Implementation of a chemotherapy prescribing training programme

Transcription

1 Implementation of a chemotherapy prescribing training programme Kumud Kantilal Macmillan Principal Network Pharmacist, Lead for Education & Training [email protected]

2 Contents Page 2 Background Developing the programme Training and accreditation pathways Challenges Review of training programmes Evaluation of new joint training programme Next steps

3 Background National and local drivers for change Page 3 National publications highlighted the need for training Prescribing should only be undertaken by appropriately trained staff 1 Chemotherapy must be initiated and supervised only by clinicians who are appropriately accredited and/or experienced 2 Prescribing errors accounted for 23.5% of anticancer medicine incidents 3 Local audit (2007) showed that 1 in 3 prescriptions had an error What was in place at GSTFT in 2007 Informal training session as part of the general induction for registrars Register available on the Trust intranet but not updated since 2006 Consultants were keen to develop formal chemotherapy prescribing training for registrars 1. Chemotherapy services in England: ensuring quality and safety. A report from the National Chemotherapy Advisory Group (2009) 2. For better for worse? A report by the National Confidential inquiry into Patient Outcome and Death (2008) 3. A themed review of patient safety incidents involving anticancer medicines, NPSA (2010)

4 Developing the programme Page 4 E & T pharmacist met with Lead Clinician Trainer (Consultant Haematologist): Determined course contents and competencies Established course format Review the accreditation process and certification method E & T Pharmacist produced: Supervised practice document AND updated the accreditation certificate Prescribing competencies using: Trust Medicines Policy and accompanying Prescribing code of practice SELCN standards for the safe use of oral chemotherapy Skills for health NOS SELCN chemotherapy service specification Royal College of Physicians chemo prescribing competencies Mock prescriptions for use during training to cover key prescribing errors Test prescriptions for prescribing competency assessment

5 Developing the programme cont. Page 5 Lead Clinician Trainer: Reviewed and approved all training material and test prescriptions Approved the new accreditation certificate and Supervised practice document Sought approval of the proposed training programme from the Heads of Service (HoS) for Medical Oncology, Clinical Oncology and Haemato-oncology Pilot training session took place in March 2009 Multi-professional speakers nurse, pharmacist, Consultant, service manager Cancer e-prescribing implemented in March 2008 Separate training sessions were available for the use of the e-system

6 Training & accreditation pathway

7 Challenges Page 7 Two separate training programmes 2 different sites leading to confusion for trainees Multiple steps Mean time to sign-off ~ 47 calendar days 3 types of assessments (clinical, technical and final sign-off by HoS) Access to e-prescribing software before authorised to prescribe by HoS Increased workload - prescriptions need counter-signature Trainee unable to fully support busy clinics Increased clinic burden for Consultant and accredited registrars Delivery managers not aware of two training programmes for new registrars therefore training not booked IT trainer unaware of need to restrict access to software until clinical training completed IT trainer could not provide any clinical support IT training examples not relevant to clinical practice

8 Review of training programmes Page 8 E-prescribing rolled-out to all solid tumours by December 2010 The need to train using paper prescriptions was becoming obsolete E & T pharmacist met with e-prescribing trainer to review prescribing training with a view to amalgamate the two programmes Simplify the pathway Reduce the time taken for final sign-off Make training relevant to current clinical practice (~ 90% of prescriptions were being prescribed electronically) E & T pharmacists reviewed the worked examples and the final competency assessment questions Joint programme launched in March 2011

9 Joint training pathway Page 9

10 Evaluation of training Page 10 Between March 2009 and March 2011, 52 registrars and 4 non-medical prescribers undertook the separate training Since March 2011 the joint programme has been undertaken by 20 registrars and 1 non-medical prescriber Joint training programme was favourably evaluated: Evaluation Mean Score 1 = Poor; 5 = Excellent Course structure 4 Clinical exercises 5 Trainers delivery 5 Trainers knowledge 5 Coursework 4 The average time taken to be signed-off was reduced from 47 to 11 calendar days after introducing the joint programme

11 Evaluation of training cont.

12 Benefits of joint programme Page 12 A multi-disciplinary approach has expedited prescribing sign-off thereby minimising service disruption Registrars are competent to prescribe chemotherapy within two weeks of induction The joint programme has promoted a consistent method of training and competency assessment

13 Next steps Page 13 On-going assessment of the joint programme Review of training material E-prescribing software upgraded in Aug 2011 Accreditation certificate updated in Sep 2011 Review of worked examples to ensure training covered common prescribing errors observed in audits

14 Kumud Kantilal Macmillan Principal Network Pharmacist, Lead for Education & Training Acknowledgements Sarah Christer Dr Matthew Smith Dr Matthew Streetly Dr Rohit Lal IT trainer for cancer e-prescribing Consultant Haematologist Consultant Haematologist Consultant Medical Oncologist