Adult Systemic Anti-Cancer Therapy (SACT) Prescribing Competencies - Standard operating procedure for

Publication: 09/06/2014  
Next review: 28/09/2025  
Standard Operating Procedure
CURRENT 
ID: 3866 
Approved By: Chemotherapy Steering Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2022  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Standard operating procedure for Adult Systemic Anti-Cancer Therapy (SACT) Prescribing Competencies

Aims

To define the process and share the correct documentation for acquiring Adult Systemic Anti-Cancer Treatment (SACT) prescribing competencies.

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Background and indications for standard operating procedure/protocol

The NHS England Quality Surveillance Programme Service indicators for Cancer:clinical chemotherapy Indicator Code: B15/S/a/itc-16-cc-005 states that “The Cancer Chemotherapy Service should keep training records of staff currently documented as competent by an authorised assessor; for any given area of competence and requires a list of authorised assessors of competence for chemotherapy practice in the CCS together with the competencies they are authorised to assess. Staff competency will only be considered valid if assessed by an assessor whose name is listed at the time of assessment and entry on to the list and maintenance on the list is dependent on the authorisation of the head of service or person(s) designated by the head.”

This SOP should be followed by all registrar, Trust Doctors and consultant level medical staff and non-medical prescribers (NMPs) (nurses, pharmacists, ACPs) who will be prescribing, reducing or changing Systemic Anti-Cancer Therapy (SACT) for adult patients.

The levels of competency used for SACT prescribing are from the Joint Royal College of Physicians

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Procedure method (step by step)

  • Departmental induction
  • Demonstration of electronic prescribing system (chemocare): Please email: leedsth-tr.ChemoCare@nhs.net
  • Prescribing assessment with pharmacy
  • Discussion/explanation of the chemotherapy pathway (consent form, chemotherapy documentation) with senior chemotherapy nurse/ chemotherapy day unit sister/pre assessment sister (J80, Level 1) Ext 67740/68180 (only needs doing once)
  • Prescriber arranges clinical opportunities for observing/being supervised in prescribing
  • Case Based Discussions (CBD), DOSTs and/or miniCEX appropriate for level the prescriber is working towards including regimen course allocation, dose modifications, supportive medicines required with senior qualified person (site specific level 4 or level
  • Local specific assessment/evidence/documentation for specific tumour types may be required eg SpR training record.(Please discuss with your Supervisor, and/or Clinical Programme Director)
  • Completion of Adult Prescribing Systemic Anti-Cancer Therapy (SACT) Competency Assessment Document for Medical and Non-Medical Prescribers when achieved each level. (See Appendix A)
  • Prescribers should return to level 2 prescribing competency if they start prescribing for a new tumour group and work through the levels according to their professional group and grade. From ST4+ , you may not be required to return to level 2 if your Supervisor, and/or educational programme director has deemed you competent to prescribe in the tumour group.

Description for each level of prescribing competency:

Level 2:

  • Has completed chemocare training with the Chemocare team
  • Has completed Prescribing SACT Competency Assessment (with Pharmacist)
  • Has met with Senior Chemotherapy Nurse to understand SACT consent/documentation/pathways
  • Can undertake a review of a patient receiving systemic anti-cancer therapy, and can confirm the next cycle of treatment to proceed. All prescriptions require countersignature (or documented on chemocare in the notes section that the trainee was supervised by an assessor)

Assessments will include:

  • DOST and/or CBDs/Mini CEX for SACT/chemotherapy pre-assessment/toxicity review to demonstrate primarily the appropriateness of continuing SACT and a further demonstration of an understanding of principles of toxicity management.

Level 3:

  • Able to confirm/continue SACT/chemotherapy without a counter signature but cannot prescribe the first cycle of SACT/chemotherapy, unless it is countersigned.

Assessments will include:

  • DOST and/or CBDs/Mini CEX for SACT/chemotherapy pre-assessment to demonstrate competence in the appropriateness of continuing SACT and a further demonstration of an understanding of principles of toxicity management, dose reductions and supportive management.

