Haematology
We welcome you to the Countess of Chester Hospital NHS Foundation trust Haematology Department and hope you will have an enjoyable and educational time with us.
Links to Transfusion resources
Contributions and acknowledgements
Dr Arvind Pillai
Dr Thomas Fitzmaurice
Departmental induction is vital to the generic induction process. The provision of written information is central to this process. This document sets out the structure of our haematology department, key staff members, roles and responsibilities of junior medical staff and sources of further information. It is important for you to read this document.
Haematology at Countess of Chester Hospital
The Clinical Haematology team is accommodated in a purpose-built, newly refurbished, Haematology-Oncology Suite. Day Case services are also provided in the unit for out-patient chemotherapy administration, blood product transfusions, bone marrow biopsies, venesection, immunoglobulin and bisphosphonate infusions. This has integrated facilities for 11 chaired patients. A total of 5 consultation rooms and a counselling room are also available.
The in-patient care is provided from Ward 43 by a team of nurses dedicated to looking after haematology, diabetic and respiratory patients. There are four side rooms with en-suite toilet and shower facilities dedicated for neutropenic patients.
The Department
Consultant Staff and Lead Roles
Dr Arvind Pillai (AP) Consultant Haematologist and Clinical Lead
Dr Salaheddin Tueger (ST) Consultant Haematologist/Chemotherapy lead
Dr Ushma Meswani (UM) Consultant Haematologist/Haem-Thromb lead
Dr Raphael Kawonga (RK) Consultant Haematologist/Clinical Audit lead
Key Departmental Staff
The department consists of highly skilled nursing staff, clinical nurse specialists, pharmacists, a dietician and a counsellor.
Ward Managers:
Sister Caterina Witkiss Ward manager - ward 43 Ext 2043
Sister Jayne Blackwell Ward manager - ward 60 Ext 2279
Haematology Specialist Nurses:
Sister Laura Whittle Bleep 2381
Sister Janine Travis Bleep 2687
Sister Rebecca Box
Laura, Janine and Rebecca are very experienced so can often help you many haematology patient related queries.
Pharmacy:
Mr Oliver Roberts Lead Haematology Pharmacist Bleep 2936
Clinical Trials Nurse
Sister Janet Spriggs Ext 2203
Anticoagulation services
Lucy Langan Senior Anticoagulant Nurse Practitioner Ext 5027
Lisa Molyneaux GP Anticoagulant Manager Ext 4862
Blood Transfusion
Louise Hodgkinson Senior Transfusion Practitioner Ext 5383
Thrish Brown Junior Transfusion Practitioner Bleep 3215
Dietetics:
Cassandra RichiutiExt 6581
Junior staff
The department has a Specialist Registrar (rotating every 6 months) and a Core Medical Trainee (rotating every 4 months)
Working day
Trainee shifts begin at 09:00 and end at 17:00.
The CMT trainee is expected to provide cover for both Ward 43 and Day Case patients attending for treatment on Ward 60. It is the responsibility of the trainees to arrange and provide cover in the 2 areas during periods of absence.
The job plan is as outlined below.
Other Responsibilities
Trainees should prepare and familiarise themselves with the following common haematology emergencies and frequent occurrences:
a) Neutropenic sepsis- see trust guidelines
b) Acute transfusion reactions and Transfusion thresholds
http://www.bcshguidelines.com/documents/ATR_final_version_to_pdf.pdf
c) Acute electrolyte disturbances
http://www.ivy/Documents/Hypophosphataemia management guidelines.doc
http://www.ivy/Documents/9.5 Minerals v2.doc
http://www.ivy/Documents/Hypomagnesaemia - Guidelines for management.doc
d) Prevention and management of Tumour Lysis Syndrome
http://www.emedicine.medscape.com/article/282171-overview
e) The list of prophylactic drugs commonly prescribed for patients undergoing Chemotherapy – see prescribing section
f) Side effects of commonly used chemotherapeutic agents
http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/
Chemotherapy/Individual drugs/Individualdrugs.aspx
Quality control procedure:
Involvement in appraisal program – see assessments section.
Consent procedures – Please refer to Trust induction document.
Critical incident reporting through the Trust’s electronic form.
Issuing timely death certificate and reporting cases to coroner. All deaths resulting from a direct complication of chemotherapy must be reported to the coroner. Please discuss with the Consultant in charge if in doubt.
· Present at Root cause analysis and Morbidity and mortality meeting
Consultant Cover for Ward
All Consultants (ST/UM/AP/RK) cover the ward on a monthly basis and do a round every Monday. There is an in-patient MDT meeting on Thursday followed by a ward round.
Monday Ward round 09:00 – 11:30
Thursday MDT Ward round 10:00 – 11:45
Friday Board round 16:00 – 16:30
We encourage you to seek assistance when they feel the limits of their competence are being approached. The Consultant Haematologist and senior nursing staff are always available for advice.
