Emerging Issues for Practice Nurses for the Management of Respiratory Disease and Cancer in Primary Care

Tuesday 13th October 2015 1.30 pm – 4.30 pm

Venue: Holiday Inn Royal Victoria Sheffield, Victoria Station Road, Sheffield, S4 7YE

Emerging Issues for Practice Nurses for the Management of Respiratory Disease and Cancer in Primary Care 1.30 pm – 4.30 pm, Tuesday 13th October 2015 Ballroom, Holiday Inn Royal Victoria, Victoria Station Road, Sheffield, S4 7YE

Agenda Time 1.00 pm 1.30 pm

Agenda Registration Welcome and introduction

1.35 pm

Respiratory health: key issues including inhalers, formulary and local guidance Understanding cancer as a long term condition, including late effects Cavendish Cancer Services - Chris Farrell, Chief Executive Refreshment break LCS scheme CEA blood monitoring – Louise Foster, Colorectal nursing, STH NHS FT Sheffield Occupational Health Advisory Service – Nick Pearson, SOHAS Manager Cancer Support and Information Centre – Karen Holmes, Centre Manager Question & Answer session Close

2.05 pm 2.30 pm 2.40 pm 3.10 pm 3.40 pm 3.50 pm 4.00 pm 4.30 pm

Lead Professor Diana Greenfield, Macmillan Consultant Nurse, STH NHS FT Joanne Watson and Neil Heslop, Sheffield Clinical Commissioning Group Professor Diana Greenfield

This event is kindly sponsored by the pharmaceutical companies Abbott, Janssen and Napp who will be exhibiting a stand at this event. The above have had no involvement in the agenda or speaker selection. The financial support provided is used to help with the cost of the venue and refreshments.

© NHS Sheffield Clinical Commissioning Group 2015. All rights reserved.

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Respiratory JTAG Guidelines

Neil Heslop Jo Watson

What we will cover • Introduce updated Respiratory section of Sheffield Formulary • Introduce local Respiratory Joint Therapy Advisory Group (JTAG) Guidelines • Answer some frequently asked questions (FAQ) around respiratory medications • Look at future and how this will be kept up to date • Leave some contact details for help

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Aims • To introduce the updated Respiratory section of the Sheffield Formulary • http://www.intranet.sheffieldccg.nhs.uk/Me dicines%20Management/medicinesprescribing/sheffield-formulary.htm

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Aims • To introduce the Respiratory JTAG Guidelines • http://www.intranet.sheffieldccg.nhs.uk/Me dicines%20Management/medicinesprescribing/prescribing-guidelines.htm

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Why both a Formulary and Guidelines? • Sheffield Formulary (SF) is long-standing • The SF has been produced under the auspices of the Sheffield Area Prescribing Group (APG) and is designed to give clear concise guidance on drug selection • List of preferred choices for non-specialist drugs and products, which will be available in both primary and secondary care • The choice of preferred drugs has been made on the basis of evidence of clinical efficacy, safety, patient acceptability and cost effectiveness • The contents reflect wide consultation within the city. • Been in existence since approx. 2001 • Separate asthma and COPD sections as previously one list and very confusing

Respiratory Guidelines • Primary and secondary care clinicians have worked together in the Joint Respiratory Therapy Advisory Group to produce the following guidelines for both asthma and COPD • This is to facilitate improved prescribing and avoid confusion over drug choice in each disease and improve patient safety • Reduces waste • The Guidelines are developed to work in conjunction with the SF • Guidelines are to advise on what choices are appropriate after the first choice drugs (SF) are seen to be inappropriate • Greater depth than SF

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Guidelines • More about looking at the patient in front of you and deciding what the issues are and how to proceed rather than just giving more or different drugs  Look at what's going on  Don’t just go down the algorithm for both Asthma and COPD  Review at every step

FAQs Its not in the SF. Can I use it? • Yes • However… the SF drugs are the first choice drugs. Please consider those SF drugs you are familiar with before moving onto non-formulary drugs. • This doesn’t mean you can’t use a non SF drug first, ever, but use your clinical judgement about justifying how appropriate it is. • New drugs are black triangle (what’s that?)

