Clinical Oncology 26 (2014) 125e127 Contents lists available at ScienceDirect

Clinical Oncology journal homepage: www.clinicaloncologyonline.net

Editorial

The Role of the Specialist Acute Oncology Nurse in the New Acute Oncology Services L. Putt*, P. Jones Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Received 24 October 2013; accepted 4 November 2013

Specialist acute oncology nurses (AON) are appearing all over the UK, not just in England, where they are a recommendation of peer review, but also in Scotland, Northern Ireland and Wales. The role of the specialist AON is multifaceted and demands that these nurses show many skills, including leadership, innovation, negotiation, teaching and, importantly, expert clinical skills. Services are designed to be responsive to local need so the role can differ between cancer centres and units. It is also influenced by the presence of an emergency department or an acute medical admissions unit. It is clear that however local services are configured, there are core elements to the specialist AON role.

Strategic The reality is that cancer patients present for emergency assessment via many routes, and it is the role of the specialist AON to work in partnership with colleagues outside of the oncology or haematology speciality and with managers to strategically streamline admission pathways so that the patient receives the expert assessment they need at the point of entry. ‘We receive alerts for patients on treatment once they hit [emergency department], this means we can assess the patient and ensure they are on the correct pathway’ (Niamh Hughes, Acute Oncology CNS, University Hospital Coventry and Warwickshire NHS Trust). Specialist AONs are collating service-specific data to provide evidence and information that will help to shape their services. Reporting this detail to managers helps to understand the patient pathways, predict busy periods and inform staffing requirements. Author for correspondence: L. Putt, Box 193, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK. Tel: þ44-1223-274734x4734. E-mail address: [email protected] (L. Putt).

Triage The UK has led the way with the development of the 24 h patient advice line services. These are now being developed in many countries, such as Australia, New Zealand and Hong Kong. The UK Oncology Nursing Society (UKONS) triage tool is now established throughout the UK and has set the standard for triage of patients who call the advice line. The formalisation of telephone triage has provided acute oncology services with a framework for training nurses within their Trusts, thus improving patient safety and empowering the nurse who takes the call to make the correct patient management decision. Information obtained from the triage records provides evidence that patients needing further assessment and support are recognised and unnecessary admission is often avoided. Reporting this level of detail to site-specific teams can alert clinicians to any complications associated with specific chemotherapy regimens. ‘The acute oncology team collected data relating to the volume of calls from breast cancer patients suffering with nausea and vomiting as a consequence of treatment, this was used for further research, and led to Trust agreement that all women undergoing treatment for breast cancer should receive an NK1 receptor antagonist, resulting in a significant reduction of this unpleasant side-effect’ (Hannah Pritchard, Macmillan AOS Team Leader, University Hospital Southampton NHS Foundation Trust) [1].

Assessment and Action Macmillan Cancer Support report that there are currently two million people living with or after cancer across the UK [2]. As we treat more patients and as cancer becomes more of a long-term condition, the need to understand what is or is not a complication of cancer is

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apparent. Patients often present with a complex set of problems that require a multidisciplinary team approach. The specialist AON is a crucial member of an acute oncology team and provides an initial assessment of the acutely ill patient and advises on oncology problems. Facilitating speedy referral to appropriate teams not only ensures that the patient receives the right care at the right time, but aids patient flow within the hospital. Specialist AON are developing their knowledge and experience of oncological emergencies and the role is developing further with the emergence of advanced nurse practitioners and consultant nurses who can take responsibility for the entire patient pathway. A nurse consultant-led model provides a comprehensive range of clinical and non-clinical activities that meet the needs of an acute oncology service and is good value for money [3]. The establishment of dedicated acute oncology assessment areas in a number of Trusts has further streamlined the patient pathway. The University Hospital of North Staffordshire opened an emergency assessment bay in 2009. The impact on patient care has: avoided admissions; provided patients with appropriate medication, advice and on-going support; reduced length of stay and associated risks of hospital acquired infections and improved the overall satisfaction and experience of the emergency care pathway for patients attending the emergency assessment bay at the cancer centre [4].

