measure 11-2C-104c) Document 1 Page 48 (Measure 11-2C-122) Measure 08-2C-125 NSSG agreed diagnosis imaging guidelines (Measure 11-2C-105c) Document 1 Page 49 (Measure 11-2C-123) Measure 08-2C-126 NSSG agreed diagnosis pathology guidelines (Measure 11-2C-106c) Document 1 Page 50 (Measure11-2C-124) Measure 08-2C-127 MDT agreed collection of MDS (Measure 11-2C-107c) Document 1 Page 51 (Measure 11-2C-125) Measure 08-2C-128 MDT agreed policy for electronic collection of MDS (measure 11-2C-125) Document 1 Page 52 Document 2 Page 27 (Completeness audit) Lung Peer Review Documentation Operational Policy KCH 2011 Page 6

7 Measure 08-2C-129 MDT agreed participation in Network audit (Measure 11-2C-108c) Document 2 Page 28 (Measure 11-2C-126) Measure 08-2C-130 MDT present results from audit participation to NSSG Document 2 Page 49 Measure 08-2C-131 MDT / NSSG agreed list of approved clinical trials (Measure 11-2C-109c) Document 2 Page 50 (Measure 11-2C-127) Measure 08-2C-132 MDT / NSSG remedial action from MDT recruitment results Document 2 Page 51. New measures to be added into new operational policy. Measure 11-2C-102 Level 2 Practitioners for Psychological Support (New measure) Document 1 Page 79 Measure 11-2C-103 Support for Level 2 Practitioners (New measure) Document 1 Page 79 Lung Peer Review Documentation Operational Policy KCH 2011 Page 7

8 East Kent Hospitals NHS Trust s Lung Cancer Service Operational Policy for Kent and Canterbury Lung Cancer MDM Lead Clinician Dr Neil R Goldsack Revised April 2011 Version 1. December 2001 Version 2. July 2003 Version 3. July 2004 Version 4. July 2005 Revised October 2005 Version 5. Feb 2007 Version 6, Mar 2009 Revised July 2009 Version 7 Mar 2010 Version 8 July 2010 Version 9 April 2011 Neil Goldsack Lead Lung Cancer Physician 11 th April 2011 Lung Peer Review Documentation Operational Policy KCH 2011 Page 8

9 MDT Operational Policy Agreement Cover Sheet This operational policy has been agreed by : MDT Lead Clinician Dr Neil Goldsack East Kent Hospitals NHS Trust Signature Date Agreed April 11, 2011 Trust Lead Clinician Dr Brett Pereira East Kent Hospitals NHS Trust Signature Present on hard copy in evidence folder Date Agreed April The MDT Policy agreed on : Date agreed March 23, 2010 Operational Policy Review Date Tuesday, March 23, 2010 Lung Peer Review Documentation Operational Policy KCH 2011 Page 9

10 Introduction. The Kent and Canterbury Lung Cancer MDM is a lung cancer MDM for patients within the East Kent locality and serves a population encompassing Thanet and the surrounding areas of Canterbury. The total population covered by this multidisciplinary team is 465,000. This MDM is one of two that covers the population (760,000) of East Kent. The other MDT is based at the William Harvey Hospital. Purpose of Kent and Canterbury Lung MDT. The purpose of the MDT is to provide high quality lung cancer care for the population of East Kent. The MDT aims for full compliance with IOG guidance and works towards the Kent Lung DOG guidelines. Members of the MDT attend the Lung DOG to ensure compliance. The work of the MDT is subject to regular audits and to external peer review. Lung Peer Review Documentation Operational Policy KCH 2011 Page 10

11 Measure 08-2C-101 (Measure 11-2C-101) Lead Clinician Lead Clinician Dr Neil Goldsack Title Lead Clinician, Respiratory Physician Responsibilities Ensure that the objectives of MDT working as per the Manual of Cancer Services To lead and support the inputting of information onto CQUINS database for peer review. To ensure that designated specialists work effectively together in teams such that decisions regarding all aspects of diagnosis, treatment and care of individual patients and decisions regarding the team s operational policies are multidisciplinary decisions. To ensure that care is given according to recognized guidelines (including guidelines for onward referrals) with appropriate information being collected to inform clinical decision-making and to support clinical governance/audit. To ensure mechanisms are in place to support entry of eligible patients into clinical trials, subject to patients giving fully informed consent with the clinical research team Overall responsibility for ensuring that MDT meeting and team meet Peer Review Quality Measures Ensure attendance levels of core members are maintained, in line with Quality Measures. Ensure that target of 100% cancer patients discussed at the MDT is met. Provide link to NSSG, either by attendance at meetings or by nominating another MDT member to attend. Supervise lead for service improvement. Organize and chair annual meeting examining functioning of team and reviewing operational policies, and collate any activities that are required to ensure optimal functioning of the team (e.g. training for team members). Ensure MDT s activities are audited and results documented. Ensure that the outcomes of the meeting are clearly recorded and clinically validated and that minutes are circulated to team members Ensure target of communicating MDT outcomes to primary care is met. Facilitate the safe introduction of PACS for lung cancer patients Liaise with clinical management board regarding care of lung cancer patients Liaise with cancer action team to ensure that difficulties with achieving 31 / 62 day targets are communicated. Support the input of data into LUCADA and local Infoflex systems. 11 th April 2011 Lung Peer Review Documentation Operational Policy KCH 2011 Page 11

12 Membership Queen Elizabeth The Queen Mother Hospital Cancer, Clinical Haematology & Haemophilia Directorate St Peter s Road Margate Kent CT9 4AN Tel: Fax: Secretary Ext th April 2011 Dr Neil Goldsack Lead Clinician KCH Lung Cancer MDT Dear Neil, Re Lead Clinician for the KCH Lung Cancer MDT Many thanks for agreeing to be the lead clinician for the KCH lung MDT. Below I have attached the key elements of the post. I would be grateful if you could check and then sign the enclosed agreement and return it to me. Responsibilities Ensure that the objectives of MDT working as per the Manual of Cancer Services To lead and support the inputting of information onto CQUINS database for peer review. To ensure that designated specialists work effectively together in teams such that decisions regarding all aspects of diagnosis, treatment and care of individual patients and decisions regarding the team s operational policies are multidisciplinary decisions. To ensure that care is given according to recognised guidelines (including guidelines for onward referrals) with appropriate information being collected to inform clinical decision-making and to support clinical governance/audit. To ensure mechanisms are in place to support entry of eligible patients into clinical trials, subject to patients giving fully informed consent with the clinical research team Overall responsibility for ensuring that MDT meeting and team meet Peer Review Quality Measures Ensure attendance levels of core members are maintained, in line with Quality Measures. Ensure that target of 100% cancer patients discussed at the MDT is met. Lung Peer Review Documentation Operational Policy KCH 2011 Page 12

13 Provide link to NSSG, either by attendance at meetings or by nominating another MDT member to attend. Supervise lead for service improvement. Organise and chair annual meeting examining functioning of team and reviewing operational policies, and collate any activities that are required to ensure optimal functioning of the team (e.g. training for team members). Ensure MDT s activities are audited and results documented. Ensure that the outcomes of the meeting are clearly recorded and clinically validated and that minutes are circulated to team members Ensure target of communicating MDT outcomes to primary care is met. Liaise with clinical management board regarding care of lung cancer patients Liaise with cancer action team to ensure that difficulties with achieving 31 / 62 day targets are communicated. Support the input of data into LUCADA and local Infoflex systems. I am most grateful for your support Your sincerely Dr Brett Pereira 11 th April 2011 Clinical Director for Cancer and Haematology Agreed by Dr Neil Goldsack Consultant Chest Physician 11 th April 2011 Lung Peer Review Documentation Operational Policy KCH 2011 Page 13

