Introducing a Patient Group Directive (PGD) for micro-enema use in the radiotherapy outpatient department

Project completed as part of the RUH Bath Green Team Competition. 

Team members: Sian Griffiths, Consultant Radiographer Urology Specialist, Hazel Clarke, Macmillan Radiotherapy Late Effects Radiographer

Setting / patient group: Radiotherapy treatment for bladder, prostate or gynaecological cancers.

Issue:Over-prescribing and over-supply of medication for bowel preparation prior to radiotherapy by using a daily micro-enemas.

Primary Aim: 

 

1. To reduce the over-prescribing and supply of micro-enemas to pelvic radiotherapy patients and reduce medication wastage by 30%, by June 2025.

Secondary Aims:

 

1. Improve patient experience by reducing the amount of time spent waiting to collect prescriptions. 
2. Reduce financial impact of micro-enemas by reducing medication wastage.
3. Reduce the workload of outpatient pharmacy. 
4. Reduce the workload of prescribers in radiotherapy who would not need to complete individual prescriptions for each patient. 

Intervention: The introduction of a Patient Group Directive (PGD) for the administration of micro-enemas for those patients that would require them as part of their radiotherapy treatment. This would enable patients to be dispensed the exact number of micro-enemas needed for their treatment course, would reduce the workload of prescribers and the outpatient’s pharmacy and reduce the amount of time (although not visits) that the patient would need to spend in the hospital at each appointment. Also representing a safer practice for prescribing and administering micro-enemas as the professional doing this would be with the patient at the point of deciding a micro-enema is clinically appropriate rather than this process occurring remotely. 

Potential Outcomes:

Patient Outcomes: A reduction in patient time spent at the hospital. In addition, there are risks associated with remote prescribing (Royal Pharmaceutical Society, 2021) that would be mitigated by the fact that the patient would be supplied with their micro-enemas after a face to face assessment and full medical history being taken. This represents safer prescribing practice.

Environmental: It is estimated that the introduction of a micro-enema PGD will result in a reduction in the carbon footprint of 800.83 kgCO2e each year.  This is the equivalent of a petrol car driving 157.7km (CO2 everything, n.d)

Financial:By reducing the amount of enemas prescribed each year through the PGD by 2020 enemas, this would result in an estimated cost saving of £1353.40 each year. This does not take into account the waste disposal costs associated with the overprescribed enemas as patients sometimes bring them back into the hospital for disposal and sometimes dispose of them at home but is also an important point to consider. 

Key learning point:

As far as the team are aware, this is the first work completed investigating and examining the carbon footprint of micro-enema use within the radiotherapy department. Once the changes have been fully implemented and the impact is fully known, the team will look at presenting these findings at a non-medical prescribing conference and look for publication within a relevant scientific journal. This will encourage other radiotherapy departments to look at their processes and hopefully replicate the changes, so the positive impacts can span a wider UK network.