Audit Algorithm

/ Merseyside and Cheshire
Palliative Care Network Audit Group
Prevp Prevention of Pathological Fractures in Palliative Care /

Retrospective Case Note Audit

ICN: Aintree Western Cheshire

Warrington Isle of Man

Liverpool Halton

St Helens and Knowsley West Lancs., Southport & Formby Wirral

SETTING: Hospice Hospital Community

PROFESSION: Doctor If so, grade......

Clinical Nurse Specialist

Other (please specify) ……………………………………

1 / The first set of questions relate to the first assessment of a patient with cancer who has bone pain. Please enter the date of this assessment.
……………………………………………………………………………………………………………………………………………………………………………………
2 / Age
18-20 21-30 31-40 41-50 51-60
61-70 71-80 81-90 91-100 101+
3 / What is the patient’s primary cancer diagnosis?
Bladder Bowel Breast
Kidney Lung Melanoma
Mesothelioma Myeloma Prostate
Metastatic cancer of unknown primary
Other, please specify
……………………………………………………………………………………………………………………………………………………………………
4 / Is the patient known to have bone metastases? [Please select all that apply]
No known bone metastases
Upper arm (humerus)
Lower arm (ulnar, radius, hand)
Pelvis and hip (pelvic bones NOT femur)
Upper leg (femur)
Lower leg (tibia, fibula, foot)
Anterior chest wall (ribs, sternum)
Cervical spine
Thoracic spine
Lumbar spine
Skull
Other, please specify or add notes
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
5 / Where is the patient experiencing bone pain? Please rank in order of severity (1= most severe), if there is one site you only need to select on answer and so on.
Upper arm including shoulder / ......
Lower arm / ......
Pelvis and hip / ......
Upper leg / ......
Lower leg / ......
Anterior chest wall / ......
Cervical spine / ......
Thoracic spine / ......
Lumbar spine / ......
Skull / ......
Other / ......
6 / What investigations has the patient had up to this point? (Please tick all that apply)
X-ray image Specify anatomical site imaged & date if known or unknown:
Please specify ………………………………………………….………………………………………………………………………………………………………………………………………
CT scan Specify anatomical site imaged & date if known or unknown:
Please specify ………………………………………………….………………………………………………………………………………………………………………………………………
MRI scan Specify anatomical site imaged & date if known or unknown:
Please specify ………………………………………………….………………………………………………………………………………………………………………………………………
Isotope bone scan: Specify anatomical site imaged & date if known or unknown:
Please specify ………………………………………………….………………………………………………………………………………………………………………………………………
Serum calcium/bone profile:
Results: Ca 2+ corrected...... Alkaline Phopshatase ......
Other
Please specify ………………………………………………….………………………………………………………………………………………………………………………………………
7 / What new investigations were organised/advised at this assessment? [tick all that apply]
X-ray image Specify anatomical site imaged & date if known or unknown:
Please specify ………………………………………………….………………………………………………………………………………………………………………………………………
CT scan Specify anatomical site imaged & date if known or unknown:
Please specify ………………………………………………….………………………………………………………………………………………………………………………………………
MRI scan Specify anatomical site imaged & date if known or unknown:
Please specify ………………………………………………….………………………………………………………………………………………………………………………………………
Isotope bone scan: Specify anatomical site imaged & date if known or unknown:
Please specify ………………………………………………….………………………………………………………………………………………………………………………………………
Serum calcium/bone profile:
Results: Ca 2+ corrected...... Alkaline Phopshatase ......
Other
Please specify ………………………………………………….………………………………………………………………………………………………………………………………………
No new investigations ordered/advised after assessment because patient too unwell
No new investigations ordered/advised after assessment because appropriate tests already ordered prior to palliative care involvement
No new investigations - low severity/risk
No new investigations - reason unclear
8 / What prompted these investigations to be ordered or advised? (Please tick all that apply based on your assessment or other team’s assessment during that episode of care)
Not applicable – none ordered
Increased pain
Pain on weight-bearing
Pain at night
Results of other investigations Please specify……………………………………
Other symptoms Please specify …………………………………
9 / Was the risk of new metastatic bone disease assessed?
Yes - risk assessed as probable metastatic disease but not graded as one of the options below
Yes - risk assessed according to British Association of Surgical Oncology [BASO] Guidelines as "minimal"
Yes - risk assessed according to British Association of Surgical Oncology [BASO] Guidelines as "low"
Yes - risk assessed according to British Association of Surgical Oncology [BASO] Guidelines as "moderate"
Yes - risk assessed according to British Association of Surgical Oncology [BASO] Guidelines as "high"
No/not documented
Not applicable - already known to have metastatic disease in that area
The following questions should be answered with information gathered after the initial assessment and investigations.
Please state last date of entry in the notes or computer system/results......
10 / Has new or existing metastatic disease been identified on imaging?
Yes
No àend of survey
11 / Was the risk of pathological fracture assessed?
Yes - Mirels' score
Yes - Harrington's classification
Yes - clinical judgement
Yes - other system [please add comment below]
No or not documented
Comments …………………………….……………………………………………………………..
12 / Following most recent investigations was the patient discussed with or referred to:
Orthopaedic surgeon
Please give details & date
Oncologist
Please give details & date …………………………...…………………………………………………………….
None
……………………………..….…………………………………………………………….
Other
Please specify & date ……………………………..….………………………………………………………
13 / What treatment(s) were considered by the relevant healthcare professionals in view of the results of the above assessment & investigations? Please include any treatments offered to but declined by the patient. If treatments were considered inappropriate please answer accordingly
Radiotherapy
Not considered
Not appropriate as previously treated:
Not appropriate due to poor performance status:
Appropriate but declined by patient:
Appropriate and planned or administered:
Please give details ……………………….………………………………………………
Chemotherapy
Not considered
Not appropriate clinically:
Not appropriate due to poor performance status:
Appropriate but declined by patient:
Appropriate and planned or administered:
Please give details ………………………….……………………………………………
Orthopaedic surgery
Not considered
Not appropriate technically:
Not appropriate due to poor performance status:
Appropriate but declined by patient:
Appropriate and planned or administered:
Please give details………………………………………………………………………
No change in treatment
Change or increase in analgesia
Please give details ……………………………………………………………………
Change in other medication
Please specify …………………………….…………………………………………
Other
Please give details………………………………………………………………………
14 / Was there a plan for further treatment or other referrals? (e.g interventional pain assessment)
Yes No N/A
Please specify …………………………………………………………………………
………………………………………………………………………………………….

Please send completed responses to:

Dr Andrew Khodabukus

Academic Clinical Fellow & Specialty Registrar in Palliative Medicine

Specialist Palliative Care,

Linda McCartney Centre,

Royal Liverpool University Hospital,

Prescot Street,

Liverpool,

L7 8XP.

Tel: 0151 706 2274

Fax: 0151 706 5688

Email:

Alternatively, this survey can be completed online at: http://tolu.na/VSrRTG