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Is my asthma patient taking too much salbutamol (SABA?) • National Review of Asthma Deaths 2014 (NRAD) suggests that pts using > 12 inhalers per year are at increased risk of DEATH • Also the same with the underuse of ICS ( 6264 JAN 15

SHEFFIELD

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Stopping smoking can be a challenge but we are here to support you. In fact, with NHS support you’re up to four times more likely to quit successfully! We’ve already helped thousands of people in Yorkshire quit, so let us help you.

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You quit, your way We know that different things work for different people, so our free and confidential NHS stop smoking specialists can help find what’s right for you. You can use any combination of our support, whatever suits you best.

Pick and mix your support from the following: Telephone support

Quit online

If you fancy a chat then just give us a call on 0800 612 0011 (free from landlines) or 0330 6601 166 (free from most mobiles).

Our online quit programme lets you create your own personal profile and you get interactive support during your quit journey.

We can tell you more about your choices and your local service, or you can complete your entire quit journey with us – on the phone. Even if you just want to talk about whether you’re ready to stop, we’re here to help.

You get all the support you need 24/7 and you can access it whenever or wherever you like.

We can also provide ongoing support via text, but only if you choose this option. We promise we won’t bombard you with text messages!

It includes: ■ ■ ■ ■ ■

A personal plan Pledges and rewards Personalised tools Optional motivational messages by email or text Online chat with our advisors An online community to connect with other quitters

Come and see us

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We’d love to see you! We run a variety of groups and clinics so there are plenty of opportunities for you to come and see us, whether you want to come somewhere close to where you live or where you work.

We even have a live chat facility, so you can have a virtual conversation with a stop smoking specialist.

You can find all our locations on our website or just give us a call.

Find out more at

www.yorkshiresmokefree.nhs.uk

Everyone’s reason for quitting smoking is different That’s why we treat you as an individual, working with you to develop a method and support programme that will suit you and lead to better results.

We’re not here to judge Deciding to quit smoking is a big decision, but one that you won’t regret. All of our staff are friendly, approachable and non-judgemental; that’s how we get such good results.

Nicotine replacement therapy We can give you advice on a range of products and medication that can help you quit (known as nicotine replacement therapy or NRT for short). In some areas, we can even help you get these products for free. Just ask us for more information. To find out more about all the different products available just go to www.youtube.com/YorkshireSmokefree

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No, unfortunately we can’t help you with your e-cig, or recommend any type or brand of e-cigs. We are not allowed to because e-cigs are not regulated and are not rigorously tested. But we can offer you lots of advice and recommendations about other regulated medications. If you want help to stop using e-cigs, we can offer you support to do this but we can’t offer you a voucher for other medication to help you stop using e-cigs.

What else - besides e-cigs – can help me quit smoking? E-cigs are one way that could help you stop smoking, and we know that many people have used them in this way. But there are many other products that are very effective and they are tried and tested. These include medications that you can get over the counter at the pharmacy or supermarket, such as nicotine patches and gum. There is also a prescription medication called Champix which we would be happy to discuss with you. These medications are all very effective and safe to use and can really help you to stop smoking for good.

Watch films about different medications at www.youtube.com/yorkshiresmokefree

• Online • On the phone • In person We provide NHS advice and support – including nicotine replacement therapy - for anyone who wants to stop smoking. So when you’re ready to quit, we’re ready to help.

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free from landlines free from most mobiles

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Can Yorkshire Smokefree Service show me how to use my e-cig?

With Yorkshire Smokefree you can pick and mix your support:

PHONE HE

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This is an individual choice for each person; you can choose whatever tools and aids you want to. We can give you lots of advice and support whichever product you decide to use. You don’t have to use any products or medication at all if you don’t want to.

Do you want to quit for good? There’s a new way!

Your feedback is welcome We invite you to share any comments, compliments, concerns or complaints you have about the Trust. Please speak to a member of staff or contact our customer services team on 0800 587 2108 who can also provide help in understanding this information.

