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2013-14 Photonet Annual report - V1 1

National Managed Clinical Network for Phototherapy in Scotland

2013/14

www.photonet.scot.nhs.uk

Dr Robert Dawe, Network Lead Clinician Mrs Mhairi Gallacher, Network Manager


CONTENTS

1. Executive Summary 3

2. Introduction 6

3. Network Aims 13

4. Plans for Year Ahead 13

5. Network Governance 13

6. Detailed Description of Progress over reporting period 15

Appendix A Photonet Audit Activity 22 Appendix B Evaluation Results from 11th National Meeting 27

Appendix C Network Membership 29


1. EXECUTIVE SUMMARY 1.1 Lead Clinician’s Report

The phototherapy centres throughout Scotland continue to meet most of the national standards. It is encouraging to see that, in particular, performance against the standard regarding waiting times from referral until starting treatment has improved. We are currently analysing data for the audit year 1st April 2013 to 31st March 2014 and have issued paperwork for “self-audit” regarding those aspects of audit against standards which cannot yet be assessed on data nationally collected through PhotoSys. There has been a lot of uncertainty regarding management arrangements for National Managed Clinical Networks. There has been a lack of ongoing clerical support for the network manager concerned with Photonet, and it remains to be seen whether or not the situation will improve with new management arrangements. An application has been made by those interested in photodynamic therapy to have a Photodynamic Therapy National Managed Clinical Network run side by side with Photonet. Because of the differences between photodynamic therapy and the phototherapies such a network could not use the audit database system of Photosys but could use the newly developed National Clinical Audit System. The addition of photodynamic therapy to Photonet will only be possible if there is adequate support for this. It is good that National Managed Clinical Network Lead Clinicians are officially allocated funding that could be used to free up a session of their normal work time to devote to network tasks: it has not yet been possible to make use of this arrangement for Photonet, but there is a hope that we may be able to do so within the next year. PhotoSys, the National Audit System and Patient Management System underpinning Photonet, is to be moved to central hosting in Edinburgh – there has been various delays in this, but it is expected that this will happen within the next year. Once that development takes place it should be possible to improve PhotoSys in various ways: several updates and changes that have been agreed upon within the Photonet Steering Group have been awaiting the initial move of the hosting of PhotoSys. The Photonet training package is to be moved to hosting by LearnPro who supply various NHS continuing professional development training packages, and this should have the advantage of allowing updates and developments to the Photonet training package. Dr Robert Dawe Network Lead Clinician


1.2 Service Improvements

A detailed description of progress during 2013/2014 is available within Section 6. Activity includes:

1.2.1 Performance Against Photonet Standards Report

Data collection from the self-audit questionnaires was combined with data retrieved from the PhotoSys System using Business Objects to produce an individual Audit Report for the majority of phototherapy units across Scotland. The draft reports were issued to the site Lead Clinician and Lead Nurse for review and comment.

Individual reports were issued to 32 units. Twenty-nine units took the opportunity to comment. This is a significant increase on the previous audit year when only 17 units of 31 audited commented. Sincere thanks are conveyed to Network members for their assistance with returning self audit data. Finalised versions of the reports were issued to the Chief Executive of the individual Health Boards. Details of the outcome of the audit process for 2012/2013 are available within Appendix A.

1.2.2 Phototherapist Education

Nurses continue to register for the online education programme.133 practitioners have now completed the course however a further 41 have registered but have yet to complete.

1.2.3 Site Visits

The Photonet Technician has visited 32 out of a possible 36 sites during 2013/14 and 62 cabinets were tested out of a possible 71. Readings taken and investigations/analysis of results will be presented at the National Meeting on 27 May 2014.

1.2.4 Research

Members continue to be fully involved in research.

1.2.5 11th National Meeting of Photonet

Photonet held it’s 11th National Meeting on 28th May 2013.

The day’s topics included an Update from our Lead Clinician, Outpatient Self Administration of UVB Phototherapy Service Development Update, An Audit of High Dose Phototherapy Patients, Photodynamic Therapy Audit. We were also pleased to welcome Trish Garibaldinos who provided the meeting with a keynote lecture on the Management of Acute Adverse Effects of Phototherapy.


Afternoon workshops were well received and covered

• CPD and Service Development

• Gaining Meaningful Patient Experience Feedback

• Phototherapy for Atopic Eczema

• Supervised Self-Administration of UVB Phototherapy

• Thinking of buying a Phototherapy Cabin? Copies of the presentations are available by emailing network office: [email protected]. The National Meeting was well attended and we would like to thank everyone again for making the day a great success. The meeting evaluated positively and the results are available within Appendix B. Suggestions and comments from evaluation forms have been used for planning the event in 2014.

1.2.6 Photonet Standards and Protocols

Photonet have reviewed and updated the standards and protocols for the Network and these have been issued to all units and are available within the professional’s area within the Photonet website.