14 Measure 08-2C-102 (Measure 11-2C-101) Lung Cancer Core Team Members Lung Cancer Core Team Members Lead Clinician Dr Goldsack (Consultant Chest Physician) Chest Clinicians Dr Ramin Raghai-Bavary Dr Pereira Dr Malamis Dr Farrow Thoracic Surgeon Miss King Radiologist Dr Entwistle Dr Shekhar Banavali (cover) Oncologist Dr Mathilda Cominos Histopathologist Dr Abdul Kadir (via teleconferencing) Lung Nurse Specialist /Palliative Care CNS Toni Fleming Mary Anne Lovett Lung Cancer Support Nurse Elaine Maslin Secretarial Support Mary Jenner / Bridget Eaves MDT co-coordinator Carol Croucher Sabina Wilmshurst Toni Fleming is the core member involved with patient / carer issues Dr Mathilda Cominos is the team member involved with recruiting patients into clinical trials. Lung Peer Review Documentation Operational Policy KCH 2011 Page 14

15 Measure 08-2C-104 Separate Pre-Diagnostic MDT There is no separate pre-diagnostic MDT. Lung Peer Review Documentation Operational Policy KCH 2011 Page 15

16 Measure 08-2C-105 / 08-2C-109 (Measure 11-2C-105and 109) The MDT Meeting Multi-disciplinary meetings These will occur on a weekly basis. It is the individual clinicians responsibility to identify patients to the MDM Co-coordinator prior to the next meeting. All patients with proven or potential lung cancer must be referred to the MDM All patients referred under the 2ww scheme are discussed, these patients are identified from clinic attendance records. Patients with potential cancer are also picked up from radiology where an abnormal X-ray or CT report is faxed through to the MDM co-coordinator for discussion at the next MDM. The MDM coordinator is copied into the bronchoscopy list and all CT guided biopsies being performed and these are discussed at the MDM. These patients are identified from the chest clinic secretaries and by the radiology department. In patient teams are encouraged to contact the lung MDM coordinator directly to have patients included on the lung MDM. Junior doctors are encouraged to attend the meeting to present their patients. The MDM Co-coordinator will upload as much information as possible to Infoflex for the meeting. The MDM Co-coordinator will ensure that the agenda is circulated 24 hours prior to the meeting to all core team members. Meetings occur at KCH on a Wednesday pm (2-3 hours). Attendance is recorded via an attendance sheet. Within the meeting computers are available for recording of patient details and to generate MDT reports using Infoflex. These reports are signed off by the lead clinician at the end of the meeting. Lung Peer Review Documentation Operational Policy KCH 2011 Page 16

17 The MDT co-ordinator will generate a report that is ed to all MDT members. In addition an action sheet will be generated at the end of the meeting with out-standing actions. A copy of this MDM report is sent through to the GP. As far as possible all request forms are filled in at the end of the meeting. Forms are made available by the MDT co-ordinator. Trackers will track the patient through the process to ensure that investigations are timely and that investigation reports are generated prior to all MDM meetings. This will enable compliance with 31 and 62 day targets. The MDM co-ordinator will liaise with the cancer directorate and the trackers to prevent breaches. A traffic light system is provided to the lead clinician each week with potential breaches identified. A pathway coordinator meeting takes place with the MDM coordinator each week. If patients require an urgent decision between meetings then the individual clinician will contact the treating physician directly to discuss the case. These patients will still be subsequently discussed at the MDM at KCH. The MDM coordinator will ensure that the MDM reports are filed in the medical notes and liaise with secretaries to ensure that relevant out-patient appointments are booked. The MDM report will also be uploaded into patient centre. Attendance records are included in the annual report. Lung Peer Review Documentation Operational Policy KCH 2011 Page 17

18 Measure 08-2C-106 (Measure 11-2C-106) Membership Arrangements (Cover for core members) MDT agreed cover arrangements for core members Core Members KCH Role Member Cover Lead Clinician Dr Goldsack Dr B-Ravary Thoracic Surgeon Miss King Mr Pilling Radiologist Dr Entwistle Dr Shekhar Banavali Oncologist Dr Mathilda Cominos Registrar Histopathologist Dr Abdul Kadir Dr Randell Lung Nurse Specialist / Palliative Toni Fleming Elaine Maslin Lung Cancer Support Nurse Elaine Maslin Toni Fleming MDT Co-ordinator Carol Croucher Sabina Wilmshurst Thoracic surgical cover is currently provided by Mr Pilling who covers the WHH Lung Cancer MDT and is able to see patients urgently if necessary at his WHH clinic 11 th April 2011 Lung Peer Review Documentation Operational Policy KCH 2011 Page 18

19 Measure 08-2C-110 Measure 11-2C-110 Policy for Communicating Cancer Diagnosis to GP. Operational Policy for communication of diagnosis to GP All new diagnoses of lung cancer are to be discussed with the GP or practice by the end of the next working day using the proforma that follows ( peach form ). The CNS will meet with the patient when they receive the diagnosis. They will then fax the GP to let them know the diagnosis and management plan using the proforma that follows. The form should be completed by the doctor in clinic, in conjunction with the clinic nurse and or CNS. The original form must be dated and signed and filed in the patient notes. Any change to the management plan decided at the MDT must be communicated to the GP within 24 hours using the proforma. For patients in peripheral clinics the consultant will let the CNS know what has been communicated with the patient. The CNS will then contact the patient by phone and offer to meet with them if the patient wishes. The CNS will contact the GP as above. Information packs for these patients are available and will be provided by the consultant. Lung Peer Review Documentation Operational Policy KCH 2011 Page 19

20 COMMUNICATING A CANCER DIAGNOSIS This form must be completed for every patient to confirm that a diagnosis of cancer has been given. Affix patient label here Please ensure: This form is faxed to the patient s GP This form is faxed to Cancer Services for the attention of the relevant MDT Co-ordinator Fax to a safe haven (KCH , QEQM , WHH ) Original is retained in the hospital notes Keyworker Name and Contact details Principal Clinician Name 1. What is the patient s diagnosis (incl. tumour site) & relevant past medical history? 2. How was this discovered? Screening Clinical Clinical Investigations Cytology Histology of metastases Histology of a primary tumour Specific tumour markers Unknown Morphology 3. What did you tell the patient? 4. Which of the following words did you use? Cancer Tumour Malignant Growth Other Myeloma Lymphoma Leukaemia 5. What treatment did you discuss with the patient? Further Investigations Surgery Chemotherapy Active Radiotherapy Palliative Care Endocrine/ Monitoring Hormone Therapy Did the patient agree to this treatment? YES NO 6. Did you discuss prognosis? YES NO If yes comments please: 7. Who was present at the time? ie: Nurse/Partner/Carer/Friend/Whole team Lung Peer Review Documentation Operational Policy KCH 2011 Page 20

21 8. Referred to:- Hospital Clinical Nurse Specialist Oncologist Hospital Palliative Care Team Community Palliative Care Team Other (please specify) 9. What is the next stage of their pathway and which if any investigations have you requested? 10. MDT Leaflet offered YES NO Accepted/ Declined (delete as applicable) 11. Information Booklet offered YES NO Accepted / Declined (delete as applicable) 12. Copy of Letter offered YES NO Accepted / Declined (delete as applicable) Signature of doctor Date of consultation (diagnosis given) treat) PRINT NAME Date of consultation (decision to Signature & Date faxed to GP Review March Version 04. CCHH Service Development Group COMMUNICATING A CANCER DIAGNOSIS Purpose of the form: To ensure that the Cancer Services team and all professionals in primary and secondary care are aware that a patient has been given a diagnosis of Cancer, enabling effective management of the rest of the patients care pathway. To notify the patients GP of a diagnosis of cancer. To inform GP and hospital staff of the name and contact details of the Key worker and Principal Clinician. It also acts as a permanent record of the Key Worker and Principal Clinician. To enable the collection of cancer data in accordance with National guidelines To enable the collection of the date of decision to treat for audit purposes in line with the 31/62 day targets. Process to be followed in the use of this form: When a diagnosis of cancer is given, this form should be completed by the doctor in clinic, in conjunction with the clinic nurse and or Cancer Clinical Nurse Specialist (Key Worker for the Cancer patient). The form must be faxed as soon as completed, to the on site Cancer Services Office KCH Lung Peer Review Documentation Operational Policy KCH 2011 Page 21

