Bowel Screening Wales E-Bulletin October 2010

Transcription

1 Bowel Screening Wales E-Bulletin October 2010 News I am delighted to have returned to work after 5 months sick leave and would like to thank everyone for all their hard work and kind wishes while I was away. Uptake has dropped slightly recently to 58% which may be the result of summer holidays, but I am keen to increase the uptake and sustain it above 60% as it has been from the beginning of the programme. Screening promotion officers and others are working hard to raise awareness of the programme, but we would be pleased to hear from anyone with ideas on how uptake can be improved. Positivity rate for faecal occult blood tests remains high at 2.6% and further statistic information is included in this E Bulletin. Uptake and positivity rate have been consistently higher than anticipated and has lead to increased demand for colonoscopy. Screening teams in Local Assessment Centres are working extremely hard to reduce waiting times in preparation for the increase in age range which is expected to start towards the end of the year. All except one unit have a plan to achieve the 2 week standard by the end of the year. The remaining unit is currently developing a plan and I am confident that this will be achieved. We have yet to agree a final plan to extend the age range, but it is likely that we will initially invite people up to the age of 71 and gradually increase up to 74 over the next few years. The extension will be rolled out nationally and can only begin if all units are within standard. Ongoing success of the programme is a result of many people s hard work. I am particularly grateful to staff in LAC s that have undertaken assessment and colonoscopy lists for out of area participants and to screening colonoscopists who have travelled to other units to undertake lists. Many thanks to everyone for helping to make the programme such a success. Best wishes Hayley Heard Head of Programme

2 Regional updates South West- By Claire Lewis, Regional Nurse The Local Assessment Centres in South West Wales have been working hard to reduce the waiting times for assessment and colonoscopy. Most of the units are now within the standard for assessment and those who have not yet reached the standard waiting time for colonoscopy should achieve this by the end of the year. Powys have recently appointed a new Specialist Screening Practitioner, Linda Phillips, who will be based at Brecon War Memorial Hospital and assisting with the colonoscopy lists at Hereford. I would also like to welcome Susan Scourfield who was appointed as the second Specialist Screening Practitioner at Singleton. South East By Alison Griffiths, Regional Nurse The Local Assessment Centres in South East Wales also continue to work hard to reduce the waiting times for colonoscopy and all 3 have started an additional screening colonoscopy list. Waiting times for assessments are mainly within standard although many additional assessments have been undertaken to achieve and sustain this, particularly in Gwent. All 3 units have appointed a new SSP to undertake the increased workload and they are undertaking their induction programme in October. Llandough Local Assessment Centre have been very helpful in allowing out of area participants to access colonoscopy there as waiting times here are the lowest in Wales. North Wales By Vivienne Breen, Regional Nurse The Local Screening Teams within Betsi Cadwaladr University LHB are currently working very hard to arrange extra screening colonoscopy lists, with the aim of bringing bowel screening colonoscopy waiting times to within the BSW 2 week standard. Congratulations to Dr Aram Baghomian who recently passed the Bowel Screening Wales Colonoscopist assessment process. He will hold an additional weekly screening list at Glan Clwyd from the 3 rd of November. 2

3 Colonoscopy Update by Dr Rhodri Davies Screening Colonoscopists There are 24 Screening Colonoscopists now approved and one individual has recently gone through on the revised assessment process. There remains a dearth of individuals putting themselves forward to become Screening Colonoscopists and the need is particularly acute in some areas. We would be grateful if you would encourage colleagues who meet the eligibility criteria to apply. This would relive the very heavy workloads of many of our current screening colonoscopists. Activity The uptake and high FOB positive rate mean that referral numbers continue to exceed colonoscopy capacity in a number of centres. This will continue, particularly with the numbers of participants coming back for high risk surveillance and with the intended age roll out. Waiting times for SSP appointments and colonoscopy remain excessively long in most of the Welsh screening centres. List numbers have been enhanced in centres where there is greatest need, but there remains a mandate to optimize colonoscopy capacity. This includes looking at existing Screener sessions; support from border Units (only Hereford are screening Welsh participants to date) and extra lists where there is greater need. Audit Report The colonoscopy QA report for 2009 has been completed and previously circulated. Screening colonoscopy is generally performed to a very high standard with the majority of Screeners easily achieving BSG auditable quality measures. Two issues to highlight from the report are: 1. The quality of bowel preparation was inconsistent with Picolax prepared participants having the highest number of poor or inadequate preparation/repeats due to poor bowel prep 2. The bleed rate following endoscopic polypectomy was 1 in 69 whereas we expect this to be less than 1 in 100. We are also not certain how completely adverse events are being reported and we are currently looking at ways to streamline this. Data collection remains an issue and we are also looking at ways to collect robust auditable outcome measures in the future. Training event The arrangements for the Screening Colonoscopy Training Event have been finalized and this will be held at the WIMAT, Heath Park, Cardiff on the 24 th of November, This is open to all Screening Colonoscopists in Wales and 2 nurses from each of the local assessment centres. The event will focus on polypectomy competency and adverse events. All Screening Colonoscopists are encouraged to attend. The programme is attached to this bulletin for information. 3