1.2.7 Phototherapy Unit Updates The following Units have provided an update in relation to service developments within their area:

• Royal Infirmary of Edinburgh – Replacement hand and foot PUVA Unit. New unit much more manoeuvrable and has more powerful bulbs that will shorten treatment times for patients.

• Crosshouse Hospital – purchase of hand and foot TL-01 machine.

• Glasgow Western – Replacement of old TL-01 machine with N-Line Pro.

• NHS Tayside – Patient self administration 1 year project commenced with Dermatology Ward at Ninewells Hospital.

• Ninewell Hospital - Patient ultraviolet therapy pathway poster and erythema signs and pictures poster displayed to support advice given to patients.


2. INTRODUCTION 2.1 Description of the Network

Photonet, the National Managed Clinical Network (NMCN) for Phototherapy, was established in 2002 to deliver the following priorities;

• The provision of equitable care for the management of skin conditions throughout Scotland.

• A standardised computer programme to assist with collection of data necessary for individual treatment courses and audit of treatment effectiveness for the Scottish Centres.

• To ensure appropriate cancer follow-up for patients receiving phototherapy, and to assist with this.

2.2 Service Covered

Care for patients requiring access to specialist opinion and management for inflammatory skin conditions is facilitated through the Managed Clinical Network approach and working to agreed national protocols. Local teams provide care for patients close to their own homes. It is desirable that all health professionals, patients, parents, young people and children have equitable and evidence-based treatment plans.

Information TechnologyPatient

Representation

Administrators

Support Services

Management

Nurses

Phototherapists

Physicists

Steering Group

Clinicians

PhotonetMCN

Information TechnologyPatient

Representation

Administrators

Support Services

Management

Nurses

Phototherapists

Physicists

Steering Group

Clinicians

PhotonetMCN


2.3 Patients Receiving Care in Scotland

• Number of Courses Delivered Number of courses of all phototherapy (for all indications) administered during the period 01/04/13 and 31/03/2014.

HEALTH BOARD UVB PUVA UVA1 TOTAL

Ayrshire & Arran 264 28 0 292

Borders 71 0 0 71

Dumfries & Galloway 100 53 0 153

Fife 386 29 0 415

Forth Valley 419 21 0 440

Grampian 462 77 0 539

Greater Glasgow & Clyde 1640 86 1 1727

Highland 213 62 0 275

Lanarkshire 958 84 0 1042

Lothian 889 50 0 939

Shetland 13 3 0 16

Tayside 1190 318 74 1582

TOTAL 6605 811 75 7491

• Number of Patients Receiving Treatment Number of patients receiving treatment during the period 01/04/2013 and 31/03/2014

BOARD NO. OF PATIENTS TREATED Ayrshire & Arran 315 Borders 90 Dumfries & Galloway 172 Fife 394 Forth Valley 395 Grampian 420 Greater Glasgow & Clyde 1209 Highland 171 Lanarkshire 892 Lothian 900 Shetland 44 Tayside 1215 TOTAL 7286


• Number of courses of UVB Phototherapy

Number of courses of UVB phototherapy (for all indications) from 2009/2010 to 2012/2014.

UVB 2009/10 2010/11 2011/12 2012/13 2013/14

Ayrshire & Arran 310 260 253 278 261

Borders 82 68 79 94 71

Dumfries & Galloway 112 133 111 119 99

Fife 399 376 399 392 386

Forth Valley 368 355 406 402 419

Grampian 384 383 372 377 449

Greater Glasgow & Clyde

1526 1611 1422 1161* 1622

Highland 119 139 147 140 213

Lanarkshire 948 885 914 936 933

Lothian 717 776 841 902 886

Shetland 0 41 41 43 13

Tayside 969 1049 1119 1078 1176

TOTAL 5934 6076 6104 5922 6528

In some health board regions, such as in Highland where there is only one phototherapy centre providing for a wide geographical area, the number of courses per hundred thousand population has continued to increase over the past five years. In other areas there is no major change or only a slight continuing increase, such as in Forth Valley. The figures for the year 2012/2013 for Greater Glasgow and Clyde are not accurate – these are still based on figures uploaded into PhotoSys for that year and there was at that time one centre in Greater Glasgow and Clyde that had not been able to enter most of its data into PhotoSys. The reduction in number of courses in the 2013/14 audit year for Shetland reflects recent problems with staffing in the, relatively new, phototherapy unit there. Orkney health board is not included here because there is no phototherapy unit on any of the Orkney Islands, although a few need to travel for phototherapy to Grampian.


The number of courses per health board, adjusted for population size, has continued to become more even:


• Number of courses of PUVA Number of courses of PUVA from 2009/2010 to 2013/2014.