Out-patient clinics at Countess of Chester Hospital
Haematology clinics run 4 days each week. There are at least three Consultants per day running clinic so trainees are encouraged to see both new and follow-up patients from each Consultant’s lists.
Chemotherapy Regimens:
Foundation and Core Medical Trainees must not prescribe chemotherapy.
You may be asked to prescribe the relevant prophylactic medications and growth factors. These medications can be found on the chemotherapy protocol card found within the chemotherapy folder on the ward 60. It is worth prescribing the growth factors advance as they can be overlooked.
Practical Procedures
The placement provides ample opportunity to perform practical procedures like bone marrow biopsy, hickman line removal and diagnostic lumbar punctures. The trainee should be cautious in patients who are thrombocytopenic and must always seek senior advice before performing invasive procedures.
Blood cultures and cannulation should be performed aseptically and the appropriate documentation completed in the patient's case notes. Peripheral cultures should be differentiated from line cultures on the MediTech request. Both cultures should be taken at the same time.
You should never perform a lumbar puncture for administration of intrathecal chemotherapy.
Discharges
All patients should have an Electronic Discharge Summary completed within 24 hours of discharge, with copies given to the patient, their GP and a copy filed in the case notes. Patients being discharged to Ellesmere Port Hospital for rehab need an EPH E-Transfer Summary form to be completed on MediTech as an alternative to an Electronic Discharge Summary.
Ensure that both Ward 60 and clinic follow up is clearly documented in both the patient notes and discharge letter, and communicated to the appropriate teams, nursing staff and ward clerk. Blood products if required should be ordered in advance before the patient’s Ward 60 attendance.
Patients going for short term leave do not require an EDS but do require short term leave TTOs on MediTech.
Infection control
Stringent infection control measures are in place in the department and it is important to maintain this at all times. The majority of patients only require routine infection control precautions as per trust policy.
Junior trainees should not access Hickman or PICC lines unless permission is granted by senior nursing staff.
Droplet or Aerosol Precaution: This group of patients will be nursed in a single isolation room with appropriate face masks and other protective equipment.
· Please see posters on doors and /or speak to nurse looking after the patient for advice on what personal protection equipment is required.
· If the trainee has symptoms suggestive of respiratory infection they must not have patient contact until cleared to do so by sister in charge or infection control team. Trainees with symptoms suggestive of gastroenteritis please follow Trust policy as to when to return to work.
Cohort nursing: Infectious patients nursed as a cohort will have their bay marked and the relevant precautions clearly sign posted. Certain line bacteraemias,
C. Difficile and MRSA infections require a Root Cause Analysis.
Leave
Trainees should work according to the set rota mentioned above. The trainees are expected to discuss this amongst themselves prior to organising any swaps or leaves (both study and annual leaves).
Requests for leave MUST be made as far in advance as possible to Dr S Tueger. Late requests are strongly discouraged and arguing that a course place has been booked, or that travel arrangements have been made, is no guarantee of approval.
If you are ill, cannot work, or need leave due to exceptional circumstances at very short notice, notify the SpR and Dr S Tueger as soon as possible. It is your responsibility to complete and submit the appropriate Trust paperwork. Any on-call swaps must be approved in advance by Dr S Tueger (swap forms available from Medical Staffing). Trainees should also ensure that any oncall swaps they make should not affect the day to day running of the department.
Many teaching sessions/meetings take place every week in the Department/Trust. The trainees should try and attend these meetings during their attachments. Attendance at the ward and Radiology MDT is mandatory. Attendance at the morphology meeting is mandatory for the registrar.
Assessments/Appraisals
The department expects the trainees to maintain an up-to-date e-portfolio in line with the deanery/JRCPTB requirements. An educational supervisor is allocated to each trainee prior to their placement by the deanery. If this is not in place the trainee should liaise with the educational department and make appropriate arrangements. The trainees are also expected to have an induction appraisal with their supervisor in the first week. The department fully supports and helps meet the trainee’s requirements for assessments but this should be led by the trainee. It is the trainee’s responsibility to complete the required number of assessments.
At any given time there are numerous audit projects going on in the department. Participation is strongly encouraged for all trainees and any new ideas are welcome. All new projects need approval from the audit lead and completion of appropriate audit forms and DATIX forms before initiation and after completion of the project. The Trust has a system in place for approving audits.
Miscellany
Tea and coffee are available for a contribution only on ward 60. Please make sure you contribute to Specialist Nurse (Beccy Box)if you are using the facility.
http://www.bcshguidelines.com/
http://www.transfusionguidelines.org.uk/
http://bloodjournal.hematologylibrary.org/cgi/collection/how_i_treat/
Useful contact numbers
