| Abstrakt: |
Background: Non-medical prescribers (NMPs) (nurses and pharmacists) work within the multidisciplinary teams at Oxford University Hospitals (OUH) Cancer & Haematology Centre, undertaking systemic anticancer treatment (SACT) toxicity review and symptom control clinics. Prescribing aligns with local protocols and competency.1 Objectives: The aim of this audit was to quantity NMP patient review numbers and workload, detail medicines prescribed, and record dose changes (including deprescribing). Method: A sample of 70 patients was identified from electronic clinic lists for colorectal, renal and breast cancer. The data were collected retrospectively for a 6-month period (1 October 2020–31 March 2021) and identified the prescribing undertaken in the NMP clinics. Patient information was collected by extracting data from electronic patient records and the SACT e-prescribing system (ARIA): • Patient NHS number, age, sex, BMI • Clinic date, diagnosis and medication. • Prescribing information in letters and electronic prescriptions • Medications and treatment changes (including the doses and details of each drug) • Details of any referrals. NMPs completed a questionnaire, questions included: • Amount and types of clinics • How long the practitioner had been an NMP • Specialities in prescribing • Number of patients seen and frequency of reviews • Types of drugs prescribed • Changes made and referrals. Results: Themedications prescribed were supporting medication and SACT. The treatments were prescribed in line with local trust guidelines and treatment toxicity. Medication changes included dose increases/decreases and delaying treatment, as per local guidelines. 70% of patients’ treatment continued to the next cycle with the same dose, 10%of treatments had dose increases and 8.5% of treatments had dose reductions (Figure 1). Laxatives, antiemetics and pain control were the most commonly prescribed drugs for toxicity. Clinic appointments were for 30 min, and the duration of patient consultations ranged from 30 to 60 min. NMPs reviewed patients regularly prior to each cycle of treatment. Referrals were made to palliative care or to the GP for a change to regular prescription. NMPs were able to successfully deal with problems and treatments for the patients. In addition to working in SACT review clinics, some NMPs worked in palliative care or onwards. Discussion and conclusion: OUHFT cancer centre workload has increased by 10%–12% annually due to the increase in • SACT delivery and complexity • patient survival • number of lines of SACT treatment available • number of drugs and regimens available for cancer treatment NMPclinics enable follow-up andtreatmentof the expanding numbers of SACT-treated oncology patients, complementing the multidisciplinary teamand increasing clinic capacity.The COVID-19 pandemic has driven trends for oral systemic anticancer treatment and telemedicine consultations. NMP clinics reduce the workload of the medical team and ensure that patients are reviewed in a timely manner, and telemedicine clinics increase clinic room capacity. The limitation of this study was the small sample of patients reviewed for only one SACT cycle. The study could be expanded to analyse the percentage of NMP clinic reviews compared to the total number of all healthcare professional clinic reviews. Future research could compare the treatments and differences in prescribing activity pre- and post-COVID-19 pandemic. [ABSTRACT FROM AUTHOR] |