PUVA 2009/10 2010/11 2011/12 2012/13 2013/14 Ayrshire & Arran 20 20 24 45 26

Borders 0 0 0 0 0 Dumfries & Galloway 45 68 47 60 51 Fife 16 27 17 25 29

Forth Valley 44 52 45 30 21 Grampian 76 57 62 56 75

Greater Glasgow & Clyde

117 111 91 89 82

Highland 19 41 55 43 60 Lanarkshire 129 98 107 106 79

Lothian 40 51 90 68 50 Shetland 0 0 2 7 3 Tayside 205 217 262 267 318

TOTAL 711 742 802 796 794

Whereas UVB use across the different health board regions in Scotland has become more even over the years this has not happened with PUVA with some decreasing availability of this treatment in parts of Scotland. There are likely to be various reasons for this – for many indications narrowband UVB works almost as well, and is simpler and safer, and so there has been some movement to using more UVB instead of PUVA. For some other indications however PUVA remains the first choice phototherapy and for many other diseases a second choice phototherapy if UVB has been inadequate. It is possible that in part the variation in use of this treatment is because of some lesser knowledge and experience of this treatment amongst dermatologists in some areas, so lack of realisation that it is often a good second choice phototherapy if UVB has been inadequate: Photonet will need to continue to encourage the availability of PUVA to all who would best be treated with it.


• Number of courses of UVA1 Phototherapy Number of courses of UVA1 phototherapy from 2009/2010 to 2013/2014.

UVA1 2009/10 2010/11 2011/12 2012/13 2013/14

GG&C 9 10 9 5 1

Tayside 34 42 44 46 74

TOTAL 43 52 53 51 75

UVA1 COURSES DELIVERED

2009/10 - 2013/14

0

10

20

30

40

50

60

70

80

2009/10 2010/11 2011/12 2012/13 2013/14

NO

. O

F C

OU

RS

ES

GG&C

Tayside


2.4 Phototherapy Treatment Sites

•Gilbert Bain Hospital

•Raigmore Hospital

•Dr Grey’s Hospital

•Aberdeen Royal Infirmary

•Stracathro Hospital

•Perth Royal Infirmary

•Ninewells Hospital

•Stirling Community Hospital

•St Andrews Community Hospital

•Victoria Hospital

•Queen Margaret's Hospital

•Royal Infirmary of Edinburgh

•Western General Hospital

•St John’s Hospital

•Forth Valley Royal Hospital

•Borders General Hospital

•Monklands Hospital

•Wishaw General Hospital

Western Isles Hospital •

Stobhill Hospital •

Glasgow Royal Infirmary •

Southern General Hospital •

Lorn & Islands Hospital •

Victoria Infirmary •

Western Infirmary of Glasgow •

Vale of Leven General Hospital •

Royal Alexandria Hospital •

Hairmyres Hospital •

Inverclyde Royal Hospital •

Crosshouse Hospital •

Mid Argyll Community Hospital •

War Memorial Hospital •

Heathfield Clinic •

Campbeltown Hospital •

Dumfries Royal Infirmary •

Galloway Community Hospital •

.....

.

..

.. .... ...

..

.

.

..

.

...

..

.


3. NETWORK AIMS 3.1 The Network aims to:

• Ensure patients are managed according to evidence-based, procedures and protocols.

• Enable provision of phototherapies in as cost effective a manner as possible.

• Develop and maintain a register of patients and summary outcome data for each course.

• Allow audit of practice and outcomes and hence provide a basis for improving the quality of care.

• Provide equity of access and service delivery at the most appropriate point of contact and supported by agreed clinical standards a transparent service model.

• Provide a full list of clinicians/sites with expertise. 4. Plans for the year ahead

Photonet will develop and endorse a workplan for 2014/15 including the following key objectives:

• Continue to promote Equity of Care

• 12th National Meeting will be held in May 2014

• Continue to explore other ways to engage with patients to gain patient experience.

• Support the centralisation of PhotoSys to NSIG and the completion of a Service Level Agreement to support required change controls

• Support the completion of the unit audit reports for 2013/14. 5. NETWORK GOVERNANCE 5.1 Lead Clinician

Dr Robert Dawe, Consultant Dermatologist, NHS Tayside was appointed to the post of Network Lead Clinician in June 2010. The Lead Clinician is designated one session per week to support the development of the Network.

5.2 Network Manager Mrs Mhairi Gallacher was appointed and commenced in the post of Photonet National MCN Manager in May 2010.

5.3 Network Administration During 2013/2014, the Network has had a number of temporary staff providing administrative and secretarial support. Mrs Aneta Gorsynski currently works part time for Photonet along with Gillian Johnston who also works part time for the Network.


5.4 Network Steering Group

Membership of the Network Steering Group was further consolidated during 2013/14, and comprises patient representation, inter-professional healthcare team members from nursing and medical groups, support services, Information Technology and management. It is anticipated that the structure will develop to keep pace with clinical advances and changing patient needs as the Network evolves. The Photonet Steering Group endorsed an updated terms of reference on 18 April 2013. The Network Steering Group has met on 3 occasions during the course of the year. The list of Photonet Steering Group members and Photonet Lead Consultants and Nurses is included in Appendix C.