22 QEQM WHH (patients seen at WHH, RVHF, BHD, Deal) To ensure Cancer MDT Co-ordinator and Cancer CNS are kept fully informed. The original form must be signed and dated and filed in the patient s hospital notes Treatment plan - If a patient wishes to take time to consider their treatment before making a decision, then the above process must still be followed to confirm that the diagnosis has been given, and the form annotated to show clearly that the patient is still considering treatment. When the patient makes their decision on their treatment plan, then this information must be added to the original in the patient notes, and the form to be re-faxed to one of the numbers shown above. This form should also be faxed to the GP notifying them of the patient s diagnosis, in accordance with National Cancer Quality measures, by the end of the next working day. The person sending the fax should sign and date to confirm that this has been done. Useful Notes for the completion of this form Date of decision to treat This is the date of the consultation at which the clinician and patient discuss and agree the patient s treatment plan. For target purposes this is the date that the 31 day target starts counting. This may not always be the same date that the diagnosis is communicated to the patient. This document must not be amended or altered. This form should be photocopied on peach paper and supplies maintained by wards and outpatient clinics. Any queries regarding this form should be addressed to the Cancer Services Operations Manager on Ext Review March Version 05. CCHH Service Development Group Lung Peer Review Documentation Operational Policy KCH 2011 Page 22

23 Measure 08-2C-111 (Measure 11-2C-111) Key Worker policy / CNS Policy Toni Fleming / Elaine Maslin / Mary Anne Lovett Responsibilities The CNS will usually be present when a patient receives a diagnosis of lung cancer. The CNS if possible will spend time with the patient and their relatives. The CNS will make arrangements to contact the patient and family if appropriate at a later date. The CNS will be responsible for ensuring that patient information is available. The CNS will provide a card with contact details and the patient and carers will be encouraged to contact if there are any concerns. The CNS will liaise with the MDT as appropriate. The CNS is also the MDT member responsible for service improvement. The CNS will usually be the key worker. The CNS will provide information packs to be made available to consultants who attend peripheral clinics. The CNS will be the person from the MDT responsible for patient / carer issues The CNS will if possible attend the Lung DOG. The CNS will participate in clinical audit The CNS will act as the key worker The CNS will work in close partnership with the Pilgrims Hospice and referrer patients in an appropriate and timely manner. CNS/Oncology Support Nurse Signature Toni Fleming and Elaine Maslin Date 11 th April 2011 Lead Lung Clinician Date 11 th April 2011 Lung Peer Review Documentation Operational Policy KCH 2011 Page 23

24 Measure 08-2C-112 Measure 11-2C-112 Diagnostic Services Histopathology All histopathologists based in East Kent take part in general histopathology EQA. This has been confirmed Dr Amino Abdul-Kadir. Evidence is uploaded in Document 1 Appendix A. 11 th April 2011 Lung Peer Review Documentation Operational Policy KCH 2011 Page 24

25 Measure 08-2C-113 Measure 11-2C-113 Details of core nurse members specialist study Certificates uploaded in Document 1 Appendix B Toni Fleming Diploma in Adult Nursing August Degree in Adult Nursing August ENB 237 Care of person with Cancer 2003 ENB Advance Communication Course 2006 MSc Module Symptom control in Palliative Care 2003 MSc Module Spirituality in Palliative Care 2007 MSc Module Concepts of Supportive and Palliative Care 2008 MSc Module Education in Palliative Care 2008 Msc Module Developments in Supportive and Palliative Care April 2009 MSc Module Ethics July 2009 Elaine Maslin Diploma in Adult Nursing 1980 ENB Advance Communication Course 2010 ENB Care of dying patient 1998 Lung Peer Review Documentation Operational Policy KCH 2011 Page 25

26 Measure 08-2C-114 Measure 11-2C-114 Agreed Responsibilities for Core Nurse Members. Clinical Nurse Specialists / Key Worker Toni Fleming / Elaine Maslin Responsibilities The CNS will usually be present when a patient receives a diagnosis of lung cancer. The CNS if possible will spend time with the patient and their relatives. The CNS will make arrangements to contact the patient and family if appropriate at a later date. The CNS will be responsible for ensuring that patient information is available. The CNS will provide a card with contact details and the patient and carers will be encouraged to contact if there are any concerns. The CNS will liaise with the MDT as appropriate. The CNS is also the MDT member responsible for service improvement. The CNS will usually be the key worker. The CNS will provide information packs to be made available to consultants who attend peripheral clinics. The CNS will be the person from the MDT responsible for patient / carer issues The CNS will if possible attend the Lung DOG. The CNS will participate in clinical audit The CNS will act as the key worker The CNS will work in close partnership with the Pilgrims Hospice and referrer patients in an appropriate and timely manner. CNS Signature Toni Fleming Date 11 th April 2011 CNS/OSN Signature Elaine Maslin Date 11 th April 2011 Lead Lung Clinician Date 11 th April 2011 Lung Peer Review Documentation Operational Policy KCH 2011 Page 26

27 Measure 08-2C-115 Agreed List of Additional Responsibilities for One Core Nurse Members. A signed copy of these roles and responsibilities is included in the evidence folder. A copy of Toni Flemings job description is attached along with the Network Key worker policy. Clinical 1. Support and manage patients requiring specialist palliative care at any stage within the disease trajectory regarding treatment and advise on control of symptoms in both malignant and non-malignant disease. Assess and identify psychological needs of palliative care patients within the hospital setting. This will include providing ongoing information and support. The average patient s case load of the service is 400 patients per year. Support patients both pre and post diagnosis, provide information regarding diagnosis and treatment options and management of symptoms. Assess and identify psychological needs of patients with lung cancer. This will include providing ongoing information and support to both inpatients and outpatients throughout their disease trajectory. The average patients case load is 130 newly diagnosed patients per year. This role involves care of patients throughout their disease including pre diagnosis and treatment as well as palliation of symptoms and care of patients who have advanced or recurrent disease. 2. Liaise with members of the multidisciplinary team in the care and treatment of patients to optimise health outcomes. Act as their advocate. Lead on communication and collaboration between all healthcare professionals both in the Hospital/Hospice and Primary Care setting, including support agencies. 3 Plan and assist in implementing National Accreditation Standards for care of patients with cancers and palliative care and audit implementation of these standards. Maintain links with the Kent Cancer Network and other specialist palliative care agencies and share knowledge and experience in order to promote best practice. Assist and facilitate in the breaking of bad news with other health care professionals and imparting frequently highly distressing information regarding terminal illness and disease progression to patients and significant other. Assist and facilitate the interdisciplinary team in ethical issues relating to palliative and terminal care. 4 Promote health and palliative rehabilitation through empowering patients, clients and carers, and offering appropriate health education, Lung Peer Review Documentation Operational Policy KCH 2011 Page 27