Level 4:

  • Able to initiate all appropriate systemic therapies for an oncology/haematology site specific area. It is estimated that suitable training would be completed within a period of time for each mandatory clinical module of respective curriculums. Therefore a level 4 competence is a requirement to complete training in all the clinical modules required for CCST/ CST.
  • Can demonstrate an understanding of the approach required for consenting and delivering SACT with palliative or potentially curative (primary or neoadjuvant or adjuvant) intent.

Assessments will include:

  • DOPS/ minCEX of presentation’s of cases/ acceptance of referrals at MDT
  • CBDs for management of palliative and non-palliative settings
  • Ensuring trainees are cognisant of clinical trials regulatory framework will be the responsibility of the clinical trials team

Level 5:

  • able to introduce a new therapy into a clinical department. This may be following a critical review of published evidence or as a clinical trial to evaluate new therapy. This prescriber can also devise a new treatment for a condition and propose appropriate methods for critical evaluation and determination of the cost effectiveness. This professional is likely to be a Consultant. The demonstration of this level of competence will be by the award of Certificate of Completion of Training (CCT) in Oncology/Haematology.

Ongoing competency at level 5 can be self- certified biannually.

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Provenance

Record: 3866
Objective:
Clinical condition:

Chemotherapy

Target patient group: Chemotherapy patients
Target professional group(s): Pharmacists
Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Joint Royal college of Physicians Levels of prescribing competency (2017)

Quality surveillance programme NHS England

Self Declaration Indicators for Cancer: Clinical Chemotherapy (model.nhs.uk)

Indicator code B15/S/a/itc-16-cc-005

Approved By

Chemotherapy Steering Group

Document history

LHP version 1.0

Related information

Appendix A

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Overview of Chemotherapy/SACT Prescribers Competency for each professional group

Medical Staff and Non-Medical Prescribers prescribing chemotherapy/SACT must have the required competency to do so. This will be documented in the Chemotherapy/SACT Prescribers Register available on the intranet

Consultants

Medical and Clinical Oncology Consultants and Haematology Consultants are deemed to be fully competent  to prescribe SACT/chemotherapy at level 5 as completion of training is a requirement for appointment.On-going competency will be self-certified bi annually following appraisal. The forms for registration and bi annual renewal (Appendix A) are available on  the intranet. To approve competence as a prescriber and assessor and enable inclusion on the prescribing competence and assessor register,  completed forms self certifying competence should be emailed to the Oncology/ Haematology SACT lead. Following authorisation these will be forwarded to the Quality Manager/deputy whose responsibility will be to maintain a SACT prescribing competency electronic staff record  Consultants starting at LTHT are required to attend Level 2 training to familiarise themselves with the e-prescribing system (Chemocare), local consenting practice, and protocols/pathways as soon as possible when commencing employmaent in LTHT. If involved in assessing and signing off medical trainees and non-medical practitioners consultants must be included on a register of SACT/chemo competency assessors.  

Specialty Registrars  

Those training in Clinical Oncology, Medical Oncology or Haematology at LTHT are required to undergo assessment in order to achieve progressive levels of chemotherapy/SACT prescribing competency as detailed in this SOP within each rotation to different cancer site specialities. Each site specific tumour type may have their own assessment booklet/SOP specific to the patient group/cancer type. Please ask your Programme lead or supervisor to confirm what is required. SpRs should have a local level 2 induction when they move Trusts as SACT prescribing systems and SACT treatment pathways may vary as soon as practicable when commencing employment. ST3’s should as a minimum aim to complete assessments for level 2 & 3 within 3 months of starting their training as a SpR in Oncology. From ST4+ we will expect trainees to achieve level 4 competency durng placements within each tumour type. Levels of competence should be assessed and documented in training logbook/eportfolio. A SACT prescribing competency form (Appendix A) should be completed and sent to Quality manager on gaining initial competence at level 3 to enable inclusion on LTHT SACT prescriber register and then every 2 years. It is accepted that levels of SACT prescribing competence will vary during the training programme as trainees rotate through different tumour sites as their expertise levels change. 

