Patient safety and novel therapy

Novel therapy - quick think challenge quiz!

What are the risks to

patients?

What can be done to improve patient safety?

Risks • New treatments – new side effects

• Not what we are used to with chemotherapy • Rapidly changing field – new treatments arriving frequently

• Healthcare staff may not recognise side effects • Especially the less obvious ones e.g. immune-related

• Side effect management can be different from chemotherapy • Patients might get the wrong intervention

• Oral treatments • patients might carry on taking it when they should take a break and seek advice

• Not knowing when to seek help • Not wanting to stop treatment

• Lots of information to take in – steep learning curve for patients, relatives and healthcare staff

Safety – interventions

• Pre-treatment assessment

• Patient information

• GP letter

• Alert card

• Telephone advice and support

• Immunotherapy guidelines

• Staff education

• Appropriate on-line resources e.g. company literature, charity sites

• SPC (Summary of product characteristics)

Pre-treatment assessment

• Prescribed on Chemocare – critical tests to guide prescribing E.G. • blood test results based on drug specific side effects e.g. LFTs

• Blood pressure and urinalysis – some TKIs

• Toxicity assessment form • Structured format designed for novel therapy side effects

Novel therapy toxicity sheet: top section, spot the difference!

Novel therapy toxicity sheet – bottom section

GP letter

Alert card and patient information

• Cards

• Leaflets

• Talks from staff

• KEY to success

• Include family/carers • pivotal to recognising the patient is unwell AND • motivating them to seek advice

• Repeat and reinforce when you have a chance • Lots of information to take in • Helps to check understanding

Telephone advice

• WAU assessment service

• 24 hour a day, 7 days a week service

• Takes approximately 700 calls a month

• One number 0114 226 5000

• Increasing treatment leading to increased demand • New service underway!

• Uses the UKONS triage tool • Structured assessment for telephone assessment

Triage pathway

Attend for assessment WPH or A&E

Follow assessment guidelines - advice on appropriate care location/service. e.g. pharmacy, GP, self monitor

Advice/reassurance

Triage Practitioner

Triage and log Sheet

Time for some group work!

Case one (Tools: Afatinib leaflet from macmillan, SPC)

• Jo Blythe is 65, a recently retired chef

• He has been diagnosed with metastatic non small cell lung cancer

• EGFR (epidernmal growth factor receptor) testing showed that Afatanib would be an appropriate treatment for his cancer

• He has come to clinic today to start his treatment and be given a patient information talk

1) Come up with the wording for your own “script” that you could use to explain to Jo how Afatanib works (you can use pictures and diagrams)

2) What is the essential information to confirm that Jo has understood before he leaves the clinic (list the topics)

Case 2: two weeks later (Tools: Afatinib leaflet from Macmillan, SPC, phone triage form)

• Jo Blythe, 65, is a recently retired chef • He has been diagnosed with metastatic non small cell lung cancer • EGFR (epidernmal growth factor receptor) testing showed that Afatanib

would be an appropriate treatment for his cancer • He started this treatment 2 weeks ago • Jo rings the phone advice line. He reports the following symptoms:

• Sore mouth and lips • Rash on his chest, face and back

• What questions would you ask Jo about these symptoms? • If they were assessed as mild to moderate what advice could you give

regarding management?

Case 3: 5 weeks of treatment (Tools: Afatinib leaflet from Macmillan, SPC)

• Jo Blythe, 65, is a recently retired chef

• He has been diagnosed with metastatic non small cell lung cancer

• EGFR (epidernmal growth factor receptor) testing showed that Afatanib would be an appropriate treatment for his cancer

• He started this treatment 5 weeks ago

• Jo rings the phone help line and is admitted with the following symptoms • Diarrhoea 8 times in the last 24 hours and about 6 times the day before

• New onset breathlessness

• What would you do initially?

• What needs to be considered about continuing his afatinib treatment?

Note

• Afatinib

• Getting the dose right for the individual patient is important • Dose reductions do not effect the efficacy

• Starting dose 40mg • Reduce if side effects

• Increase to 50mg if no or mild side effects