28 information and advice. Promote health through empowering patients, clients and carers, and offering appropriate health education, information and advice. 5 Liaise with multidisciplinary team members within hospital and community services to ensure appropriate hand-over of patients and relevant and timely discharge planning and ongoing management of care. 6. Refer directly to other agencies/disciplines to optimise health outcomes. 7 Manage and facilitate on the development of proposals for nursing practice development in relation to palliative care. 8. Maintain accurate records and submit an annual report on the service to the Trust and Macmillan Cancer Relief Management 1. Efficiently utilise the resources required to meet service objectives. 2. Manage and co-ordinate the development of policies, procedures and clinical protocols related to the care and management of palliative care patients in liaison with other Clinical Nurse specialists both within the trusts and the Kent Cancer Network. 3. Continuously develop service delivery to palliative patients in line with local and national guidelines. 4. Develop standards of practice against which quality of care can be measured. 5. Participate in the local cancer/palliative nurse network and liaise with other clinical cancer nurse specialists to plan and review the delivery of service. 6. Submit activity statistics and data as required by the Trust in order to maintain a database on the care and management of palliative care patients. 7. Ensure that the service is covered in the absence of post holder Education 1. Identify the specific education needs of individual patients and carers in relation to the care and management of their disease, and facilitate meeting these needs. 2. Lead and facilitate in the training and education needs of the multidisciplinary team within the trust in relation to all aspects of palliative care. Set up education programmes related to lung cancer/ palliative care with multidisciplinary team collaboration and Lung Peer Review Documentation Operational Policy KCH 2011 Page 28

29 appropriate educational institutions, both locally and across the Kent Cancer Network 3. Act as a role model to staff, providing formal and informal education and support to staff in their provision of lung cancer/palliative care across the service. Audit & Research 1. Identify the development of research based practice within the service and, in conjunction with appropriate managers and clinicians. Implement and encourage the use of research based practice with regard to lung cancer and palliative care within the service. 2. Develop and implement mechanisms for auditing care within the service. In conjunction with senior medical staff and nursing staff, manage the development of multidisciplinary audit. 3. Participate in or support, where appropriate, nursing and/or collaborative clinical research in lung cancer and palliative nursing. To be a named research lead locally on specific medical research councils trials. 4. Develop and implement mechanisms for involving patients/users in the monitoring and development of service provision Personal Professional Development 1. Acknowledge the need for support and supervision and to take necessary steps to initiate this. 2. Understand, familiarise and continuously update yourself with Statutory, Trust and Cancer Services policies, procedures and protocols 3. Recognise own needs for continual education and updating in cancer treatment and care, and take appropriate measures to meet these needs. 4. Participate in individual performance review of personal development plans. Lung Peer Review Documentation Operational Policy KCH 2011 Page 29

30 EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST Job Description 1. JOB DETAILS Job Title: Macmillan Clinical Nurse Specialist Lung Cancer/Palliative Care Grade: Band 7 Location: Accountable to: Reporting to: Base Kent and Canterbury Head of Cancer Services Lead Cancer Nurse 2. JOB PURPOSE To provide a flexible, specialist nurse-led service for patients with Lung Cancer and progressive life limiting disorders within the hospital setting. The post holder will act as a specialist resource for patients, their carers, nursing colleagues, the multidisciplinary teams and other healthcare workers by offering expert skills, specialist advice and support, as needed. The post holder will also participate in the achievement of National Accreditation Standards. The post holder will act as an expert resource and facilitator to educate and train all disciplines of staff working with this group of patients. The post holder will act as a change agent and facilitate change within defined clinical and organisational boundaries. 3. DIMENSIONS Within the complex nature of cancer and other life-limiting conditions, the Clinical Nurse Specialist will lead and coordinate the patient s palliative pathway whilst providing expert care, counselling skills and support to the patient and family who have been identified to them. The post-holder will have continuing responsibility for the co-ordination and Organisation of individual treatment programmes from time of referral to discharge from the service. The post holder will demonstrate leadership in all areas of palliative care and act as an expert resource to other professionals involved in the care of these patients. Within the complex nature of lung cancer, poor prognosis and the broad range of symptoms experience by these patients, the Clinical Nurse Specialist will provide expert care and counselling support and demonstrate leadership to patients who are identified as requiring care and support from a Cancer Clinical Nurse Specialist. Lung Peer Review Documentation Operational Policy KCH 2011 Page 30

31 The post holder will lead on and facilitate on the implementation of service development in relation to NICE and supportive and palliative care guidance e.g. Liverpool integrated care pathway 4. ORGANISATION CHART Associated Medical Head of Cancer Services (Lead Cancer Manager) Trust Lead Cancer Nurse Lymphoede Cancer Clinical Nurse Chemothera Counselling 5. KNOWLEDGE, SKILLS AND EXPERIENCE Education/ Qualifications: Registered Nurse on the Practicing Register ENB 237 or Diploma/Degree in Cancer Nursing ENB 285 specialist care of the dying patient ENB 931 continuing care of the dying patient First and/or Higher Degree in Nursing/Health Services Teaching qualification/experience Willingness to undertake MSc Management certificate/course and/or leadership course The above are all essential. Other Knowledge: Research and audit experience essential Skills: Experience: Highly developed interpersonal/counselling skills - Essential Organisational skills - Essential Leadership skills - Essential Self-motivation - Essential I.T. skills Essential Project Management Desirable Experience of Nursing Audit Essential Networking skills Essential 1 st level Registration with a minimum of 5 years post registration experience, at least two of these at G or H in Cancer Care/Palliative Care Experience in counselling/psychological support - Essential 6. KEY RESULT AREAS Lung Peer Review Documentation Operational Policy KCH 2011 Page 31

32 The Clinical Nurse Specialist will be a core member of a multidisciplinary team, providing direct/indirect support and advice to patients. Act as a named Key Worker providing direct/indirect support and advice to patients and significant others with Lung Cancer in accordance with Cancer Quality measures. The Clinical Nurse Specialist will plan and manage specialist care and recommend treatment of patients, including assessing and interpreting specialist acute lung cancer related conditions and recommending appropriate management, acting as a resource to the core multidisciplinary team and extended team members. The post-holder will liaise with the primary care sector and the Kent Cancer Network. The Clinical Nurse Specialist will manage on all aspects of specialist palliative care within the hospital setting. The post holder will act as a resource to the core multidisciplinary team and extended team. The post holder will assess, plan, prescribe and evaluate the psychological, physical, emotional and cultural needs of Lung Cancer and Palliative care patients. The post holder will work as an independent autonomous practitioner to provide both practical and emotional support for patients and their carers throughout their care pathway. The post holder will liaise with colleagues, peers, the Cancer Services and Trust Clinical Audit Team to establish information and audit systems for Lung Cancer and Palliative patients seen within the Trust. The post holder will demonstrate active involvement with patient and carers, including monitoring patients and carers satisfaction within the service The post holder will implement patient focused benchmarking within the developing service provision. 7. MAIN DUTIES AND RESPONSIBILITIES Clinical 1. Support and manage patients requiring specialist palliative care at any stage within the disease trajectory regarding treatment and advise on control of symptoms in both malignant and non-malignant disease. Assess and identify psychological needs of palliative care patients within the hospital setting. This will include providing ongoing information and support. The average patient s case load of the service is 400 patients per year. Support patients both pre and post diagnosis, provide information regarding diagnosis and treatment options and management of symptoms. Assess and identify psychological needs of patients with lung cancer. This will include providing ongoing information and support to both inpatients and outpatients throughout their disease trajectory. The average patients case load is 130 newly diagnosed patients per year. This role involves care of patients throughout their disease including pre diagnosis and treatment as well as palliation of symptoms and care of patients who have advanced or recurrent disease. Lung Peer Review Documentation Operational Policy KCH 2011 Page 32

