CATNAP Prior Art

Nurse Led Pathway for Incidental Pulmonary Embolism (IPE) in Cancer Patients, Hull

HUTH have developed a nurse-led service for the treatment of IPE. It was implemented to address the challenges of timely intervention, ownership of patient, connection of radiology and acute oncology, development of a VTE multi-disciplinary team, optimal standardised SOP-led management and cost savings of managing these patients as outpatients. The core elements of the service include a comprehensive training programme for Clinical Nurse Specialists (CNS) and radiographers.

Since implementation in 2010 there has been a significantly improved flow of patients through departments and improved communication between professionals and patients has resulted in prompt referrals and assessments. Recent Trust audit data shows that 100% of patients are now assessed in adherence to evidence-based guidelines and 100% of patients receive the appropriate anticoagulant or procedures due to the use of risk stratification. Additionally, the pathway incorporates safe and recommended follow-up schedules.

This service won “Best work in cancer associated thrombosis” at the national Anticoagulation Achievement Awards (AAA) in London, 2017 and 2019.

Royal University Hospitals, Bath

The RUH, has a dedicated pharmacist-led CAT service with the support of a Consultant Haematologist. This service was set up in 2017 and won an award for “Best work in cancer associated thrombosis” at the national AAA in London in 2018.

Patients are reviewed via telephone at 3 weeks, 3 months, and 6 months post CAT diagnosis. A shared care protocol has been set up with primary care for the provision of low molecular weight heparin (LMWH) and DOACs. Utilisation of shared care protocols and use of DOACs in appropriate patients has resulted in a significant cost saving for the Trust. The service works closely with the patient’s oncologist, GP, and other relevant professionals such as palliative care. Feedback from patients and staff has been incredibly positive. Audit data has shown a significant improvement in the way these patients are managed.

Swansea Bay University Health Board

The Swansea Bay UHB CAT service is a pharmacy-led service that is based in the acute GP unit at Singleton Hospital. Referrals are accepted from anywhere in the health board. Patients are initially seen via a face-to-face review in clinic whereby they are initiated on an appropriate anticoagulant and given an opportunity to discuss their new treatment and their diagnosis. They are offered two further clinic appointments with the pharmacy team, before being transferred to a technician led “virtual clinic” that ensures the safe monitoring and supply of anticoagulation up to the six month review point. At that time, they are offered an appointment in the joint pharmacy-haematology clinic to discuss a longer term plan. To support this decision making, a virtual multi-disciplinary team has been formed with oncology. The service operates with four independent prescriber pharmacists and one technician.