Implementation of a chemotherapy prescribing
training programme
Kumud Kantilal
Macmillan Principal Network Pharmacist, Lead for Education & Training [email protected]
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Contents
Background
Developing the programme
Training and accreditation pathways
Challenges
Review of training programmes
Evaluation of new joint training programme
Next steps
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Background
National and local drivers for change
•
National publications highlighted the need for training• Prescribing … should only be undertaken by appropriately trained staff1
• Chemotherapy must be initiated and supervised only by clinicians who are appropriately accredited and/or experienced2
• Prescribing errors accounted for 23.5% of anticancer medicine incidents3
•
Local audit (2007) showed that 1 in 3 prescriptions had an errorWhat 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 registrars1. 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)
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Developing the programme
E & T pharmacist met with Lead Clinician Trainer (Consultant Haematologist):
Determined course contents and competencies
Established course format
Review the accreditation process and certification methodE & 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 assessmentPage 5
Developing the programme cont.
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
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Challenges
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
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Review of training programmes
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
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Joint training pathway
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Evaluation of training
•
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:•
The average time taken to be ‘signed-off’ was reduced from 47 to 11 calendar days after introducing the joint programmeEvaluation Mean Score
1 = Poor; 5 = Excellent Course structure 4 Clinical exercises 5 Trainers’ delivery 5 Trainers’ knowledge 5 Coursework 4
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Benefits of joint programme
•
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
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Next steps
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
Acknowledgements
Sarah Christer IT trainer for cancer e-prescribing Dr Matthew Smith Consultant Haematologist
Dr Matthew Streetly Consultant Haematologist
Dr Rohit Lal Consultant Medical Oncologist
Kumud Kantilal
Macmillan Principal Network Pharmacist, Lead for Education & Training [email protected]