33 2. Liaise with members of the multidisciplinary team in the care and treatment of patients to optimise health outcomes. Act as their advocate. Lead on communication and collaboration between all healthcare professionals both in the Hospital/Hospice and Primary Care setting, including support agencies. 3 Plan and assist in implementing National Accreditation Standards for care of patients with cancers and palliative care and audit implementation of these standards. Maintain links with the Kent Cancer Network and other specialist palliative care agencies and share knowledge and experience in order to promote best practice. Assist and facilitate in the breaking of bad news with other health care professionals and imparting frequently highly distressing information regarding terminal illness and disease progression to patients and significant other. Assist and facilitate the interdisciplinary team in ethical issues relating to palliative and terminal care. 4 Promote health and palliative rehabilitation through empowering patients, clients and carers, and offering appropriate health education, information and advice. Promote health through empowering patients, clients and carers, and offering appropriate health education, information and advice. 5 Liaise with multidisciplinary team members within hospital and community services to ensure appropriate hand-over of patients and relevant and timely discharge planning and ongoing management of care. 6. Refer directly to other agencies/disciplines to optimise health outcomes. 7 Manage and facilitate on the development of proposals for nursing practice development in relation to palliative care. 8. Maintain accurate records and submit an annual report on the service to the Trust and Macmillan Cancer Relief Management 1. Efficiently utilise the resources required to meet service objectives. 2. Manage and co-ordinate the development of policies, procedures and clinical protocols related to the care and management of palliative care patients in liaison with other Clinical Nurse specialists both within the trusts and the Kent Cancer Network. 3. Continuously develop service delivery to palliative patients in line with local and national guidelines. 4. Develop standards of practice against which quality of care can be measured. Lung Peer Review Documentation Operational Policy KCH 2011 Page 33

34 5. Participate in the local cancer/palliative nurse network and liaise with other clinical cancer nurse specialists to plan and review the delivery of service. 6. Submit activity statistics and data as required by the Trust in order to maintain a database on the care and management of palliative care patients. 7. Ensure that the service is covered in the absence of post holder Education 2. Identify the specific education needs of individual patients and carers in relation to the care and management of their disease, and facilitate meeting these needs. 2. Lead and facilitate in the training and education needs of the multidisciplinary team within the trust in relation to all aspects of palliative care. Set up education programmes related to lung cancer/ palliative care with multidisciplinary team collaboration and appropriate educational institutions, both locally and across the Kent Cancer Network 3. Act as a role model to staff, providing formal and informal education and support to staff in their provision of lung cancer/palliative care across the service. Audit & Research 1. Identify the development of research based practice within the service and, in conjunction with appropriate managers and clinicians. Implement and encourage the use of research based practice with regard to lung cancer and palliative care within the service. 2. Develop and implement mechanisms for auditing care within the service. In conjunction with senior medical staff and nursing staff, manage the development of multidisciplinary audit. 3. Participate in or support, where appropriate, nursing and/or collaborative clinical research in lung cancer and palliative nursing. To be a named research lead locally on specific medical research councils trials. 4. Develop and implement mechanisms for involving patients/users in the monitoring and development of service provision Personal Professional Development 5. Acknowledge the need for support and supervision and to take necessary steps to initiate this. Lung Peer Review Documentation Operational Policy KCH 2011 Page 34

35 6. Understand, familiarise and continuously update yourself with Statutory, Trust and Cancer Services policies, procedures and protocols 7. Recognise own needs for continual education and updating in cancer treatment and care, and take appropriate measures to meet these needs. 8. Participate in individual performance review of personal development plans. 5. This Job Description is not exhaustive and may be subjective to change depending on service needs, discussion with, and agreement of the post holder and appropriate management staff. It is recognised that additional training maybe needed. 8. Extended Role As a registered nurse, midwife or health visitor, you must maintain your professional knowledge and competence You must keep your knowledge and skills up-to-date throughout your working life. In particular, you should take part regularly in learning activities that develop your competence and performance. To practice competently, you must possess the knowledge, skills and abilities required for lawful, safe and effective practice without direct supervision. You must acknowledge the limits of your professional competence and only undertake practice and accept responsibilities for those activities in which you are competent. If an aspect of practice is beyond your level of competence or outside your area of registration, you must obtain help and supervision from a competent practitioner until you and your employer consider that you have acquired the requisite knowledge and skill. You have a duty to facilitate students of nursing, midwifery and health visiting and others to develop their competence. You have a responsibility to deliver care based on current evidence, best practice and, where applicable, validated research when it is available. 9. COMMUNICATIONS AND WORKING RELATIONSHIPS Internal: Other NHS: Lead Cancer Nurse Other Cancer Clinical Nurse Specialists Trust Consultants Trust Cancer Services Team Lead Clinicians for Cancers within the Trust Heads of Nursing Ward Managers/Ward Nurses Clinical Trials Nurses Trust Palliative Care Teams Chemotherapy Day Units Trust Clinical Audit Teams Trust Practice Development Teams Multidisciplinary team members Cancer services counsellor Chaplaincy Team Kent Oncology Centre Consultants and Team Kent Cancer Network Lung Peer Review Documentation Operational Policy KCH 2011 Page 35

36 Primary Care Teams, Primary Care Groups and Primary Care Trusts Pilgrims Hospices Cancer Services Collaborative Tertiary Centres External (to NHS): Macmillan Cancer Relief Social Services Cancer Charities Higher and Further Institutions Royal College of Nursing Royal Colleges in Healthcare Voluntary Agencies 10. MOST CHALLENGING PART OF YOUR JOB Implementing specialist lung cancer/palliative care within the culture of an acute hospital trust. Breaking of bad news with other health care professionals and imparting frequently highly distressing information regarding terminal illness and disease progression to patients and significant other. Working collaboratively with all care groups in the patients journey, developing a comprehensive specialist lung cancer/palliative care service for the care and management of patients with cancer, associated disorders and non-malignant disease. The post-holder will co-ordinate the care between the Trust, Kent Cancer Network, and the Community, as appropriate. The potholder will ensure compliance with the Trust s Risk Management Policies and Procedures. These describe the Trust s commitment to risk management, the recognition that our aim is to protect patients, staff and visitors from harm, and stress that all staff have a responsibility to minimise risk TJS/2005 CNS Signature Toni Fleming Date 11 th April 2011 Lead Lung Clinician Date 11 th April 2011 Lung Peer Review Documentation Operational Policy KCH 2011 Page 36

37 Measure 08-2C-117 Measure 11-2C-116 Membership Arrangements (Extended team member) User issues and information for patients Toni Fleming PET Service / reporting Dr Gordon Ellul attends weekly Survivorship Study Mary Anne Lovett x64477 Chaplains. Reverend Christopher White x Dr Paul Kirby x Social workers. Kerry Stuart and Beata harrington x73611 Dietitian. Helen Turner, Oncology Lead Dietitian KCH. x Catriona McIntyre, Oncology Dietitian QEQM x86113 Psychologist / Bereavement Care Maureen Potter x Oncology Counselling / Psychology K&C Hospital Canterbury WH Hospital Ashford QEQM Hospital Margate Mrs Elizabeth Taylor Dir: Ext:73611 Fax:01227 Ms Martine Bliss Dir: Ext:88790 Fax: Ms Maureen Potter Dir: Ext:64202 Fax: Palliative Care K&C Hospital Canterbury WH Hospital Ashford QEQM Hospital Margate Ms Jane Sellen Mrs Toni Fleming Ms Terri Oliver Ms Julie Jones Ms Pauline Reed Mr Keith Duffy Dir: Ext:74977 / Fax: Dir: Ext:86024 Fax: Dir: Ext:65074 / Fax: Pilgrims Hospice Canterbury Dir: Fax: Ashford Dir: Fax: Margate Dir: Fax: Lymphoedema Service Pilgrims Hospice Ashford Ms Christine Wise Lymphoedema Lead WH Hospital Ms Faye Hames Dir: Dir: Ext: Fax: Lung Peer Review Documentation Operational Policy KCH 2011 Page 37

