The Role of an Upper GI Clinical Nurse Specialist

Transcription

1 The Role of an Upper GI Clinical Nurse Specialist At a District General Hospital At Chesterfield Royal Hospital Emma Waterfield & Jessica Rouse

2 Emma Waterfield I have worked at Chesterfield Royal Hospital since 1997 I Started the role as the Upper GI CNS in A new role for the trust. For 5 years the service was covered with 30 hours of CNS time, Currently the role is a job share of 22.5 hrs each.

3 Jessica Rouse I have worked for the trust for 6 years initially starting as a health care assistant. I have been qualified for 3 Years. Spent 2.5 years on a General Surgical ward. I started my secondment in Upper GI in May 2018

4 Objectives To give an overview of what we do in a District General Hospital when patients are referred with a suspected oesophageal and gastric malignancy and then following a confirmed diagnosis. To outline the role of the Clinical Nurse Specialist. The role of the MDT at a local District General Hospital.

5 District General Hospital Chesterfield Royal Hospital is part of the South Yorkshire and North Derbyshire Cancer Alliance. Patients who present with specific alarm symptoms which could potentially represent an oesophageal or gastric malignancy should be referred as a 2 week wait cancer target to their local hospital via the GP.(dysphagia, weight loss, abdominal pain, dyspepsia, early satiety) All the hospitals in the Cancer Alliance will complete all the staging investigations. The initial staging investigations include: Gastroscopy and staging CT Chest Abdominal Pelvis. An overall assessment of the patients general health is also done including Performance Status.

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7 Once all the investigations are completed, the patients have been reviewed in clinic and their overall fitness has been assessed their case will be discussed at the local Multi Disciplinary Team (MDT) meeting. CRH MDT is on a Monday Patients diagnosed with an oesopgheal cancer that is potentially operable on CT imaging and are fit will require further staging in the form of a PET CT and EUS (endoscopic ultra sound ) Patients with a potential operable gastric malignancy will usually need a staging laparoscopy at Sheffield. Following our discussion at the local MDT all patients are then discussed at the central Sheffield MDT. Patients who are potentially operable are taken over by Sheffield to be assessed. Patients that are inoperable are referred back locally where they will then be referred on to either an oncologist or palliative care team. CNS provide ongoing support and assessment through out their treatment and act as the patients key worker.

8 It is essential we have a good working relationship with the Sheffield team and the Clinical Nurse Specialist. We work closely together liaising about patients management and potential transfer of care. We regularly contact the CNS from Sheffield for updates on patients treatments and progress.

9 Informative Clinical Info Performance status Recent Investigations

10 Palliative Care At diagnosis the majority of patients are for palliative oncology care or are for best supportive care. Locally We do a lot of inpatient referrals to our palliative care team for patients who are symptomatic and also community referrals. Dietetic referrals Admit patients from the community if having significant problems with dysphagia for stent insertion Complex discussion about preferred place of death and discussions about final wishes. HNA Assessments DS1500 forms Respect Forms DNAR Referral to community supportive services: OT, physio, psychology, welfare rights advisor, red cross ect

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14 Summary DGH complete all staging Investigations needed for patients with oesophageal and gastric malignancy. All patients should be discussed at a local MDT and at the central Sheffield MDT for a management plan to be formulated. We work closely with Sheffield to hopefully make the patients cancer journey as timely as possible. The CNS have a pivotal role to play in supporting patients and their families.

15 Thank you Any Questions?