NHS TaysideCentre for MCNs

Core Group

Head of Managed Clinical Networks

NHS Tayside

Patient representation

Photonet

Steering Group

NursesSub Group

PhotophysicsSub Group

PhotoSysSub Group

KEYAccountable to

Professional Advice

and Communication Link

National Services Division


6. DETAILED DESCRIPTION OF PROGRESS OVER THE REPORTING PERIOD

RAG status key

RAG status Description

RED (R) Little/no progress been made to date to achieving network objective/standard

AMBER (A) Significant progress been made to date to achieving network objective/standard, however further work is required to fully achieve the network objective

GREEN (G) The network has been successful in achieving the network objective/standard OBJECTIVE (Link to MCN Principles & PHOTONET Standards)

Target Completion Date

Responsible Lead (L) Supporting (S)

Description of progress towards meeting objective

Outcome / evidence RAG status

Patient Centred: Providing Care that is responsive to individual preferences, needs and values and assuring that patient values guide all clinical decisions.

1. Patient & Public Involvement:

Encourage and facilitate the involvement of patients, parents, carers and lay representatives in the development of the Network.

MCN Principle 4 Photonet Standards 1,2

1.1 Appropriate links are made available on the updated website.

Ongoing MCN Manager(L) MCN Administrator (S)

www.photonet.scot.nhs.uk. New website has been developed and is now live and being regularly updated. Information on individual site locations and contact details have been added to the website.

Patient support links identified on website.

G

1.2 Patient satisfaction survey is carried out annually.

March 2014 MCN Manager(L) Patient satisfaction surveys issued and returned. 398 surveys returned. Results published in individual centre reports for consideration as well as the Photonet Audit against Standards Report.

Network collaborates and involves patients, carers and public in the planning and delivery of services.

G

1.3 Explore other ways to engage with patients to gain patient experience.

March 2014 Lead Clinician (L) MCN Manager(S)

Network Manager member of Patient Experience Project Group. Patient Experience Workshop facilitated by Network Manager during Annual Meeting on 28

th May 2013.

Ninewells, Aberdeen, Perth, St Andrews and Forth Valley have been

Appropriate links made with patients to gain feedback on services.

A


visited by either the Network Manager or Administrators. (Other clinics will also be visited.) Network Manager/Administrator met with patients/parents to undertake survey on priorities for care when attending clinics. (Feedback obtained using the ipad programme). Plan to use findings to revise the patient questionnaire and trial in one unit prior to rolling out across Scotland. Questionnaire will be made available online using http://www.care-experiences.com/ with the assistance of Healthcare Improvement Scotland colleagues. Network Manager also undertaking a survey on patient information (feedback again obtained using the ipad programme). Findings will be used to review patient information.


OBJECTIVE





Safe: Avoiding injuries to patients from care that is intended to help them

2. Education:

The safety of patients is the highest priority of the Network. Treatment should only be administered by trained staff. Principle 4, 8, 9 Standard 3, 4, 6, 7

2.1 Continue to assess Phototherapist Education

2.1.1 Continue to encourage all phototherapists to complete the online course.

March 2014 Nursing Sub-Group (L) MCN Manager (S)

Nursing are encouraged to complete online course. Total registered: 174 Total completed: 133 Still to complete: 41

Nurse workforce in its entirety is knowledgeable, skilled and confident.

G

2.1.2 Identify changes required to improve online course. Scope work and costs involved in upgrade.


Application made to NHS Tayside to move course to Learnpro system. NHS Tayside have indicated that they plan to start this work in May 2014. Network Manager linking with Glasgow MCN Office colleagues who are liaising with NES regarding developing online education courses.

A

2.1.3 Assess the potential for an advanced phototherapists course.


Photonet are working with the British Dermatology Nursing Group’s Phototherapy Sub-Group and the British Photodermatology Group in defining competencies for Phototherapists.

G

2.2 Organise and Host 11th National Photonet Meeting.

2.2.1 One day education event to meet the audit and information needs of a variety of staff.

May 2013 Lead Clinician (L) MCN Manager (S)

Annual meeting organised and held 28/5/13. Meeting was well attended and feedback available in Appendix B.

G

2.3 Organise Dosimetry Training Workshop 2.3.1 Photophysics Group should

organise a dosimetry training workshop with attendance of at least 50% of staff.

March 2014 Photophysics Sub-Group (L) MCN Manager/ Administrator (S)

Workshop held on 20 March 2013.

G


OBJECTIVE





EFFECTIVE: Providing services based on scientific knowledge

3. Standards, Guidelines & Protocols Principle 5, 6, 9 Standard 6, 7

3.1 Performance against standards is monitored through the use of Business Objects and Self Audit.

3.1.1 Units issued with self audit questionnaires to review a sample of patient records in relation to a number of agreed National Standards.