38 Ashford QVM Hospital Herne Bay Ms Larna Hamlin Heather Smith Ext:63637 Fax: Dir: Ext: Macmillan Radiographer Brenda Manktelow Ext:74098 Occupational Therapy Ms Justine Robinson Ext:73076 Dietician Ms Helen Turner Ext:74129 Social Worker Ms Beata Harrington Ext:73611 Mrs Kerry Stuart Macmillan Welfare benefits caseworker Marian Nyman Medical Photographer Ms Jill Fell Ext:74258 Patient Experience Team (formerly PALS) Canterbury Dir: Ext:74259 Ashford Dir: Ext:86615 Margate Dir: Cancer 2-WW Office Respiratory Nurses K&C Hospital Canterbury Whitstable & Tankerton Ext: Dir: Ext:74848 Fax: Pam Jordanson Dir: Patient Service Centre Trustwide Lung Peer Review Documentation Operational Policy KCH 2011 Page 38

39 Measure 08-2C-118 Measure 11-2C-117 Patient and Carer Feedback and Involvement Permanent Consultation Records. Policy for copying letters to patients Patients will be offered a copy of their letter when they attend for their first oncology or surgical appointment An example of these letters from the oncologists and the thoracic surgeons is attached at the end of the documentation (Appendix C). Lung Peer Review Documentation Operational Policy KCH 2011 Page 39

40 Measure 08-2C-121 Measure 11-2C-119 Patient and Carer Feedback and Involvement Information Offered to Patients A large number of information leaflets are offered to patients. This constitutes a package that is given to every patient with lung cancer or to their carers. Within this information there is also contact details of their key worker / CNS. We are part of the 1 st wave for implementation of Information Prescriptions due to commence in September We are part of the 1 st wave of information prescriptions sites starting from September 2011 and our local information will be uploaded to the after this date. All Lung CNSs have had training in Information Prescriptions and will be able to offer patients tailored information in a variety of different ways eg booklet form, via . Documents include Understanding Lung Cancer Help with the Cost of Cancer The Cancer Guide An Intro to Lung Cancer MDT Lung Cancer Macmillan Cancer Support Macmillan Cancer Support Macmillan Cancer Support East Kent Hospitals NHS Trust Roy Castle Lung Cancer Foundation. A copy of the front pages of these documents is included at Appendix D of Document Lung Peer Review Documentation Operational Policy KCH 2011 Page 40

41 Measure 08-2C-122 Measure 11-2C-120 Recording MDT Decisions. Within the meeting computers are available for recording of patient details and to generate MDT reports using Infoflex. Usually the minutes will be entered by a clinician. These reports are signed off by the lead clinician at the end of the meeting. The MDT co-ordinator will generate a report that is ed to all MDT members. In addition an action sheet will be generated at the end of the meeting with out-standing actions. As far as possible all request forms are filled in at the end of the meeting. These will be made available by the MDT co-ordinator. The MDM coordinator will ensure that the MDM reports are filed in the medical notes and liaise with secretaries to ensure that relevant out-patient appointments are booked. The MDM report will also be uploaded into patient centre. A dictating machine is available in the meeting for additional GP or patient letters and these are typed by Dr Goldsack s secretary the following day. Dr Goldsack signs them all to ensure letters are sent promptly. Lung Peer Review Documentation Operational Policy KCH 2011 Page 41

42 The MDT Meeting Measure 08-2C-122 Recording MDT Decisions. An example of an MDT report follows. These minutes are subsequently placed in the hospital notes. Lung Peer Review Documentation Operational Policy KCH 2011 Page 42

43 NAME HOSPITAL NO NHS NUMBER DOB/AGE CONSULTANT xxxxxx xxxxxx xxxxxx xxxxxx xxxx ADDRESS TEL NO GP NAME & ADDRESS GP TELEPHONE NO xxxxxxxx Home: Work: Mobile: Dr. GARLAND Tel: Fax: REFERRAL SOURCE Referral from General Medical Practitioner DATE REQUESTED DATE SEEN SEEN IN SEEN BY BREACH DATE xxxxx xxxxx 62: xxx 31: xxxx PRESENTATION & PREVIOUS HISTORY (IF APPLICABLE): RAPID ACCESS 6 X 7 inhomogeneous mass in right lower lobe and 4 X 5 mass in left upper lobe, enlarged mediastinal lymph nodes and left adrenal mass Moderate to severe COPD - FEV (55% of predicted) with 60 pack years. Type II diabetes. Probable indigestion Histology shows: moderately differentiated Squamous carcinoma. CT shows: bilateral masses, nodal disease and left adrenal mets. Discuss with Dr Cominos urgent OPA in Chest Clinic Staging: TYPE OF TEST DATE OUTCOME X-RAY 05/02/2010 5/2/10. There is a fairly well marginated soft tissue density nodule is seen in right mid zone. Further smaller nodule is seen in left perihilar region overlapping the superior branches of left pulmonary artery. These are suspicious for mitotic lesions. Cardiac size is normal. A CT scan will be booked for further evaluation. Please arrange for the serum creatinine and egfr for expediting the scan. Please refer this patient to the appropriate rapid access clinic under the two week wait process. No appointment will be sent until your referral has been received. Report faxed to GP and Lung MDM coordinator. BRONCHOSCOPY CT SCAN 10/02/ /2/10. CT Chest/Abdo/Pelvis With Contrast : There is a mass in the right lower lobe measuring 6.4 x 7.2 cm in diameter. The lesion is inhomogeneous with areas of necrosis and gas pockets. The mass encases right lower lobe artery. There is an impression of the filling defect in the artery lumen which would indicate an embolus. There is inhomogenous lobulated 4 x 5 cm mass in the left upper lobe causing pleural tethering. Minor fibrotic changes are demonstrated in the right base. No evidence of pleural effusion is seen. There are enlarged mediastinal lymph nodes, the largest prevascular measures 11 x 18mm. Lung Peer Review Documentation Operational Policy KCH 2011 Page 43

44 There is enlarged right retrocrural lymph node. No evidence of size significant retroperitoneal lymph nodes. No focal lesions are demonstrated in the liver. There is left adrenal mass, measuring 2.8 x 4.5 cm. Normal right adrenal gland, kidneys and pancreas. There is deformation of the left iliac bone which may be due to previous traumatic injury. No evidence of bone destruction. No focal bone lesions seen elsewhere. Summary: The overall appearances are suggestive of metastatic malignancy, possibly lung primary. Please arrange rapid access referral. Report faxed to the GP. PET SCAN CT GUIDED BIOPSY 17/02/2010 NA BONE SCAN MRI SCAN ULTRASOUND SCAN LUNG FUNCTION FEV 1.45 OTHER SMOKER EXPOSURE TO ASBESTOS YES Ex Heavy up 100 per day 60 pack years no Pathology: HISTOLOGY SNAME:xxxxx PR:0xxxxx 12/10/1xxxx FNAME:xxxxx Male RDATE:17/02/2010 SENDER: Dr Dionyssios Malamis QENDO QEQM Specimen No : PH005444F/09 (Cellular Pathology) <PgUp> for earlier samples 17/02/2010 u/k CTB Respiratory Biopsies Report Sequence : 1 Clinically Approved on 23/02/2010 at 16:41 by Dr. A. Abdulkadir on Generic Ward enquiry Nature of Specimen:- Right bronchial washings Clinical Details: Weight loss of voice - smoke right lower lobe. Very necrotic mass + 2nd perilobular mass?lung ca Macroscopic Description: Multiple pieces of tissue the larger piece measures up to 4mm the smaller <1mm. All embedded in one cassette. Lisa Jaynes Histology: This is a moderately differentiated squamous cell carcinoma. Peer review: Dr R Oommen T26000 M80703 Pathologists:- Dr A. Abdulkadir(Cons), Dr. R.Oommen (Cons) RDATE:17/02/2010 RCLN:Dr Dionyssios Malamis LOC:QENDO HOSP:QEQM Specimen No : PN000899N/10 (Cellular Pathology) <PgUp/PgDn> for more Lung Peer Review Documentation Operational Policy KCH 2011 Page 44

