ECN Pharmacy Group Education and Training Strategy Name of person presenting document: Reason for document development: Names of development team: Specify groups of staff to whom the document relates: Approved by: Date approved: Next Review date: Lead Pharmacist, ECN Pharmacy required ECN Oncology Pharmacy Group Cancer pharmacy staff within ECN ECN Oncology Pharmacy Group and ratified by ECN MM Board Version No: 3 Responsibility for review: Lead Pharmacist, Essex Cancer Network Page 1 of 6
Contents Scope... 3 Introduction... 3 Definition of Prescription Verification... 3 Principles for All... 3 Principles for Level One Training... 4 Knowledge... 4 Training... 4 Key elements of syllabus... 4 Revalidation... 4 Principles for Level Two Training... 4 Knowledge... 4 Training... 4 Principles for Level Three Training... 5 Knowledge... 5 Post graduate Education... 5 Revalidation... 5 To be covered in annual appraisal... 5 Competencies for verification... 5 Approved list... 6 Competences... 6 The RPS and BOPA are working together to produce a set of competences for oncology pharmacists. Once these are published this document will be reviewed.... 6 Page 2 of 6
Scope This strategy has been developed to ensure that there is a baseline requirement for training for all pharmacy staff within ECN. This guidance applies to parenteral and oral administration of SACT including chemotherapy and non-cytotoxic medicines such as targeted therapies, antibody treatments and novel therapies, e.g. rituximab, sunitinib and lenalidomide Introduction The Department of Health requires that all chemotherapy prescriptions should be checked and authorised by a pharmacist The National Cancer Action Team report into the Quality and Safety of Chemotherapy Services published in August 2009 states All chemotherapy prescriptions should be checked by an oncology pharmacist, who has undergone specialist training, demonstrated their appropriate competence and is locally authorised/ accredited for the task. This strategy sets out to explain how this will be achieved within ECN. Definition of Prescription Verification Prescription verification describes what key steps a pharmacist must take when checking prescriptions for anticancer medicines. It is recognised that the there are other terms in common use to describe this process e.g. clinical checking, screening or validation etc Principles for All All new staff should complete an oncology pharmacy training programme. This will be targeted to one of the three levels below depending on their role. o Level One: For any staff who may come across chemotherapy in their normal job, such as dispensary technicians, assistants and aseptics staff. o Level Two: For all staff involved in prescription verification of SACT prescriptions o Level Three: For specialist oncology staff, who work within the area of cancer for more than 50% of their time, or are designated as a cancer specialist at their trust. All pharmacy staff should undertake Continuing Professional Development (CPD). In order to support dispensary staff involved in the dispensing and supply of oral anticancer medicines, there must always be available in the organisation a trained oncology pharmacist who is able to provide oncology pharmacy advice to dispensary staff. Further work is ongoing in defining specific educational competencies outlining the knowledge and understanding that an appropriately trained pharmacist verifying a prescription must have. Guidance will be sought from BOPA / new Professional Leadership Body (PLB) in setting the standards for cancer pharmacy. A single pharmacist trained to level two or three must be identifiable as having verified the prescription. This is separate to a final check undertaken by another person (who can be trained to level one, two or three). Page 3 of 6
Principles for Level One Training Knowledge Basic background knowledge of cancer Training One hour lunchtime session held each year. The network will provide a presentation to the designated oncology pharmacists in each trust to base their training on. Key elements of syllabus Health and safely/ safe handling Relevant protocols/sops to trust Labelling Counselling Where to go for further advice Background and principles of chemotherapy Revalidation To be revalidated the individual must attend a yearly update in oncology training session. Principles for Level Two Training Knowledge Basic level of understanding of the principles involved in treating the more common forms of cancer Knowledge of common side effects and how to treat them Training Training with a level three pharmacist or experience level 2 pharmacist if deemed competent by level 3 pharmacist: Training must include the following: o Principles of treatment (neoadjuvant to palliative), cell cycle kill o Surgery, radiotherapy and chemotherapy o How common classes of chemotherapy agents work cell cycle, targeted therapies o Common side effects and management o Counselling o Where to go for further advice o Basic role of Cancer Network A period of supervised verification of chemotherapy prescriptions. o During this period all prescriptions should be double checked by a level three pharmacist (or level 2 were appropriate) and a log sheet kept of a min 50 chemotherapy items (30 prescriptions for Basildon Hospital). These must include a variety of different prescriptions that reflect local case mix It is the responsibility of level 3 pharmacist to ensure that all training has been completed and that level 2 pharmacists are competent. The network will provide a level 2 training document to the designated oncology pharmacists in each trust to base their training on. Page 4 of 6
To maintain competency, level 2 pharmacists must keep a log of at least 20 prescriptions verification every 6 months (10 prescriptions for Trusts who treat haematology patients only) These should reflect local case mix. Revalidation Annually: To remain on the approved list, the individual must satisfy a level three pharmacist that they are competent. If this is not possible, then either a period of supervised verification of chemotherapy prescriptions or mock test is to be completed. Principles for Level Three Training Knowledge In depth knowledge of the treatment and support of patients with a wider range of cancers Post graduate Education Expected to undertake CPD and further training to ensure up to date in current oncology issues. Opportunities for achieving this may include: Oncology module in a post graduate diploma in clinical pharmacy MSc Oncology whole or selected modules Attendance at BOPA symposium Revalidation To be covered in annual appraisal Competencies for verification 1. Demonstrates understanding of the biology of cancer including classification, mechanism of action and scheduling of systemic therapy and disease progression. 2. Demonstrates understanding/ knowledge all regimens used within scope of practice. 3. An in-depth understanding of principles of chemotherapy and SACT and the mechanism of actions / pharmacology of drugs used. 4. Knows how to access local regimen /protocol information and check if regimen/ protocol is approved for use. 5. Demonstrates understanding of key roles of the local multidisciplinary oncology, haematology teams and structure of local cancer services 6. Demonstrates understanding of common terminology used in cancer, staging systems, tumour markers, and performance status. 7. Demonstrates ability to accurately verify chemotherapy prescriptions within scope of practice. 8. Demonstrates understanding/ knowledge of management of common toxicities of cancer treatment. 9. Demonstrates understanding/ knowledge of management of common symptoms/complications of cancer treatments e.g. mucositis, neutropenia, nausea and vomiting, etc. to a depth appropriate to the regimens in use. 10. Demonstrates understanding/ knowledge of the impact of cancer on the patient and their family. i.e. need to be able to communicate sensitively about the prescription they have verified. 11. Demonstrates understanding/ knowledge of systemic therapy dose calculations including body surface area (BSA) determination. Page 5 of 6
Approved list Each trust will have an approved list of designated pharmacists who are competent to verify cancer medicine prescriptions (level two or three pharmacist) which is maintained by the clinical lead responsible for cancer services. Competences The RPS and BOPA are working together to produce a set of competences for oncology pharmacists. Once these are published this document will be reviewed. Page 6 of 6