Non-medical Prescribers (NMPs) (Nurses, Pharmacist, ACPs)  

Will follow the SACT prescribing competency  levels outlined in this SOP. Level 2 and 3 must be completed on the SACT Competency Assessmemt form (Appendix A) on initial attainment of competence, and on a biannual basis for competency renewal. This is available on the intranet.  Each site specific tumour type may have their own assessment booklet/SOP. Please ask your Supervisor for specific requirements . Time to complete competence  is dependent on clinical practice exposure and prior experience and should be negotiated with clinical supervisor/assessor/line manger as appropriate. It is the responsibility of the non-medical prescriber to arrange an initial and bi annual assessment with an assessor of competence . This assessor must be working within the same tumour specific group as the NMP. All NMP’s on the SACT prescriber  register must be on the LTHT Non Medical Prescribers Register. All NMPs are responsible for ensuring that they discuss their on-going prescribing practice each year with their line manager as part of their appraisal and NMC revalidation.

Assessors of competency must be included in the Register of SACT/Chemotherapy Prescribers and must meet the following additional criteria:

  1. Assessors must be of Consultant grade and work in Clinical Oncology, Medical Oncology or Haematology at LTHT.
  2. Assessors must have been awarded a Certificate of Completion of Specialist Training (CCST) in Clinical Oncology, Medical Oncology or Haematology.
  3. Assessors should ideally have undergone formal training in assessment methods.

LTHT Adult Oncology/Haematology Chemotherapy Lead

Inclusion in the Chemotherapy/SACT Prescribers and Assessors Registers as a consultant must be authorised by the LTHT Adult Oncology/Haematology Chemotherapy Lead . Once the authorisation section is completed the forms should be sent to the quality manager for inclusion on the register.

Staff grade/Trust doctors

Should work within a defined tumour group and attain levels of competence appropriate to their experience. They should have their competencies reassessed biannully. If they move tumour groups they should be assessed for compentency prescribing SACT regimens within the new tumour group.

NOTE: Staff returning from parental leave or long term absence, should be re assessed against SACT prescribing competencies on their return to work.

NOTE: Intrathecal chemotherapy training and competency assessment are the responsibility of the lead chemotherapy nurse and are out of the remit of this document.

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Appendix B

DOST Guidance (Directly Observed assessment of Systemic Therapy Skills) 

This form can be used for non-medical prescribers as well as medical trainees. Registration details with relevant professional organisation post title and grade should be entered onto the form. The DOST focuses on the core skills that trainees require when managing the initiation of or continuation of systemic therapy. Where possible all elements of the process should be assessed on one occasion. You should explore a trainee’s related knowledge as appropriate.

The process should be trainee led. It is the responsibility of the trainee to choose a suitable clinical case and assessor. The assessor should agree that the clinical case is appropriate.

Instructions:

The assessor must have expertise in prescribing the systemic therapy being assessed. Must be at level 4 or 5.

Descriptors of competencies demonstrated during assessments:

Rationale for treatment

Understands the indications for and can define the aims of treatment
Understands the potential risks and benefits of treatment
Evaluates available test results and identifies any omissions or findings which impact on treatment strategy

Obtains informed consent

Confirms patients disease status and discusses rationale for treatment plan
Discusses potential risks and benefits of treatment
Ensures that the patient has the relevant written information
Completes consent form accurately
Interacts professionally with the patient and companions

Pre-treatment procedures / tests

Identifies tests or procedures which are required prior to therapy
Ensures that all pre-treatment requirements are fulfilled

Clinical assessment of patient

Ensures patients fitness to proceed with therapy
Assesses toxicity of previous systemic therapy
Carries out appropriate clinical examination

Awareness and management of complications

Demonstrates awareness of side effects of treatment
Ensures patient knows about likely side effects
Explains actions required if side effects are experienced

Prescription

Generates an appropriate prescription (including supportive drugs) which is accurate, safe and meets local and national standards.
Gives clear instructions for management before, during and after treatment.

Documentation of consultation

Documents key aspects of the process clearly, including:
-rationale for treatment and potential side effects discussed with patient
-assessment of patient and results of relevant investigations
-treatment prescribed and any modification, plans for future management

Interaction with staff

Communicates effectively with all members of the team.
Seeks advice where appropriate e.g. from consultant, pharmacist, nurse

 

Communication with patient

Explores patient’s perspective, ensures all patient’s concerns are addressed, and agrees management plan with patient.

Overall ability to prescribe this therapy

An overall judgement based on above. Even If the trainee is considered ”Able to prescribe without supervision” this assessment does not automatically entitle him/her to do so.

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Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.