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Holistic Needs Assessment

Implementing in Clinical Practice

Diane Dearden

Gynaecology Oncology CNS

25th April 2013

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The Patients Journey

Surgical Oncology Centre

DGH

CNS

Primary care

Patient

Oncology Centre

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MCCN Gynaecology-Oncology

  • MCCN Gynaecology –Oncology Clinical Nurse Specialist Group (implemented June 2006)

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  • Assessment pathway developed shared Nationally and adopted by other trusts incorporating paper HNA

  • Nursing Oncology & Palliative Care Guidelines

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  • Patient satisfaction

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  • Presented nationally at medical and nursing forums

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  • MCCN Follow up Guidelines

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  • Macmillan eHNA pilot (2012)

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Pilot

  • Network
  • Cover three sites
  • Post treatment
  • Patients given option of where done
  • Designated Appointment
  • Transfer care plan across key workers

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  • Appointed part time CNS to cover my Role
  • Key stake holders from the onset

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  • Unit
  • Administration Support
  • Increased Clinic Activity
  • Pre / Post treatment /SOS
  • Knowledge of onward services
  • Audit Impact on service e.g. Telephone contacts
  • Steering group
  • Links Macmillan information centre

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Implementing in clinical practice

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April 2013 all site specific CNS s (10) at STHK will have incorporated HNA into one key stage in the patients pathway.

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This is to be rolled out to at least two stages in line with the national cancer survivorship initiative recovery programme

(March 2013)

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MCCN Gynaecology Oncology

  • Pre treatment & post treatment /in and out pts
  • Designated clinic sessions / as needed
  • Patient Information

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  • Assessment and care plan shared on transfer of key worker to Cancer Centre
  • Offered personalised care plan / GP letter
  • Assessment shared among MDT
  • Clinical Support

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  • Information prescriptions
  • Tool for referral
  • Specialist Services (paracentesis)
  • Advanced Care Planning
  • Survivorship programmes

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Implementing in clinical practice

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  • Does everyone understand the idea of HNA and why it needs to be done?

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  • Looked at their existing processes and see how HNA can be built on these, avoid duplication or addition workload.

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  • Practicalities – IT, capacity in clinical areas, job plans, cohort of patients.

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  • Looked at patient pathway identify key stages that HNA can be implemented and who is best placed to do the assessment.

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Implementing in clinical practice

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  • Consider the best environment and whether patients have enough time available with the person undertaking the assessment.

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  • Decide what tools - STHK eHNA –Distress thermometer (MCCN Guidelines).

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  • Start small – discuss how it went – clinical supervision / steering group / MDT

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Implementing in clinical practice

Assessment is not a new skill for most experienced HCP, HNA puts structure and rigour into the process ensuring all aspects, physical, social, psychological and spiritual aspects, of a person are considered

National cancer action team 2007

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Implementing in clinical practice

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  • Base line Audit
  • Steering group / feed back through CNS forum

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  • Competencies – MCCN HNA training , Spiritual gate, advanced Communication Skills, end of life care (ACP) and e HNA, core member MDT (MCCN guidelines). e-Learning packages available

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  • Clinical supervision

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Implementing in clinical practice

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  • Information prescription / patient information on HNA

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  • Training regarding analytic data for annual reports/ audits

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  • Looking at resources and support services available and how to access them

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  • Each team to “lift speech” about HNA at MDT

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  • Executive support through trust cancer committee ( lead cancer nurse)

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Implementing in clinical practice

  • Patient satisfaction

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  • Incorporated into Job plans / Appraisals – sustainability

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  • Analysis data collect for service development / audit

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  • Raise awareness to primary care and patients

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  • Treatment Summary

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  • Agreed pathway for each MDT on a Key Stage for HNA

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Progress

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Currently

Planned

Haematology

4-6

Pre chemotherapy

In / out patients

Designated Clinic

Mid and post treatment

Skin

4-6

Stage IV pre / mid and end treatment

Designated Clinic starting mid April

Lung

Designated “opt in” clinic for newly diagnosed and post surgery patients Advanced care planning

Plans to roll out to all patients post primary treatment

Upper GI

4

Decision to treat appointment for new patients during routine appointment

Designated Clinic Inpatients / ACP

Breast

6

Own assessment tool at time diagnosis / post surgery

To use HNA mid and post chemotherapy

Gynaecology

5-6

2 designated clinics pre / post treatment. Inpatients SOS.

Pre clinical trials referred from cancer centre

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Progress

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Planned

Colorectal

5

Post operatively follow for major resections during routine appointment

Acute Oncology

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Pre and Post chemotherapy for patients of Cancer Unknown Primary, designated appointment incorporating chemotherapy assessment

Urology

Post diagnosis muscle invasive bladder cancer. Incorporate into general clinic.

ENT

4

Post diagnosis before transfer to centre for surgery

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Concerns about Implementation

  • Wider service issues/problems that can impact upon direct clinical work.

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  • How does HNA fit in with this?

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  • Fragmented job roles

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  • Feeling that there is not enough time or resources to be able to do an adequate job of exploring concerns. Learning about different ways of doing HNA from colleagues e.g. clinics/telephone calls

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  • Looking at the process of doing HNA e.g. using I pads/ paper version of concerns checklist

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  • How to get started

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�Barriers to doing HNA �

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  • Fear of “opening up a can of worms”

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  • Confidence about assessing potential risk e.g. suicide

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  • Confidence that offer anything helpful if someone is distressed

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  • When is the right time to do HNA? “should we do it if someone has recently had bad news?” Reflecting on how to support patients/family members who may be feeling angry/distressed at their situation and implications of this.

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�Barriers to doing HNA �

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  • Working with people who do not engage in treatment – why might this be happening? What may be helpful to try and encourage engagement?

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  • How to support someone who may be feeling low in mood/anxious and onward referral.

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  • How to try to engage people in the process – opt in/out

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Positive aspects of doing HNA

  • Identifying and managing issues at an early stage

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  • Preventing future crisis

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  • Reduction of time-consuming phone calls

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  • Having a way to ask difficult questions

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  • A format for making sure that certain issues may not be missed

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  • Raised awareness of the patient journey - including importance of communication between health professionals & a joined up approach to patient care

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  • Job satisfaction from getting to know more about patients

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For any further information/questions

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Diane Dearden

Gynaecology Department

Whiston Hospital

diane.dearden@sthk.nhs.uk

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