|
County Durham and Darlington NHS Foundation
Trust
Inga Andrew, Macmillan senior clinical pharmacist
Colette
Hawkins, consultant in palliative medicine
Kerry Waterfield,
staff grade in palliative medicine
Graeme Kirkpatrick, deputy
chief pharmacist and Keith Holden, principal clinical pharmacist
City Hospitals Sunderland NHS Foundation Trust
Stephen Williams, Macmillan development manager
Tony Hildreth, trust medical statistician and deputy
head of research |
Sir Cyril Chantler with Inga Andrew |
Standardising methods which any health care professional can use to
improve the care of cancer patients with anorexia-cachexia syndrome (ACS)
was the subject of a winning project from County Durham and Darlington
NHS Foundation Trust, run by a Macmillan senior cancer pharmacist.
A baseline review at the hospital found that staff who came into contact
with cancer patients had variable understanding of ACS and that there
was a lack of useful tools about how to manage the syndrome.
An audit was undertaken of 23 patients suffering from the syndrome, using
the Patient Generated Subjective Global Assessment tool (recording eating
habits, symptoms, activity-related problems etc). A diet history, drug
history and a medicines use review were also carried out.
A total of 147 symptoms were reported (77 of which did not appear to
have been managed by pharmacological means and were
active problems for the patients) and a management plan was established.
This
included 80 recommended medication changes, non-pharmacological advice
(on topics such as oral hygiene) and referrals to a dietitian.
Prescribing guidelines and shared care agreements were
written for several of the medicines.
Presenting the project, Inga Andrew explained that these were simple
strategies that any health care professional could use, and the team
wanted to standardise them. This led to the development of a resource
pack to help with the systematic assessment and management of common
problems experienced by ACS patients. The pack includes an abridged version
of the patient assessment tool, simple dietetic and physiotherapy management
pathways, a symptom management tool and leaflets for patients and carers.
The Durham Macmillan cachexia pack is currently being piloted locally
and is expected to be launched nationally at the end of the year.
Previously, a large number of patients with ACS will have had their symptoms
unrecognised or unmanaged. This study is ongoing but the researchers’ impression
is that there has been an improvement in the symptoms and well-being of patients. |
The
Pharmaceutical Journal