Best practice in nurse-led chemotherapy, standardising services as well as electronic prescriptions and nurse-physician communication
Elaine Lennan – University Hospital Southampton NHS Foundation Trust, UK
Tell us about your article, ‘Best practice in nurse-led chemotherapy review’.
There was a need for a position statement because there was some confusion around how to develop nurse-led chemotherapy services. There are lots of different models and one type doesn’t fit all and so it was looking to try and establish what is the key requirement for developing nurse-led chemotherapy clinics. There are some institutions that are well advanced and others that are just beginning so it was trying to pull something together from the national society that might help individuals and individual trusts to develop their services.
What are the key responsibilities in nurse led clinics?
It’s really most important that you never work in isolation. So although they’re titled nurse-led clinics, you are part of a team and you will be working with your medical colleagues and your pharmacy colleagues. It’s really important that things have gone through your governance structures, so things are robust and that it’s not pulled together in a piecemeal way.
What skills are required for the nurses running these clinics?
Being a nurse often offers many of the skills that are required so clear communication skills, advanced communication skills, I would say. Perhaps something new to nurses in these roles is clear history taking; some physical assessment, although it’s not a prerequisite; some good documentation skills and perhaps some non-medical prescribing skills.
Can you discuss the section focussing on business cases?
Because nurses generally are not skilled in putting business cases together, as soon as one door shuts they tend to move on to the next thing. So really it’s about trying to give some clues as to how to develop the business case because you need a business case in order for sustainability and the robustness of the service.
What about administration support?
It’s really important that the nurse doesn’t try to do it all herself or himself, just to try and get something off the ground. In order for it to be a sustainable service, it needs to be treated as any other clinic or any other service that would operate in the trust so that means reception staff, it means somebody to pull the notes, it means somebody to do all the things that are needed to run a good functioning clinic and nurses tend to feel sometimes that they have to do it all themselves.
How can we audit and monitor these clinics?
It’s really important to be able to demonstrate what you’re doing and very clearly nurses are now required to measure what they do and try and develop some outcomes. So simple things around just how many people you’re seeing and how many people you might be delaying or what the outcome of that particular consultation is is really easy to do, as well as perhaps some patient experience audit so that we’re confident that patients are happy to see the nurse and feel confident in their care.
Have you had any feedback regarding the article?
We certainly have from UKONS’ members to say that it’s long overdue, it’s very much needed and it’s useful for them. It’s a very new article so in terms of beyond UKONS’ members I wouldn’t like to say.
What is it like being an author?
It’s great to be an author, it’s great to be the lead author although it was very much a team effort in terms of pulling it together. National societies, I think, are there to try and help guide and put standards together to help organisations develop what we all need to do. So it’s great that it’s out there, the real beauty of this particular article is the speed of publication because it’s something that is needed now, in practice, for nurses to use.
What about standardising the service?
We’re suggesting there is a bare minimum to developing these services and these are the elements that are needed for that service. There are some things in there that we would say would be gold standard, including non-medical prescribing but it’s not absolutely necessary in order to get yourself up and running. So these are things that people need to consider and there are definitely some things that absolutely have to occur before you can operate.
What about electronic prescribing?
Electronic prescribing of chemotherapy has been a standard for a good few years now, that’s around a safety issue. For some people it has been very difficult to actually implement electronic prescribing, there was some funding available for all trusts from the government but even so some people have found it quite difficult, quite challenging. Most places have plans now and many are fully functioning now but it’s absolutely the standard that we should be aiming for.