About e-cigarettes Yorkshire Smokefree provides specialist support to thousands of people across Yorkshire. What are electronic cigarettes (e-cigs) and how do they work? E-cigarettes (also sometimes known as vaporizer cigarettes) are devices that give out doses of vaporized nicotine that you then inhale.

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IN PE

Do I need to use any products – or e-cigs – to help me stop smoking completely?

They usually have a re-chargeable battery, an atomiser and a cartridge of liquid. When you puff on your e-cig as you would an ordinary cigarette, the battery powers the device to heat the liquid and vaporize it. So what you are inhaling is vapour, not smoke.

You quit, your way JOB NO: 6085 AUG14

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Electronic cigarettes (e-cigs) are used by many smokers as a way of helping them to stop smoking completely. But, at the moment, e-cigs are not regulated. The government is considering classifying e-cigs as medication to ensure that they are tried and tested and are safe to use. But in the meantime, take a look at our information so you know more.

Is there nicotine in e-cigs? Nicotine is the addictive substance in ordinary cigarettes, and, yes, it is also in e-cigs. So whilst you’re not using tobacco – as in normal cigarettes – you still get the ‘hit’ of nicotine. The amount of nicotine depends on the mixture of the particular liquid cartridge installed in the device. Some products contain nicotine amounts comparable to regular tobacco cigarettes, but some products may contain less nicotine or even more nicotine. There are also cartridges available that don’t have any nicotine, for people who just want the sensory experience but without the addictive nicotine.

Are e-cigs safe? We don’t really know until they have been thoroughly assessed and monitored in a large population over time. There isn’t any evidence to definitely state that e-cigs are safe or unsafe. But they are unregulated - this means they are only covered by general product safety legislation; they cannot be legally promoted and sold to children, and we cannot be sure of their ingredients or how much nicotine they contain.

Are they better for me than normal cigarettes? Well, they’re still not good for you – and they still create an addiction! But some health professionals believe that using an e-cig to help a smoker to quit is much safer than smoking an ordinary cigarette. This is because they believe that there are fewer cancer-causing chemicals in e-cigs. Nicotine is not as dangerous as the chemicals in conventional cigarettes but it is still a poison. Without doubt, all health professionals would agree that the best thing would be not to smoke at all – e-cigs or normal cigs.

Are there side-effects? We don’t know for sure because they are still to be thoroughly assessed and monitored. We do know that some e-cig users are ‘vaping’ (using e-cigs) for long periods of time, and therefore getting higher doses of nicotine than they would have when smoking their usual number of ordinary cigarettes. This is making them feel sick, which can be a symptom of nicotine overdose. There have been a few recorded cases where e-cigs or their chargers have exploded or melted when used inappropriately. There have also been a few cases where pets or young children have been poisoned when they accidentally swallowed the liquid in an e-cig cartridge.

Can Yorkshire Smokefree support me to stop smoking if I’m using an e-cig? Yes! We can help anyone who wants to quit, whether you use ordinary cigarettes,e-cigs or any other stop smoking aids.

Unfortunately we can’t offer you any specific advice or support around e-cigs themselves. We are not allowed to recommend an e-cig or help you to use an e-cig which is not tested and regulated for your complete safety (unlike other medications which are tested and safe to use).

Unfortunately we can’t offer you any other medications such as patches or gum if you are using an e-cig to quit. What we can do however is give you lots of support to quit, and tell you all about the other tried and tested medications that are alternatives to e-cigs, and have been proven time after time to be effective in helping smokers to quit – products like patches, gum and lozenges or prescription medications like Champix.

