Benefits of protocol standardization and evidence-based best practiceBernadette LaveryMember CLFOncologist Oxford University HospitalsClinical Director, Thames Valley Cancer Clinical Network, NHSE

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Disclosure

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• The official procedure or system of rules governing affairs of state or diplomatic occasions.

• The original draft of a diplomatic document, especially of the terms of a treaty agreed to in conference and signed by the parties.

• A formal or official record of scientific experimental observations.

Protocol

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Hazards of not following the protocol!

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How war has driven medical advances

What makes a protocol ‘good’?• Clarity• Based on robust evidence• User Friendly• Addresses an important issue (high risk/complex situations)• Makes my job easier• Makes good outcome more likely

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Where did the drive for protocol use in oncology come from?• Incidents in healthcare

• Appreciation that quality doesn’t just happen

• IOG publications

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Airline incidents• Air France Flight 447

– Rio de Janiero – Paris flight, 2009, crashed 350 miles beyond Brazil NE coast, all 228 on board killed

– Entered aerodynamic stall and crashed into Atlantic after falling 38000ft in 3.5 minutes, hitting sea at 280km/hr

• KLM/PanAm collision– 2 747 jumbo jets collided awaiting take-off on runway in Tenerife, in

foggy conditions. – 583 people killed

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• Team work – empowering all members of the team to speak up if they think protocol not being followed

• Everybody makes mistakes, even very experienced• Clarity of communication essential• Practice important• Technology can go wrong• Human error can be increased by distraction

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Learning from airline incidents

NCAG 2009: Chemotherapy services in England: ensuring quality and safety• NPSA Rapid Response Alert on oral chemotherapy: January 2008 • NCEPOD report: November 2008

– Need to get the basics right –e.g. consent, performance status, investigations, recording of toxicities, prescribing

– Need to focus on management of complications • Prescribing and dispensing

– Up to date lists of designated staff for prescribing (first and subsequent cycles), verification and dispensing

– Protocols to be agreed across networks – and to be readily available and kept up to date

– Eliminate handwritten prescriptions for parenteral chemotherapy Page 10

CQC and IRMER

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CQC report

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IR(ME)R (from IPEM guide): aims to protect patients

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National Cancer Peer Review Programme aimed to improve cancer care by:• Ensuring services are as safe as possible;• Improving the quality and effectiveness of care;• Improving the patient and carer experience;• Undertaking independent, fair reviews of services;• Providing development and learning for all involved;• Encouraging the dissemination of good practice

In all tumour-group national measures there was a requirement for clinical guidelines to be produced at network level, and to be adopted by every local MDT

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Patient benefits of clinical protocols

• Receive optimal treatment • Safety in delivery of treatment• Confidence that they can trust the team – ‘all singing from

the same hymn sheet’ (and hopefully the correct hymn)

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Staff benefits• Efficiency of service• Protection from a ‘senior moment’• Confidence that they are practising within reasonable range

in comparison with peers• Help in keeping up to date, especially if well referenced.• Participation in reviewing and updating protocols can

contribute to CPD• Reduced litigation risk

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Organizational benefits• Efficiency in processes, leading to lower cost per procedure

and greater capacity• Fewer risks of error• Compliance with regulatory requirements giving protection

against prosecution under IRMER

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Potential Downside• Stifling innovation• Loss of creativity• Less familiarity with less common techniques.• Inappropriate care for the complex or exceptional patient

• Need acknowledgment that clinical protocols may only cover around 80% of situations

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Thank-you