Making the most of opportunities for advanced practice in Radiotherapy Pretreatment

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Making the most of opportunities for advanced
practice in Radiotherapy Pre-treatment
or Whats in it for us? John Burton,
Pre-Treatment Superintendent, ECC
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Overview

• What have we done?
• Why did we do it?
• What do we get out of it?
• Where does it take us?

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What have we done?

• Treatment volume definition
• Breast planning and prescribing
• Fast Track Palliative planning and prescribing
• Treatment isocentre definition
• Placement of treatment isocentre using virtual
  simulator
• Administration of medicine
• Contrast administration
• Supply of microenema

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Why did we do it?

• Service requirements
• Waiting list targets service redesign
• Responding to change oncologist availability
• Technical
• Satisfying demands for greater image enhancement
• Managing a protocol for bladder/rectal fill

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Why did we do it?

• Service requirements
• Waiting list targets service redesign
• We hypothesised radiographers defining the
  isocentre at CT, designed a potential process and
  identified potential issues.
• A departmental review in to how we could satisfy
  the 62 day target identified the simulator as a
  bottleneck.
• We re-proposed our isodownload technique as a
  potential solution. Six months later all issues
  resolved and in clinical use.

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Why did we do it?

• Service requirements
• Responding to change oncologist availability
• Changes to the pattern of oncologist workload
  meant that the breast team were interested in
  exploring Skill Mix options radiographer led
  planning
• The Fast Track palliative planning process had
  been similarly developed to free up oncologist
  time
• We proposed and developed radiographer
  prescribing under protocol to enhance the process
  - planning and treatment can be undertaken
  without the oncologist present in the department.

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Why did we do it?

• Technical
• Satisfying demands for greater image enhancement
• Head and neck team required contrast enhancement
  of blood vessels radiographer cannulation
• Increasing requirement - Gynae, colorectal, lung,
  CNS
• - oncologist availability
• Procedure developed to enable radiographers to
  take responsibility for the administration of
  contrast only requires an oncologist available
  in the department

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Why did we do it?

• Technical
• Managing a protocol for bladder/rectal fill
• We proposed the use of micro-enemas to help
  manage the requirement for empty rectum for
  prostate.
• The GU team want to dose escalate they had to
  consider rectal filling status
• Difficulty in managing the process we liaised
  with our pharmacists and designed a Standard
  Operating Procedure for radiographers to order
  and supply the enemas

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What do we get out of it?

• Individual / department benefit
• Career development opportunities
• Practitioner to Advanced Practitioner
• Modular competencies CPD records / KSF evidence
• Flexibility for bookings and choice of process
• Spare capacity

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Where does it take us?

• Increased professional recognition
• Formal responsibilities in training and
  assessment of trainee oncologist grades
• Opens up possible routes to consultant
  radiographer posts
• Breast
• Palliative radiotherapy
• Pre - treatment

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ConclusionWhats in it for us, is it worth it?

• Yes the benefits always outweigh the costs of
  developing advance practice opportunities
• The unwritten rule is to say yes we can do it
  and then we work out afterwards exactly how.