Our friendly, approachable experts can support anyone to quit - this includes people who are using e-cigs instead of cigarettes. We offer a range of services and options to suit you. We can also give you advice on a range of products and medication that can help you quit (known as nicotine replacement therapy or NRT for short.) In some areas, we can even help you get these products for free. All of these medications are safe and really effective in helping people stop smoking. We offer a range of services and options to suit you. We can also give you advice on a range of products and medication that can help you quit (known as nicotine replacement therapy or NRT for short.) In some areas, we can even help you get these products for free. All of these medications are safe and really effective in helping people stop smoking. To find out more about all the different products available just go to www.youtube.com/YorkshireSmokefree

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Clinical Audit is here to stay. We can help. Visit our intranet pages to find out more. (http://www.intranet.sheffieldccg.nhs.uk/qualityincentive-schemes.htm )

A VERY QUICK OVERVIEW OF CLINICAL AUDIT 1. Choose your topic. • Choose a subject that you consider to be important or significant. • Check with others who would be involved in making changes. This is important, as you won’t achieve change if you don’t involve key people right from the start. • Register your project with the Clinical Audit and Effectiveness Department. 2. Select your evidence based criteria and set standards. 3. Data. • Choose your sample, time period and source. 4. Measure performance • Design and PILOT your data tool • Collect and analyse your data 5. Compare practice against criteria standards • If the standard has been met, ask the question ‘What good practice has taken place?’ • If standards have not been met, then you need to identify the reasons why not. • Report on your findings. • Discuss recommendations.

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6. Make Improvements. Think through in detail and organise a plan of action. • What needs to be done? • Who is going to do it? • When will it be done? • How, resources and support? Remember to send a copy of your report and action plan to the Clinical Audit and Effectiveness Department.

Saying ‘we’ve got to do better’ won’t result in change. Remember: Audit is a continuous cycle. If you don’t meet the standard and you’ve planned changes, you will need to repeat the audit to ensure the changes have been implemented and that improvements have been made. If the standard has been met you will still need to reaudit at a later date to demonstrate continuity.

Other ways in which the team can help • We keep track of all audit work within the CCG. • We can provide advice about current clinical standards. • We can help with audit tool design. • We can provide assistance with data analysis. • We have templates for Clinical Audit Reports and Action Plans.

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CCG Clinical Audit Contacts: Beverly Ryton Clinical Audit & Effectiveness Manager Tel: 0114 305 1105 [email protected]

Susan Alibone Clinical Audit Improvement Facilitator Tel: 0114 305 4464 [email protected]

Tracey Robinson Clinical Audit & Effectiveness Assistant Tel: 0114 305 1141 [email protected]

Sheffield Clinical Commissioning Group 722 Prince of Wales Road Sheffield S9 4EU Tel: 0114 305 1000 Fax: 0114 305 1001 www.sheffield.nhs.uk

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Evaluation & Feedback Thank you for attending the Emerging Issues for Practice Nurses for the Management of Respiratory Disease and Cancer in Primary Care event today. As ever, we would love to hear your feedback and ask that you take 5 minutes to complete enclosed questionnaire included in your goody bag. Certificates of attendance will be made available for download on the PRESS Portal week commencing the 16th November and can be downloaded from: www.sheffieldccgportal.co.uk/pressv2/index.php/list-events/event-materials/item/delegate-pack-evaluation-andcertificates-for-respiratory-disease-and-cancer-pli-13th-october-2015 To save paper – please print off only your own certificate. As always the latest information about all of our events can be found on the PRESS Portal at www.sheffieldccgportal.co.uk/pressv2/index.php/list-events which is updated regularly. Your feedback is very important to us and has helped us shape these events to meet your needs. We will continue to make improvements and appreciate your help in making these a success. Thank you – The Events Team

The PRESS Portal The Elective Care Portfolio has worked diligently to provide a one stop shop of information for GPs and Practice Nurses. This online tool is host to a wide array of useful documentation such as pathways, referral forms, event materials and other resources. Content is kept up to date with regular reviews to ensure that only the very latest information is available to you, and you can easily find the document or information you need by using the Search box or word map. All Education and PLI events are advertised on the PRESS Portal, with the very latest information maintained by the Events Team. Flyers for forthcoming events, delegate packs from historical PLI’s and other useful information such maps to venues, links to external sites, youtube videos etc. are all available at the click of a button.

www.sheffieldccgportal.co.uk

© NHS Sheffield Clinical Commissioning Group 2015. All rights reserved.