June 2013 MCN Manager (L) Nursing Sub-Group (S)

There are 35 phototherapy units in Scotland currently treating patients. Self audit documentation was updated and issued to Lead Nurses in 32 Units for completion. 31 returns were received. Audit programme has been expanded this year to include audit against specific Medical Physics Standards. Medical Physics teams issued with self audit documentation.

G

3.1.2 Audit data retrieved from the PhotoSys System in relation to a number of agreed National Standards.

June 2013

MCN Manager (L)

Data retrieved and added to individual unit reports. 32 reports drafted for consideration and comment by Photonet Lead Clinician. G

3.1.3 Draft Reports issued to the site Lead Consultant and Lead Nurse for review and Comment.

Sept 2013 MCN Manager (L) MCN Administrator (S)

Draft reports issued for comment.

G

3.1.4 Finalised versions of the reports issued to the Chief Executive of the individual Health Boards.

Nov 2013 MCN Manager (L) MCN Administrator (S)

Final Reports Issued.

G

3.1.5 Full Audit Report issued to National Services Division.

Dec 2013 MCN Manager (L) MCN Admin (S)

Full Audit Report endorsed following minor amendment at PSG at meeting on 6 Feb 2014. Final report sent to NSD on 20 Mar 2014.

G

3.2 Each site will be revisited during 2013-2014. Output for whole body cabinets will be recorded and published.

Ongoing Photonet Technician (L)

Photonet technician has a schedule of visits which will be completed within timescales.

G

3.3 Dosimetry of hand held MED testers to be checked during dosimetry visits during 2013-2014.

Ongoing Photonet Technician (L)

Photonet technician has a schedule of visits which will be completed within timescales.

G

3.4 Actively share Photonet standards and outcomes with other areas in England and Wales to facilitate benchmarking.

Ongoing Lead Clinician(L) MCN Manager(S)

Lead Clinician attended a meeting in April with colleagues from England. Network Manager attending meeting in London with SE England Phototherapy Network on 28 Nov 2013.

G


OBJECTIVE





Efficient: Avoiding waste, including waste of equipment, supplies, energy and ideas.

4. Data Collection: The PhotoSys database must evolve to ensure it meets the growing needs of the expanding Network. Principle 6, 9 Standard 6

4.1 Developments in the PhotoSys database will continue to be identified and added to the existing list of outstanding change controls.

Ongoing PhotoSys Sub-Group(L) MCN Manager(S)

Up to date change controls identified, however delays in centralisation of Photosys to NNMS (National Network Management Service) is resulting in developments not being undertaken.

A

4.2 Address information governance issues in the use of PhotoSys by the yearly review of the PhotoSys System Security Policy and Secure Operating Policy.

April 2013 PhotoSys Sub-Group(L) MCN Manager(S)

PhotoSys System Security Policy and Secure Operating Policy was reviewed and endorsed at the Steering Group Meeting on 18th April 2013.

Policy available.

G

4.3 Support the centralisation of Photosys to NISG and the completion of a Service Level Agreement.

March 2014 PhotoSys Sub-Group (L) MCN Manager (S)

Delays have been experienced in moving Photosys to NNMS. Meeting held on 4 November 2013 between Network Manager, NHS Tayside IT colleagues & Gordon Shaw. NHS Tayside IT and NSS Strategic Business Unit will progress project plan to take forward move and development of a Service Level Agreement.

A


OBJECTIVE





Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or economic status

5. Provide equity of access and service delivery at most appropriate point. Principle 9 Standard 7 5.1 Continue to explore models of care

for equity of access to phototherapy. Mar 2014 MCN Lead

Clinician(L)

Audit of Unit opening times included in 2012/13 annual self audit. Exploring collection of additional equity of access information including treating patients with a disability and travelling times to clinics. Equity of access questions will be considered for updated Patient Experience Questionnaire.

G

OBJECTIVE






6. Stakeholders Communications Plan Develop and deliver a communication strategy to support timely, accurate and effective exchange of information across services. Principle 2, 9 Standard 2, 3, 5

6.1 Website reviewed and maintained with up-to-date information.

Ongoing MCN Manager(L) MCN Admin staff

www.photonet.scot.nhs.uk. New website has been developed and is now live and being regularly updated

Timely, accurate and effective exchanges of information across the Network. G

6.2 Development and circulation of bi-annual Newsletter.

Aug 2013 Feb 2014

MCN Manager (L) MCN Admin staff

Autumn Newsletter circulated.

A

6.3 Communication strategy and stakeholder analysis reviewed and endorsed by Steering Group.

March 2014 MCN Manager(L) Steering Grp (S)

Agreement at Performance Review Meeting with NSD to carry this objective forward to 2014/15 workplan.

