Download Palliative care audit tool

Lung cancer
Audit support
Implementing NICE guidance
Palliative interventions and
supportive and palliative care
2011
NICE clinical guideline 121
Audit support: Lung cancer (2011)
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This audit support accompanies the clinical guideline: ‘Lung cancer: the diagnosis
and treatment of lung cancer’ (available online at
www.nice.org.uk/guidance/CG121).
Issue date: 2011
This is a support tool for clinical audit based on the NICE guidance.
It is not NICE guidance.
Implementation of this guidance is the responsibility of local commissioners and/or
providers. Commissioners and providers are reminded that it is their responsibility
to implement the guidance, in their local context, in light of their duties to avoid
unlawful discrimination and to have regard to promoting equality of opportunity.
Nothing in this guidance should be interpreted in a way which would be inconsistent
with compliance with those duties.
National Institute for Health and Clinical Excellence
MidCity Place, 71 High Holborn, London WC1V 6NA; www.nice.org.uk
© National Institute for Health and Clinical Excellence, 2011. All rights reserved. This
material may be freely reproduced for educational and not-for-profit purposes. No
reproduction by or for commercial organisations, or for commercial purposes, is allowed
without the express written permission of NICE.
Audit support: Lung cancer (2011)
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Using audit support
The audit support document can be used to measure current practice in palliative
care for people with lung cancer against the recommendations in the NICE
guideline. This audit tool is intended to complement the National Lung Cancer Audit
(LUCADA) and enable services to carry out local audit in more detail as needed in
this area of lung cancer care.
Audit support contains criteria and a data collection tool. The data collection tool
can be used or adapted for the data collection part of the clinical audit cycle by the
trust, service or practice.
A baseline assessment tool is also available
www.nice.org.uk/guidance/CG121/BaselineAssessment. This can help ascertain
your trust’s baseline against the guideline’s recommendations and enable you to
prioritise implementation activity, including clinical audit.
The sample for this audit should include patients with lung cancer who need
palliative support and care. Select an appropriate sample in line with your project
aims or local clinical audit strategy.
Whether or not the audit results meet the standard, re-auditing is a key part of the
audit cycle. If your first data collection shows room for improvement, re-run it once
changes to the service have had time to make an impact. Continue with this
process until the results of the audit meet the standards.
Links with other clinical audit priorities
The audit based on this guideline should be considered in conjunction with other
clinical audit priorities such as:
 The National Lung Cancer Audit (LUCADA) www.ic.nhs.uk/services/nationalclinical-audit-support-programme-ncasp/cancer/lung
 Cancer waiting times
www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatist
ics/HospitalWaitingTimesandListStatistics/CancerWaitingTimes/index.htm
 The National Cancer Patient Experience Survey (due to be repeated in 2011)
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/D
H_122516
Audit support: Lung cancer (2011)
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Criteria for ‘Lung cancer- palliative interventions and
supportive and palliative care’
Palliative interventions and supportive and palliative care
Providing palliative care
Criterion 1
Patients who may benefit from specialist palliative care services should
be identified and referred without delay
Exceptions
None
Guideline reference
1.5.2
Definitions
None
Managing endobronchial obstruction
Criterion 2
When patients have large airway involvement, they should be monitored
(clinically and radiologically) for endobronchial obstruction to ensure
treatment is offered early
Exceptions
None
Guideline reference
1.5.4
Definitions
None
Criterion 3
External beam radiotherapy and/or endobronchial debulking or stenting
should be offered to patients with impending endobronchial obstruction
Exceptions
None
Guideline reference
1.5.5
Definitions
None
Other palliative treatments
Criterion 4
Pleural aspiration or drainage should be performed in an attempt to
relieve the symptoms of a pleural effusion
Exceptions
None
Guideline reference
1.5.7
Definitions
None
Criterion 5
Patients who benefit symptomatically from aspiration or drainage of fluid
should be offered talc pleurodesis for longer-term benefit
Exceptions
None
Guideline reference
1.5.8
Definitions
None
Audit support: Lung cancer (2011)
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Criterion 6
Patients with troublesome hoarseness due to recurrent laryngeal nerve
palsy should be referred to an ear, nose and throat specialist for advice
Exceptions
None
Guideline reference
1.5.12
Definitions
None
Criterion 7
Patients who present with superior vena cava obstruction should be
offered chemotherapy and radiotherapy according to the stage of
disease and performance status
Exceptions
None
Guideline reference
1.5.13
Definitions
None
Hypercalcaemia, bone pain and pathological features
Criterion 8
For patients with bone metastasis requiring palliation and for whom
standard analgesic treatments are inadequate, single-fraction
radiotherapy should be administered
Exceptions
None
Guideline reference
1.5.17
Definitions
None
Follow-up and patient perspectives
Criterion 9
All patients should be offered an initial specialist follow-up appointment
within 6 weeks of completing treatment to discuss ongoing care
All patients should be offered regular appointments thereafter, rather
than relying on patients requesting appointments when they experience
symptoms
Exceptions
None
Guideline reference
1.6.1 (key priority)
Definitions
None
Audit support: Lung cancer (2011)
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Data collection tool for ‘Lung cancer – palliative
interventions and supportive and palliative care’
Complete one form for each patient.
Patient identifier:
No.
Data
item
no.
Sex:
Age:
Organisation/service:
Criteria
Yes
No
NA/
Exceptionsa
Palliative interventions and supportive and palliative care
Providing palliative care
1.1
Was the patient suitable for specialist palliative care?
1.2
Was there any delay in their referral for specialist palliative care?
1
Managing endobronchial obstruction
2.1
Did the patient have large airway involvement?
2.2
Were they monitored clinically and radiologically for endobronchial
obstruction?
Were the following offered:
2
2.3