4 Radiology Dr Conor Corr has recently stepped down from his post as QA advisor for Radiology due to other work commitments. We are very sorry to lose Conor and would like to thank him for all his hard work and support. We are very pleased to welcome Dr Gareth Tudor to the team. Gareth is a Radiologist in ABMU Health Board and has recently been appointed as the BSW QA advisor for Radiology and will take up his post from the 1 st of November. Pathology by Dr Namor Wyn Williams 1) Adenoma size - The NHSBCSP Pathology Committee re-iterated that the size of adenomas should be measured microscopically to the nearest mm (if the adenoma fits on a section) otherwise the macroscopic size to the nearest mm should be given. The endoscopic size should be used for biopsies or where the adenoma is removed piecemeal. An audit from the NE of England looking at endoscopic v macroscopic v microscopic size is being presented in December. 2) EQA - The NHSBCSP and BSW agree that the Bowel Screening EQA is mandatory for all pathologists who report BSW cases. 3) Tis - Tis stage for TNM classification of colorectal neoplasms (and its synonyms adenocarcinoma-in-situ and intramucosal adenocarcinoma) are not to be used in reporting BSW cases. These are all classified as high-grade dysplasia in the UK classification. Surgery by Mr Andrew Radcliffe Quality Assurance for surgery will be underpinned by the principle that surgery must be appropriate and safe. A paper was presented to the All Wales Management Group in September and contained details of the following points: Available data for surgical activity and outcomes. This relies heavily on CaNISC. Whilst key indicators are largely complete others, for instance those required to assess safety, are not Obtaining data for patients undergoing surgery for large benign polyps Data from NBOCAP- will provide a baseline to compare future outcomes, e.g. emergency admission rates Analysis of the surgical activity for the first year of the programme has been undertaken. This reinforces the limitations of the data available. Determining the appropriateness of surgery is largely a MDT function and a programme based on the data available will be proposed A significant proportion of BSW participants have Duke s A lesions. There are difficulties in pathological assessment of early cancer (T1) 4

5 and paucity of evidence based treatment guidelines. Better understanding of MDT decision making in early cancer is needed The surgical issues in early cancer interface with considerations in colonoscopic assessment of lesions and pathological assessment. It is therefore proposed to consider the establishment of network MDT for difficult polyps and early cancer QA visits to LAC s will included a surgical component. To develop the components a questionnaire will be sent to lead colonoscopists in each screening centre seeking their views on the above and in particular questions and issues that should be addressed within the QA programme for surgery. I would be grateful for feedback on these issues to Hayley Heard or myself ( agrradcliffe@aol.com) to help formulate the questionnaire, allow it to be circulated after the results are analysed and presented to the AWMG by the end of the year. Welsh Bowel Screening Centre As the programme nears the end of the prevalent round of screening, The Central Administration Office at the Bowel Screening Centre are undertaking a review of participant pathways, commencing with those participants who have been affected by changes in protocol. This is a significant piece of work which will be ongoing. The CPA inspection for the bowels screening laboratory will take place next spring and work is ongoing to ensure documentation and processes are in place to ensure a successful outcome. Statistics From the beginning of the programme to the beginning of October 2010: 370,943 invitations sent 58% uptake 1.7% spoilt kits 2.6% positive rate 4,226 participants found fit for colonoscopy 340 participants diagnosed with cancer 2186 participants had polyps removed Cancer and polyp detection rates are expected to rise as data becomes available due to the ongoing development of the Bowel Screening Information System. 5

6 Events The training event for screening colonoscopists and endoscopy nurses on November the 24 th will be preceded by a gathering at the Bowel Screening Centre in Llantrisant the evening before. This will be the first opportunity for all Screening Colonoscopists to get together to look around the screening centre. We are hoping to host the first BSW conference in April next year and are currently considering a suitable venue. Staff training sessions are on going on a monthly basis in the centre and are open to the wider Screening Division team. Each month has a different theme and participants have attended to tell their stories. We d like to hear from you If you have any comments or content suggestions for this e-bulletin we d like to hear from you. Please send them to: Helen Rose PA to Hayley Heard, Head of Bowel Screening Wales 18 Cathedral Road Cardiff CF11 9LJ or helen.rose2@wales.nhs.uk If you would like to receive future issues of this e-bulletin, please send your address to Helen at the above address. For further details about Bowel Screening Wales, visit our website at: 6