B


OBJECTIVE






7. Continue to develop and implement a clear management and accountability framework within the MCN. Principle 1, 2, 3, 7 Standard 1

7.1 Yearly review of list of Photonet Sites and contact details for clinicians.

March 2014 MCN Manager(L) Administrator(S)

Review complete. Up to date list of clinicians and sites with expertise available within annual report and website.

G

7.2 Endorsement of Photonet Standards and Network.

March 2014 MCN Manager(L) Steering Grp (S)

Awaiting further update from NSD on the national MCN validation process.

Will progress in line with NSD network endorsement plans. A

7.3 Ensure clarity around Network Structures and lines of responsibility by development of terms of reference.

April 2013 MCN Manager(L) Steering Grp (S)

Terms of Reference reviewed annually by steering group, endorsed 18 April 2013.

Yearly review of terms of reference and membership on Steering Group and Sub-Groups.

G

OBJECTIVE





Timely: Reduce waits and sometimes harmful delays for both those who receive care and those who give care

Principle 9 Standard 7

8.1 Maintain a risk register of Photonet Care across Scotland.

Ongoing MCN Manager(L) Steering Group(S)

Risks identified through Self-Audit Process are discussed at regular Steering Group Meetings and added to risk register.

G


APPENDIX A PHOTONET AUDIT ACTIVITY 1. Self Audit

The data collection from the self-audit questionnaires is combined with data retrieved from the PhotoSys System using Business Objects to produce an Audit Report for each site. The draft reports are issued to the site Lead Clinician and Lead Nurse for review and comment. Finalised versions of the reports are issued to the Chief Executive of the individual Health Boards. A full audit report for the Network is submitted to the National Services Division. The self audit involves the review of patient records in relation to a number of agreed National Standards.

Patients referred for Phototherapy are referred by a dermatology clinic. A referral form should be used to prescribe phototherapy. A computer-generated summary sheet including information on lifetime cumulative UVB and PUVA exposures should be updated following each treatment course. The consent form, which is combined with the referral form, is signed by 90% patients prior to starting each course of UVB or PUVA treatment and is filed in patient’s record. Each patient will have a phototherapy assessment carried out prior to commencing treatment, which will include assessment of special needs. A record of this phototherapy assessment will be filed in every patient’s Phototherapy notes A letter is sent to the patient’s GP within ten working days following completion of a course of phototherapy. A copy of this letter is filed within the patient’s notes.

Units were also asked to report on the following standards:

>95% of patients will have received relevant Patient Information Leaflets prior to commencing treatment. Written evidence based protocols for all relevant forms of phototherapy are available, and used, in every centre. Written dosimetry protocols are available in all departments. A discharge protocol is in place in 100% of units and is followed by phototherapists. It contains guidance on when to stop treatment, and when to seek dermatologist’s advice on when to stop a course of treatment. A medical physicist should be responsible for UV measurements in all phototherapy units. All phototherapists charged with supervising phototherapy treatment in their department have received an update (e.g. Photonet National Meeting, Photonet online course, local training event) within the previous 3 years. 100% of all phototherapy units have at least one trained phototherapist in the department whenever patients are being treated.


2. Additional Clinical Treatment Methodologies and Outcomes

• Courses Achieving Clearance The national standard is that “Whole-body UVB treatment for psoriasis has an outcome of clearance/near clearance (minimal residual activity) in >70% of completed UVB courses”.

Most centres have met this agreed standard of 70% or more of whole body courses of narrowband UVB phototherapy for psoriasis reaching clearance/minimal residual activity. The proportions of patients excluding those who did not attend (DNA), so outcome known, reaching clearance / MRA were higher (see above graph) including in some centres where patients travelling from long distances for treatment so perhaps more likely just to stop attending if clear. There was discussion around this at Photonet steering group meetings; whether we should change the standard to relate to only patients for whom outcome known, and change standard upwards (perhaps to 80% clear / MRA) but the consensus for now was to leave the standard as is but also to report, as above, the proportions where outcome known (excluding DNAs).


Waiting times to start phototherapy (any sort) by phototherapy centre in Scotland

The national standard is that 90% of courses should be started within six weeks of referral from within a dermatology department. Although several centres are still failing to succeed in meeting this national standard there has been an overall improvement with in particular now only two centres showing very long waiting times to start treatment.

Each box incorporates the interquartile range with most of the remaining waiting times incorporated in the “whiskers”.


3. Status of each centre against identified standards (2012/2013 Audit) (Note: Arbitrary Centre Numbers within table below are not the same as the centre numbers used in the other graphs within this report).

