The Chemotherapy Safety Project between the Uganda Cancer Institute and Cambridge

Denise visit in January 2020

Written by Dr Joyce Balagadde-Kambugu, Consultant Paediatric Oncologist, Uganda Cancer Institute and Dr Denise Williams, Consultant Paediatric Oncologist, Addenbrooke's Hospital, Cambridge. 

In January 2020 the Cambridge team made a brief visit to the Uganda Cancer Institute with Dr Joyce Balagadde-Kambugu, UCI and Dr Denise Williams, Cambridge (photo above). Dr Joyce Balagadde discussed some of the concerns she had over the safety of chemotherapy prescription and administration for children. The department is busy with 600 new referrals each year.  The service split between an out- patient/day unit and an inpatient area. Both teams agreed that a chemotherapy safety project would be a good collaborative initiative that involves doctors and nurses in both countries. The project would encompass the entire spectrum from chemotherapy prescription, transcription, preparation, dispensing administration and documentation.  It was agreed to tackle this massive project in phases starting with chemotherapy prescription and transcription.

Progress was initially hampered by the COVID outbreak, but is now gathering momentum. An audit tool was developed for the initial phase, and the UCI team collected data over a 2 week period in August 2020 which included:

  • Demographic data
  • Diagnosis and staging information of the patient and assignment of a treatment protocol
  • Details prescribed chemotherapy, supportive drugs such as antiemetics and fluids

A total of 83 patients were audited across the inpatient and outpatient areas over a 2 week period and the information collated and analysed by the UCI team.

Team members at the Uganda Cancer Institute

A number of issues were identified which the teams in UCI and Cambridge have been discussing with a view of identifying approaches to resolve them. The discussions have been interesting and fruitful, both partners freely discussing the issues found, contributing factors in the UCI setting, and workable solutions using examples of practice both in Cambridge and other LMIC countries.

Both teams are optimistic that the collaboration will be productive from a quality of care perspective as well as help to build a close working relationship in a number of areas involved in a child’s journey through their cancer journey. We have also jointly submitted a grant application which we hope will be successful to support our clinical collaboration with 3 main areas on which to focus:

  1. Paediatric oncology nurse training using competency-based training packages, adapted and developed specifically for the Ugandan setting. Senior staff at UCI will take leadership roles developing and delivering the training, and then facilitating roll-out to other centres in Uganda.
  2. Improve the safety of chemotherapy prescription and administration. The audit of patients in 2020 identified areas where changes in documentation would improve safety e.g., simple road maps, prescription charts.
  3. Develop an educational package to be delivered to parents and volunteers to improve their understanding of aspects of their child’s care, enabling them to work with the nursing staff to improve care delivered to the children whilst in hospital. 

We will be very happy to update everyone on progress in the future.

For more information regarding the collaboration between Cambridge and the Uganda Cancer Institute, see the Uganda Cambridge Cancer Initiative pages