external beam radiotherapy

endobronchial debulking

stenting?
Other palliative treatments
3.1
Did the patient have a pleural effusion?
3.2
Was pleural aspiration or drainage performed?
3.3
Did the patient benefit symptomatically from aspiration or drainage
of fluid?
3.4
Were they offered talc pleurodesis?
4.1
Did the patient have troublesome hoarseness due to recurrent
laryngeal nerve palsy?
4.2
Were they referred to an ENT specialist?
5.1
Did the patient have superior vena cava obstruction?
5.2
Were they offered chemotherapy and radiotherapy?
3
4
5
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Hypercalcaemia, bone pain and pathological features
6
6.1
Did the patient have bone metastasis requiring palliation?
6.2
Was standard analgesic treatment inadequate?
6.3
Was single-fraction radiotherapy administered?
Follow-up and patient perspectives?
7
7.1
Was the patient offered a specialist follow-up appointment within
6 weeks of completing treatment?
7.2
Was the patient offered regular appointments for follow-up?
7.3
Did the patient request these?
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Further information
For further information about clinical audit refer to a local clinical audit
professional within your own organisation or the Healthcare Quality
Improvement Partnership (HQIP) website www.hqip.org.uk. HQIP was
established in April 2008 to promote quality in healthcare, and in particular to
increase the impact that clinical audit has on healthcare quality in England
and Wales.
Supporting implementation
NICE has developed tools to help organisations implement the clinical
guideline on lung cancer (listed below). These are available on our website
(www.nice.org.uk/guidance/CG121).
 Costing tools:
 costing report to estimate the national savings and costs associated with
implementation
 costing template to estimate the local costs and savings involved.
 Slides highlighting key messages for local discussion.
 Implementation advice on how to put the guidance into practice and
national initiatives that support this locally.
 Baseline assessment tool for identifying current practice and prioritising
implementation of the guideline.
 Audit support for local clinical audit:
 access to services and referral
 diagnosis and staging
 small cell lung cancer
 non-small cell lung cancer
 palliative care (this document).
A series of practical guides to implementation are also available on our
website (www.nice.org.uk/usingguidance/implementationtools).
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The guidance
You can download the guidance documents from
www.nice.org.uk/guidance/CG121. For printed copies of the quick reference
guide or ‘Understanding NICE guidance’, phone NICE publications on 0845
003 7783 or email [email protected] and quote N2502 (quick
reference guide) and/or N2503 (‘Understanding NICE guidance’).
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