Standard 1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 22 23 24 25 26 27 28 29 30 31 32 34 35

2a.1

2c.2

4a.1

4a.2

5a.1

5a.2

5a.3

5b.1 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

6b.1

7a.1

7b.1

7b.2

7c.1 N/A N/A N/A

7d.1

7e.1

7f.1/2

7g.1 N/A

7h.2 N/A N/A

7i.1

7i.2

7i.3 N/A N/A N/A N/A N/A N/A N/A N/A N/A

Erythema

Arbitrary Centre Number:

Key

Red R Amber A Green G Blue B

Action Required

Monitoring Required

No Action Required

Data Not Reported


4. Patient Satisfaction Survey Results (398 questionnaires returned)

PSQ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 22 23 24 25 26 27 28 29 30 31 32 34 35

No of Questionnaires returned 13 13 13 6 12 19 13 10 6 19 7 12 15 2 8 7 9 17 20 13 19 15 9 13 20 19 15 10 9 12 12 6 5

Phototherapy Treatment Centre within one

month of being seen by a Dermatologist? -

%Yes 100 31 85 100 100 100 100 50 100 79 100 58 100 50 100 100 44 88 100 100 100 93 67 100 95 89 100 100 100 100 83 100 100

Q2 - Was your proposed treatment fully

explained to you by a nurse at your book-in

appointment? - %Yes 100 100 100 100 100 100 100 90 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 92 100 100 100

Q3 - Were you offered an information leaflet

prior to starting treatment? - %Yes 100 77 100 88 83 89 100 80 83 100 100 92 93 100 100 71 67 100 100 100 100 100 89 100 90 100 100 100 100 100 100 88 100

Q4 - Were you given an opportunity to ask

questions at your book-in appointment? -

%Yes 100 100 100 100 100 100 100 80 100 100 100 92 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100

Q5 - If Yes, were you satisfied with the

answers you were given? - %Yes 85 85 92 63 100 89 100 70 100 95 86 100 93 50 100 100 78 88 100 85 95 87 89 85 85 100 93 100 100 100 100 63 100

Q6a - Did you feel the nurse had sufficient

knowledge of your condition? - %Yes 100 100 92 100 100 100 100 70 83 95 100 100 100 100 100 100 100 100 100 92 100 100 100 100 95 100 93 100 100 100 100 100 100

Q6b - Did you feel the nurse had sufficient

knowledge of your treatment? - %Yes 100 100 85 100 100 100 100 80 83 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100

Q7 - Were you treated within half an hour of

your appointment time or given an

explanation for the delay? - %Yes 100 77 62 100 100 84 100 80 100 100 100 92 100 100 100 86 89 94 100 92 100 100 100 100 100 100 100 100 100 92 100 100 100

Q8 - During the course of your treatment,

have you been seen by a doctor when you

required or requested? - % Yes & N/A 100 92 100 100 100 100 100 100 100 95 100 100 100 100 100 86 100 100 100 100 100 100 78 100 100 100 100 100 100 100 100 100 100

Q9 - Have you been satisfied with the care

you have received during your course of

treatment? - %Yes 100 100 92 100 100 100 100 90 100 84 100 100 100 100 100 100 100 100 100 100 100 93 100 100 100 100 100 100 100 100 100 100 100

Q10 - Do you feel the treatment centre

allowed sufficient privacy during the course

of treatment? - %Yes 100 100 100 100 100 100 100 80 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100

Q11 - Having completed a course of

treatment, do you know how to seek further

advice about your condition? 100 69 100 100 100 89 100 80 83 95 100 92 100 100 100 86 89 88 95 100 100 100 100 100 100 68 100 80 100 100 82 100 100

Arbitrary Centre Number:


APPENDIX B

Evaluation forms were returned from 48 delegates.

Rating system: Strongly agree 5..4..3..2..1 Strongly disagree

Question 5 4 3 2 1

Q1 - I learnt a great deal from this event 11 27 10 0 0

Q2 - The meeting was very well structured 12 25 9 2 0

Q3 - The organisation of the meeting was efficient 14 22 9 3 0

Q4 - The speakers communicated effectively 22 23 3 0 0

Q5 - The information was well presented 21 22 4 1 0

Q6 - There was sufficient time available for discussion 21 18 9 0 0

% POSITIVE / NEGATIVE RESPONSES

11TH NATIONAL PHOTONET MEETING

97.9, 98%

2.1, 2%

Positive

Negative

Evaluation of Workshops held- 44 / 48 participants answered all 3 questions

Question 5 4 3 2 1

The workshops were informative 13 24 7 0 0 Would like to see workshops at future National Meetings 16 21 7 0 0