45 samples 17/02/ :02 Bronchial Brushings Specimen Comment : BRONCHIAL BRUSHINGS Request Reason : RIGHT LOWER LOBE SMOKER WT LOSS LARGE MASS RLL VY NECROTIC Report Sequence : 1 Clinically Approved on 20/02/2010 at 16:02 by Dr. Rachel Oommen on Generic Ward enquiry Nature of Specimen: Bronchial brushings and washings Macroscopic Description: 1) 2 x prepared slides labelled bronchial brushings 2) 5ml opaque bloodstained fluid labelled washings Micro: 1 & 2 show similar features. The smears show atypical keratinising squamous cells with bizarre shapes and fibre cell forms and occasional cohesive sheets. Conclusion: Features are those of a squamous cell carcinoma. Source of Specimen: Dr Dionyssios Malamis, OPD, QEQM Pathologists:- Dr. R.Oommen (Cons), Dr Sonia Saw SPR CYTOLOGY SNAME:xxxx PR:0xxxxx 12/10/xxxx FNAME:xxxxx xxxxxx, Male RDATE:17/02/2010 SENDER: Dr Dionyssios Malamis QENDO QEQM Specimen No : PH005444F/09 (Cellular Pathology) <PgUp> for earlier samples 17/02/2010 u/k CTB Respiratory Biopsies Report Sequence : 1 Clinically Approved on 23/02/2010 at 16:41 by Dr. A. Abdulkadir on Generic Ward enquiry Nature of Specimen:- Right bronchial washings Clinical Details: Weight loss of voice - smoke right lower lobe. Very necrotic mass + 2nd perilobular mass?lung ca Macroscopic Description: Multiple pieces of tissue the larger piece measures up to 4mm the smaller <1mm. All embedded in one cassette. Lisa Jaynes Histology: This is a moderately differentiated squamous cell carcinoma. Peer review: Dr R Oommen T26000 M80703 Pathologists:- Dr A. Abdulkadir(Cons), Dr. R.Oommen (Cons) SNAMExxxxx PR:xxxxxx 12/10/1xxx Male FNAMExxxxx RDATE:17/02/2010 RCLN:Dr Dionyssios Malamis LOC:QENDO HOSP:QEQM Specimen No : PN000899N/09 (Cellular Pathology) <PgUp/PgDn> for more samples 17/02/ :02 Bronchial Brushings Lung Peer Review Documentation Operational Policy KCH 2011 Page 45

46 GRADE/STAGE T2 N2 M1 WHO STATUS 1 KEYWORKER Toni Fleming Specimen Comment : BRONCHIAL BRUSHINGS Request Reason : RIGHT LOWER LOBE SMOKER WT LOSS LARGE MASS RLL VY NECROTIC Report Sequence : 1 Clinically Approved on 20/02/2010 at 16:02 by Dr. Rachel Oommen on Generic Ward enquiry Nature of Specimen: Bronchial brushings and washings Macroscopic Description: 1) 2 x prepared slides labelled bronchial brushings 2) 5ml opaque bloodstained fluid labelled washings Micro: 1 & 2 show similar features. The smears show atypical keratinising squamous cells with bizarre shapes and fibre cell forms and occasional cohesive sheets. Conclusion: Features are those of a squamous cell carcinoma. Source of Specimen: Dr Dionyssios Malamis, OPD, QEQM Pathologists:- Dr. R.Oommen (Cons), Dr Sonia Saw SPR Hospital: KENT & CANTERBURY HOSPITAL Date of MDM: 25/02/ :00:00 - MDM Discussion and Actions: Histology shows: moderately differentiated sqaumous carcinoma. CT shows: bilateral masses, nodal disease and left adrenal mets. Discuss with Dr Cominos urgent OPA in Chest Clinic Refer Dr Cominos (consultant oncologist). Oncology referral completed at MDM Lung Peer Review Documentation Operational Policy KCH 2011 Page 46

47 Measure 08-2C-123 Measure 11-2C-121 Treatment guidelines (including palliative care) NSSG Agreed clinical guidelines The MDT has agreed to the NSSG guidelines Lung Peer Review Documentation Operational Policy KCH 2011 Page 47

48 Measure 08-2C-124 Measure 11-2C-122 NSSG agreed referral guidelines The MDT agreed to the referral guidelines from the Kent and Medway Cancer Network. Lung Peer Review Documentation Operational Policy KCH 2011 Page 48

49 Measure 08-2C-125 Measure 11-2C-123 and 124 Diagnostic Services Imaging and Pathology The MDT is in agreement with the Network Diagnostic guidelines for imaging and pathology. Imaging Guidelines Lung Peer Review Documentation Operational Policy KCH 2011 Page 49

50 Measure 08-2C-126 Measure 11-2C-124 Diagnostic Services NSSG agreed diagnosis assessment pathology guidelines Pathology Guidelines Lung Peer Review Documentation Operational Policy KCH 2011 Page 50

51 Measure 08-2C-127 Measure 11-2C-125 Data Collection MDT Collection of MDS Information systems. The MDT is committed to the development of the Infloflex data system with the Kent Cancer Network. This system has been in use since December The referral part of Infoflex is used to provide data for the Thames Cancer Registry and to monitor patients to ensure compliance with 31 and 62 day targets. A new system is being developed for All patient data is recorded via Infoflex. A portion of this data is then uploaded to LUCADA for National collection. Unfortunately due to incompatibility problems with Internet Explorer 7 patient data sets were unable to be uploaded in This issue has been taken up with the chief executive and the Kent and Medway Cancer Network. Dr Goldack personally validated all patient details for the LUCADA database in the 14 key fields for all patients seen and treated in The dataset was uploaded into LUCADA and is available on request. Data for 2010 is currently being collected. Lung Peer Review Documentation Operational Policy KCH 2011 Page 51

52 Measure 08-2C-128 Measure 11-2C-125 Data Collection MDT Electronic Collection of MDS The MDT agreed to the electronic collection of the Kent and Medway Cancer Network Minimum Data Set (see measure 126). Lung Peer Review Documentation Operational Policy KCH 2011 Page 52

53 Additional Policies Bronchoscopy operational policy Fibre-optic bronchoscopy has been performed at all sites within East Kent for many years now and has been found to be a safe and valuable diagnostic tool. The procedure will usually be done as a day case but many patients may already be undergoing investigations as an in-patient having been admitted to the hospital as an emergency or less commonly as an elective case. Booking arrangements for bronchoscopy will be co-ordinated by the secretaries who work alongside the respiratory team. Patients will be asked to complete a form which contains important data collection points and safety requirements. Patients will receive an instruction booklet and also a booklet that outlines the procedure for them. On the day of admission they will attend the bronchoscopy unit and will be seen by an endoscopy unit nurse. Consent will take place in the admissions area and patients will be asked to sign the consent form. As per the East Hospitals NHS Trust policy, patients will be offered a copy of the signed agreement. Bronchoscopies will be carried out according to the BTS guidelines. Different consultants use different forms of sedation. Currently all pathology specimens are processed at our central laboratories in Ashford. Samples taken at the other sites will be sent urgently by taxi after the procedure to ensure that a quick turn-over of these specimens occurs. Patients will be allowed to recover for 2-4 hours prior to discharge. Lung Peer Review Documentation Operational Policy KCH 2011 Page 53