Clinical Audit/Data Collection The peer review measure for neutropenic sepsis requires the collection of audit data to evidence the administration of intravenous antibiotics within 1 h of a patient presenting with a suspected neutropenic sepsis. The audit information is proving to be useful for evaluating the target of ‘1 h door to needle’. Identification of the reasons that this target is not met can be used as a lever to obtain resources. It is also vital to use this information to educate and raise awareness of the condition and change clinical practices in order to improve the patient pathway. Cancer networks initially required the specialist AON to submit data, which has provided a strategic overview for the development of local services. Many acute oncology services have been established with limited funding and resources, with some having a caveat to produce evidence of their success to achieve further funding or to obtain better resources. Teams are now able to use the improved data collection to strategically review and tailor their services to meet the local specific needs. For example, this has helped to provide extra staffing and dedicated acute oncology assessment units at Cambridge University Hospitals NHS Foundation Trust and Oxford University Hospitals NHS Trust.

Communication Excellent communication between the oncology team and acute medical and emergency care teams is vital to

improve patient care and safety and reap the organisational benefits of an efficient acute oncology service. One of the serious concerns raised in the National Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2008) report [5] related to the poor communication between care teams. Specialist AON are the link between teams ensuring that all those involved in the patient’s care are aware of the patient’s circumstances. The specialist AON provides patients and carers with information, advice and support with the aim of:  Encouraging self-management and monitoring patients remotely when appropriate.  Advising patients on the relevance of their cancer to their current problem.  Assuming the key worker role when appropriate. ‘The majority of patients felt safe and secure that the AON would monitor and review them even if they were not able to be admitted to the oncology ward. Patients always liked to see a familiar face, particularly as that familiar face was able to co-ordinate any aspects of their oncology care that were relevant to their emergency admission’ (Angela Cooper, Oncology Ward Manager, Shrewsbury Cancer Centre).

Education Oncology nurses have often heard the phrase ‘this is an oncology patient, where is the oncology team’ echoing around the busy emergency areas. Acute oncology patients belong to all of us and the specialist AON is working hard to ensure that patients are managed well 24/7. The specialist AON either provides early intervention or equips other healthcare professionals to do so. The role is therefore one of educator and facilitator. This is a continuous process with the need to encourage all to develop the habit of thinking ‘acute oncology’. The specialist AON provides teaching and education to develop acute oncology skills in all entry portals so that the appropriate assessment and management of this group of patients can be provided at all times and is not reliant on the presence of the acute oncology team. This is an extremely important aspect of the role and has specific significance in Trusts that have a single-handed AON and/or visiting oncologists. They are charged with ensuring that patients receive the same level of assessment and management in their absence.

The Future This is an emerging speciality, combining skills from acute and emergency nursing with specific knowledge and expertise from oncology and haematology. Acute oncology nursing has the potential to become a speciality in its own right. Although these are challenging times within healthcare, AON have a window of opportunity to review and streamline patient pathways and to work with managers

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and commissioners to identify service and funding requirements to ensure efficient use of healthcare resources. Data collection and patient feedback will shape the services we provide. The specialist AON is central to this process and the strategic nature of this role should not be overlooked. Acute oncology is developing to meet a need. As we manage more patients, with complex treatments, and the pressure on services increases, in particular emergency departments and acute medicine, it is essential to bring together clinicians from acute medicine, emergency care, oncology and haematology to ensure that patients receive rapid assessment and appropriate management. Locally, the specialist AON is the oil in the machine working to make sure that all parts function smoothly, safely and efficiently to ensure a robust consistent service. Nationally, the AON forums are working together to share good practice and support the specialist AONs to develop a standardised approach to acute oncology care.

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References [1] Providing a Lifeline, Hannah Pritchard, Team Leader, Macmillan Acute Oncology Service, University Hospital Southampton NHS Foundation Trust. Mac voice; Spring 2013. [2] It’s no life; living with the long term effects of cancer. Available at: http://www.macmillan.org.uk/Documents/ GetInvolved/Campaigns/Campaigns/itsnolife.pdf. [3] Feber T. Developing an acute oncology service. Cancer Nursing Pract 2011;10:14e19. [4] Efficiency of Emergency Assessment Bay model for OncoHaematological related emergencies. Rachael Morgan-Lovatt, Oncology Advanced Nurse Practitioner, University Hospital of North Staffordshire. Available at: http://connect. qualityincare.org/oncology/patient_experience/case_studies/ Efficiency_of_Emergency_Assessment_Bay_model_for_OncoHaematological_related_emergencies. [5] Department of Health. For Better or Worse? National Confidential Enquiry into Patient Outcome and Death. The Stationery Office, London, 2008.

The role of the specialist acute oncology nurse in the new acute oncology services.

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