Leading change

The London Lead Cancer Nurses in collaboration with Capital Nurse led on the development and implementation of an educational tool consisting of theoretical and competency elements to train and assess chemotherapy skills for cancer nurses across the locality. The development has addressed unwarranted variation in skills and competency assessments carried out across hospital Trusts as well as supporting improved use of resources, experiences and outcomes.

Where to look

The number of people diagnosed with cancer continues to rise, but despite this increasing trend, cancer mortality rates have decreased due in part to advances in medicine, technology and diagnostics (Office for National Statistics, 2018). Two out of three patients will receive Systemic Anti-Cancer Therapy (SACT). With more lines of treatment, regimes are becoming more complex. A skilled competent workforce is required to deliver this as part of ensuring that patients receive equitable and holistic care when they are treated (NHS England, 2013).

The London Lead Cancer Nurses forum were exploring the concept of a London-wide approach to developing Systemic Anti-Cancer Therapy (SACT) competencies which would address the issue of unwanted variation in the training and assessment of nurses administering SACT. There was local variation in practice and a lack of transferable competency certificates across NHS trusts which made recruitment and retention of cancer nurses challenging.

Capital Nurse had also identified with Directors of Nursing that Cancer Nursing was a priority area and this had led to a number of stakeholder events bringing together cancer nurses, managers and educators from across London to identify and explore the issues and potential solutions.

Together this presented an opportunity for the Nursing Leads – with Capital Nurse support – to work collaboratively ensuring evidence-based practice and competence was applied across the locality.

What to change

It was identified that the current system of how nurses were developing competencies in Systematic Anti-Cancer Therapy (SACT) varied. There were academic modules (of differing quality), formal in-house programmes as well as informal clinical support and this differed between providers.

The stakeholder events had demonstrated a need to remain focused on patient education and experience to continue to deliver safe and effective SACT administration. This supported the findings of previous research which had been conducted by the nurse leading on this project, which indicated poor relationships with patients, often stemming from poor patient education and involvement, contributed to treatment delays and poor outcomes (Oakley et al., 2016).

It was important to have a more standardised approach, which supported a mobile group of nurses and which supported equitable quality of care for patients. It was agreed that the way forward was to undertake a collaborative programme of work to develop a comprehensive standardised competency document which was named the ‘SACT passport’.

How to change

A SACT Passport steering group was established to design and spearhead the implementation of this work across London. Led by a London based Chemotherapy Nurse, in collaboration with other specialist nurses and Capital Nurse, they set out to deliver change.

The developed SACT passport is an educational tool consisting of theoretical and competency elements to train and assess chemotherapy skills for cancer nurses. Developed from the Wales Clinical Competencies document, the passport provides a standardised and portable approach to training and competency for a nursing specialism in London, enabling nurses to move between Trusts without having to re-train. Specifically, it is a competency and assessment framework for the administration of oral, intramuscular, subcutaneous and intravenous SACT for adult patients.

There are three steps to competency attainment:

• Step one involves completion of the relevant theoretical sections, which serves as ‘The Passport’, and is not required to be repeated. The theoretical section is designed to be marked either by a clinician in practice e.g. practice educator or a course module leader.
• Step two requires completion of the relevant clinical practice competency sections.
• Step three involves completion of the annual reaccreditation certificate.

The passport provides support to ensure SACT training is patient-centred, consistent, up-to-date and standardises best practice.

Adding value

A formal evaluation is underway to explore the impact on patients, nurses and the organisation(s).

Better outcomes –The passport aims to ensure SACT training is patient-centred, consistent, up-to-date and standardised best practice across London and importantly strengthens care and the consistency of nursing support for patients receiving treatment for cancer. It promotes equitable care wherever treatment takes place and provides patients with a level of quality assurance.

Better experience – Anecdotally chemotherapy nurses report that the SACT passport is extremely popular and existing chemotherapy competent nurses are using it to update their knowledge and skills as it easy to use and it encourages them to focus on patient education more than the previous training method. Nurses satisfaction in care delivery has increased and the new approach has been reported to include a sense of belonging (to wider system including Capital Nurse) as they feel their training has value across organisations. It supports nurses’ career development and offers them opportunity of greater choice of work place.

Patients have also responded well to the new SACT passport. The standardised approach has enhanced the patient experience with initial reports of feeling increasingly confident about their care and safe.

Better use of resources – The SACT passport reduces the previous practice of repeated training and therefore enables greater mobility of trained nurses to deliver the right care, at the right time. This suggests a more cost-effective model as it aims to reduce delays in treatment due to more nurses trained and greater transferability. The SACT passport is now nationally used and is recordable as a clinical skill on the Electronic Staff Record (ESR). Furthermore, other registered healthcare professionals such as Cancer Therapy Radiographers and Community Pharmacists can also now complete the SACT Passport and record it onto their training record.

Challenges and lessons learnt for implementation

• Ensuring implementation was consistent.
• Collaboration is key with all parties needing to feel engaged and listened to.
• Effective engagement has supported organisations developing leadership at all levels to support the programme which is a key success of the passport.
• Networks and capacity for systems leadership has been vital.
• The success of the passport has led to it being adopted nationally by UK Oncology Nursing Society (UKONS) as a standard approach to training and assessing nurses delivering SACT.
• Capital Nurse are now considering other areas of focus and embedding work to date.

Find out more

For more information contact:

• Jacqueline Robinson-Rouse, Capital Nurse Retention Clinical Lead, Health Education England, capitalnurse@hee.nhs.uk