54 It is the policy of the units that all patients must have someone with them after the procedure. On the rare occasions when this is not possible then prior arrangement for overnight admission will be made. The unit also operates a policy for diabetic patients, that is available on request. NICE guidance suggests that CT scan should be done before bronchoscopy. This issue is currently being audited. Lung Peer Review Documentation Operational Policy KCH 2011 Page 54

55 CT-Guided Biopsies of peripheral mass lesions (PMLs) This is arranged at the MDM. On the day of the biopsy, the patient will be asked to complete a consent form in the presence of one member of the radiology team. The radiologist will be on hand to answer any questions should the need arise. Following the biopsy, the patient is returned to the day ward for observation on a ward for a minimum of 4 hours. The patient is usually able to return home once the risks of developing a significant pneumothorax have passed (normally within 4 hours of the procedure). Approximately 5% of patients will go onto develop a pneumothorax of sufficient size to require intercostal tube drainage. All patients will undergo a CXR prior to discharge. The result will be discussed at the next MDM Lung Peer Review Documentation Operational Policy KCH 2011 Page 55

56 Endobronchial Ultrasound Biopsies This service is currently not available within East Kent but our patients are referred to Dr Santis and Dr Breen at St. Thomas s Hospitals. Forms are filled out at the MDM. There is a specialist referral form which is faxed along with the MDM minutes and a short referral note. Results are usually faxed back within 48 hours. Lung Peer Review Documentation Operational Policy KCH 2011 Page 56

57 Surgical Biopsies Occasionally it will become necessary to refer patients for further surgical investigation at St Thomas s prior to establishing the diagnosis e.g. mediastinoscopy, thoracotomy, or rigid bronchoscopy. Patients considered for these procedures will be reviewed at the KCH MDM. If the MDT feel that this procedure is necessary then the patient is referred to the surgical clinic at KCH. Patients are contacted by the clinic team prior to the visit. At the clinic appointment patients will be seen by Miss King and consent obtained. A standard proforma for referral has now been generated (see appendix) MRSA screening will be done at clinic appointment. Miss King will generate a letter to the referring clinician which is also ed to Guys and then the patient is contacted for admission. A surgical patients leaflet will be sent to the patient / or given to them at the clinic appointment. After the procedure the operation notes will be sent to the referring clinician and follow up is arranged. This process occurs by communication. For diagnostic pleural procedures a separate referral form has been generated (see appendix) Lung Peer Review Documentation Operational Policy KCH 2011 Page 57

58 Breaking bad news Bad news will usually be given in the clinic setting by the consultant chest physician. Of paramount importance, is to recognize the need to establish what the patient wishes to know and what their current perception of their problem appears to be. Much of the discussions will therefore be guided by the patient, their relatives or carers if necessary. Providing these steps are adhered to, it is our experience that most patients are keen to be told their diagnosis and many are relieved to know what is wrong with them. The lung CNS are also undertaking Nurse led clinics where they give significant news including breaking bad news to patients. When patients do not wish to know their diagnosis or perhaps appear incapable of understanding it (which is more common in the very elderly or those with underlying dementia) we very much value the opinions of relatives. In circumstances where it would be clearly beneficial to inform the patient of their diagnosis e.g. curative treatment planned against their wishes, our approach is to fully inform their relatives and allow them time to explore these issues with the patient over the next few weeks. In general, we do however advise against collusion as it can be very difficult to do well and frequently leads to feelings of guilt and mistrust once it is uncovered. Patients and carers are seen by the lung CNS and the CNS then becomes that patient s key worker (as per the Lung Cancer Measures). East Kent Hospitals NHS Trust is committed to ensuring that cancer MDT s communication skills are of the highest standard. To this end two senior cancer nurses have been externally trained by a recognized cancer charity to train the MDT s. There is a roll-out program for the implementation of this. Lung Peer Review Documentation Operational Policy KCH 2011 Page 58

59 Lung Peer Review Documentation Operational Policy KCH 2011 Page 59

60 Mesothelioma The MDT has accepted the guidelines for the investigation and management of mesothelioma from the Kent and Medway Cancer Network. Lung Peer Review Documentation Operational Policy KCH 2011 Page 60

61 Individual Team Member Responsibilities Respiratory Physicians Dr Pereira /Dr Farrow / Dr Malamis / Dr Baghai-Ravary Responsibilites Development and co-ordination of the MDT and its activities. Ensuring the MDTs activities are audited, and the results documented. Collating training needs of the team members. Linking with cancer services Lead Clinician of the cancer unit and with colleagues in the cancer network through membership of the NSSG. Ensure 100% of patients with lung cancer are discussed with the MDT Oncologists Dr Cominos Responsibilities To adhere to policies agreed by the MDT. Attend meetings Input into discussions relating to patients, policies and guidance Liaise with MTW trust to ensure that patients are entered into clinical trials Thoracic Surgeon Miss J King Responsibilities To adhere to policies agreed by the MDT. Attend meetings Input into discussions relating to patients, policies and guidance To arrange surgery within recognised clinical targets Pathologist Dr Abdul Kadir Responsibilites Discuss appropriate pathology / slides. Liaise with Dr Oomen (cytologist) regarding cytology Interpret pathology / slides To adhere to policies agreed by the MDT. Attend meetings by video-link Input into discussions relating to patients, policies and guidance Lung Peer Review Documentation Operational Policy KCH 2011 Page 61

62 Radiologists Dr Entwistle Responsibilites Discuss appropriate radiology Organise additional investigations as discussed with MDT To adhere to policies agreed by the MDT. Attend meetings Input into discussions relating to patients, policies and guidance MDT Co-ordinator Carol Croucher / Sabina Wilmshurst Responsibilites To co-ordinate the MDM Obtain patient details and record them on relevant computer system Arrange for notes and X-rays to be available for next meeting Provide minute taking in real time to the MDM Generate MDM reports after the MDM with action plans Record attendance records Lung Peer Review Documentation Operational Policy KCH 2011 Page 62

63 Referrals to Thoracic Surgery Unit at Guy s and St Thomas Room 2D01 Southbank Technopark 90 London Road London SE1 6LN Tel: Fax: th December 2009 Dear Colleagues Re: Referrals to Thoracic Surgery Unit at Guy s and St Thomas Foundation Trust. As we work towards the achievement of the 31/62 day cancer waiting times targets, I am writing to clarify the process for referring patients to the Thoracic surgery unit at Guy s and St Thomas Foundation Trust. I hope this will help to minimise delays in transferring patients between Trusts and ensure targets are met. The following processes should be adhered to for cancer patients and pleural disease patients: Cancer patients requiring a surgical opinion All patients with lung cancer who require a surgical opinion should be referred using the attached proforma. The proforma should be ed to LungMDM@gstt.nhs.uk or faxed to The proforma should contain the following information on the patients waiting times: Whether the patient needs their first definitive treatment for their cancer Whether the patient was originally referred as a two week wait patient and the date the patient was originally referred as a two week wait patient What day the patient is at on their patient pathway on the day of referral (counting from the date the patient was originally referred as a two week wait patient). The proforma should include details of any appropriate adjustments. The proforma should contain information on which diagnostic tests have been performed. All cytology and histopathology results should be ed or faxed as an attachment with the referral proforma. The relevant diagnostic films should be sent as soon as possible to the department (Hard copy or CD) if the patient is at home. If the patient is an inpatient they should be sent along with the patient. The films/cds should be sent to: Thoracic Surgery Secretaries, 6 th Floor New Guy s House, Guy s Hospital, St Thomas Street, SE1 9RT It will need to be highlighted on the proforma whether MRSA screening has been undertaken and the date on which it has been undertaken. GSTT Infection Control demands screening of the nose, axilla, groin and any invasive device or wound. Microbilology results should be attached The proforma consists of two pages, the second page can be used to highlight any additional relevant clinical information. Lung Peer Review Documentation Operational Policy KCH 2011 Page 63