Enough time allocated to workshop sessions 8 15 13 7 1

% POSITIVE / NEGATIVE RESPONSES FOR WORKSHOPS HELD

11TH NATIONAL PHOTONET MEETING

98%

2%

Positive

Negative

Evaluation results from 11th National Meeting - 28 May 2013


Comments: Enjoyed the meeting Well organised & informative. Enjoyed the morning Excellent meeting. Very informative Well Structured Well Organised Longer with Dr Dawe would have been good Would have liked more time for workshops Day well organised and informative Good to share knowledge and meet other phototherapy nurses. Good meeting for sharing ideas/ learning from other's experiences Workshops a bit disorganised- but sure there will be smooth running in the future Better organisation of rooms for workshops Excellent workshops- good to get opinions of wider group on patient feedback Lunch area too small, long wait for coffee/tea Interesting day, good mix of speakers Lecture theatre very cold Inadequate seating for lunch Meeting area not big enough for volume of people Very cold, large amount of time spent waiting. Not enough seating areas for number of people Queuing for coffee was time consuming. Workshops difficult to find. Rooms were freezing. I did not find the service development workshop useful- pointless scenario Better to work on a real potential service development angle Not so many audit reports-it got a bit tedious. More of a clinical slant would be good. Dr Dawe's workshop excellent. A bit of a mix up with the rooms Workshops poorly organised in terms of room allocation. Massive queue for refreshments Problems keeping with time- possibility of missing trains Some charts very difficult to understand Workshops could be numbered better Was all a bit rushed Confusing moving between workshops Excellent Meeting


APPENDIX C

NETWORK MEMBERSHIP

1. Steering Group Membership

Robert Dawe Network Lead Clinician Mhairi Gallacher Network Manager, NHS Tayside Paula Beattie Consultant Dermatologist, NHS Greater Glasgow & Clyde Billy Brant Dermatology Nurse, NHS Grampian Liz Callan Dermatology Nurse, NHS Lanarkshire Kevin Campbell Photonet Technician, NHS Tayside Fiona Craig Consultant Dermatologist, NHS Grampian Una Donaldson Dermatology Nurse, NHS Fife Lynn Fullerton Senior Clinical Technologist, NHS Tayside Helen McAteer Psoriasis Assocation Helen McKendrick Dermatology Nurse, NHS Borders Harry Moseley Consultant Medical Physicist, NHS Tayside Ruth Ray Associate Specialist, NHS Lothian Sally Reddy Dermatology Nurse, NHS Tayside Nick Wainwright Consultant Dermatologist, NHS Lanarkshire Patient Representative


2. Photonet Lead Consultants & Nurses

Hospital City Consultant Nurse Contact

Aberdeen Royal Infirmary Aberdeen Frank Muller Judith Logie

Monklands Hospital Airdrie Nick Wainwright Wendy Gilchrist

Vale of Leven District General Hospital

Alexandria Dr Daniel Kemmett

Suzanne Hartness

Heathfield Hospital Ayr Colm Dwyer Alastair Kerr

Mary Jamieson

Wishaw General Hospital Wishaw Nick Wainwright Linda Lindsay

Dumfries & Galloway Royal Infirmary

Dumfries Jon Norris Helen Smith

Ninewells Hospital Dundee Robert Dawe Sally Reddy

Queen Margaret Hospital Dunfermline Sheena Russell Una Donaldson

Hairmyres Hospital East Kilbride Nick Wainwright Marge Mills

Royal Infirmary of Edinburgh Edinburgh David McKay Janice Carter

Western General Hospital Edinburgh David McKay Michael Byrne

Dr Gray's Hospital Elgin Frank Muller Gillian Barber

Forth Valley Royal Hospital Larbert Colin Morton Brenda Smith

Glasgow Royal Infirmary Glasgow Colin Clark Charlotte Ashton

Glasgow SGH Glasgow David Bilsland June Whyte

Glasgow Western Infirmary Glasgow Dr P Beattie Christina MacLean

Stobhill General Hospital Glasgow Dr Clark Sharon Murray

Inverclyde Royal Hospital Greenock Dr Alexander Milligan Suzanne Hartness/Yvonne Fulton

Raigmore Hospital Inverness James Vestey Sandra Cunningham

Crosshouse Hospital Kilmarnock Colm Dwyer Alastair Kerr

Alison Neil

Victoria Hospital Kirkcaldy Sheena Russell Gail Mitchell

St John's Hospital Livingston Dr Murray Serena Liddell Borders General Hospital Melrose Simon Laube Helen McKendrick

Royal Alexandra Hospital Paisley Isabell Hay Suzanne Hartness

Perth Royal Infirmary Perth Colin Fleming Linda Malcolm

St Andrews Community Hospital

St Andrews Robert Dawe Sharon Sergeant

Stirling Community Hospital Stirling Colin Morton Jayne Field

Stracathro Hospital By Brechin Robert Dawe Maureen Pirie

Lorn & the Islands Hospital Oban Daniel Kemmett Jane Midlane

Western Isles Hospital Isle of Lewis James Vestey Angela Woodley

Campbeltown Hospital Argyll Susie Mukherjee Margaret MacFarlane

Mid Argyll Community Hospital

Lochgilphead Richard Sloan Marion Sansom

Gilbert Bain Hospital Shetland John Hewitt Jasmine Moncrieff

Victoria Hospital Glasgow David Bilsland Catherine Christie

Galloway Community Hospital

Stranraer Jon Norris Helen Smith

Western Isles Hospital Stornoway James Vestey Angela Woodley

National Managed Clinical Network for Phototherapy in ... · Because of the differences between...

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