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RADIATION THERAPIST

ORIENTATION BOOKLET

CANTERBURY REGIONAL CANCER & HAEMATOLOGY SERVICE PH 3640020

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

Issue Date: 12/04/2018 Issue number: 0.02


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Table of Contents Welcome to Christchurch Oncology.......................................................................................2 Radiation Therapists Orientation Programme........................................................................3 Core Values...........................................................................................................................4 Helpful tips for International Staf.........................................................................................5 Radiation Therapy General Information.................................................................................7 Structure and organisation of the department......................................................................7 Administration........................................................................................................................9 Training and Education.........................................................................................................12 Research and Clinical Trials..................................................................................................13 Fire and Occupational Health ..............................................................................................13 Oncology Lower Ground Floor Organisation Structure.........................................................15 Christchurch Oncology Equipment List.................................................................................16 Record & verify system.........................................................................................................16 Simulation/Planning.............................................................................................................16 Treatment units....................................................................................................................17 Brachytherapy......................................................................................................................18 Items of interest...................................................................................................................18 Informed Consent................................................................................................................19 Uniform Guidelines.............................................................................................................22 Check Lists...........................................................................................................................23 First day checklist.................................................................................................................23 Week 1-2 checklist...............................................................................................................25 First month checklist............................................................................................................26 Second month checklist.......................................................................................................28 Third month checklist...........................................................................................................28 Wellbeing, Health & Safety Induction checklist...................................................................29 Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Skills & tasks during orientation..........................................................................................32 CT.........................................................................................................................................32 Dosimetry.............................................................................................................................32 Treatment.............................................................................................................................33 Mosaiq..................................................................................................................................34 Imaging checklists................................................................................................................35 Desktop Pro R7.0x Training checklist...................................................................................35 XVI 4.5 Training checklist......................................................................................................37 iViewGT Training checklist....................................................................................................41 Performance review & job description.................................................................................44 Interim Feedback & Performance review guidelines...........................................................44 Interim & PR flow chart........................................................................................................48 Education............................................................................................................................49 Course/Conference application form...................................................................................49 MRTB....................................................................................................................................52 NZIMRT.................................................................................................................................52 Reimbursement of association fees form............................................................................52 Courses /Conferences..........................................................................................................52 Interesting papers................................................................................................................52 Educational resources..........................................................................................................52 Current journals...................................................................................................................52 Learning Modules................................................................................................................53 Must read Protocols............................................................................................................54 Reflective Journal................................................................................................................55 Evaluation...........................................................................................................................59

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Welcome to Christchurch Oncology

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Radiation Therapists’ – Orientation Programme This section contains information to assist in your orientation as a Radiation Therapist at Oncology Services, Christchurch Hospital. The programme is designed to help you become part of our team. During your orientation, you will be assigned a buddy, but please feel free to ask questions of any team member. An orientation timetable has been arranged to ensure you spend some time in all work areas or where Radiation Therapists may be required to assist. There is also some time in other areas of Oncology who you will interact with regularly as part of the Oncology team. Your role during the orientation period is mainly to observe, but feel free to step in and help out if you want to. In each area, someone has been assigned as a point of contact to orient you to their work space. In addition to your timetable, information contained in this folder includes:  General Information for Radiation Therapists  Uniform Guidelines  Staff Lists and Organisational Charts  Equipment List  Required Reading Protocol  Check list of skills/tasks  Sample of department QA documents and learning modules Check Lists For each work area, a check list has been created to guide you and those orientating you, about the key tasks that occur so that you can be given the appropriate training. The aim of the checklists is to help ensure you are shown the way we do things – not lef to figure it out for yourself. The checklists have space for you to record when you have been given tuition and are comfortable with performing each task. At the back of the orientation folder there is space for you to provide feedback on the orientation programme. Your comments, criticisms and suggestions would be most appreciated so that our programme can be developed.

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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CORE VALUES

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Helpful tips for International Staff Work Visa There are many types of work visas that you can apply for. Here is the link to the Immigration New Zealand website: http://www.immigration.govt.nz/ Bank Account Set up a bank account before you get to NZ so that you can get paid when you start working. Here is a link to the Bank of New Zealand (BNZ) where you can apply for a bank account online: http://www.bnz.co.nz/personal-banking/international-andmigrant/moving-to-new-zealand Once you apply with the BNZ they will send you an e-mail to set up an appointment so that you can set up your accounts and deposit money. They will also tell you how to telegraphically transfer money into your new account. There are many different banks in New Zealand. The BNZ is just an example of one you may be interested in.

Employee joining form

Instructions for Enclosed Forms

Once you have your bank account set up fill out this form and send it back to Phil Daley as soon as possible. Tax Code Declaration In order to fill out this form you will need an IRD number. You will not be able to apply for an IRD number until you arrive in NZ. In the meantime, please read the following; http://www.ird.govt.nz/how-to/irdnumbers/individuals/ Confidentiality form Read, sign and send back to Phil Daly as soon as possible. Two copies of your Employment Agreement Read and sign one and send it back to the Clinical Manager as soon as possible. The other copy is for your records.

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Pre-placement Immune Status Questionnaire Fill out this form and ensure that you have the appropriate medical test results. It could take several days (even weeks) to get these results from your GP. Ministry of Justice Form Fill out the form and drop it off at the Clinical Managers office when you start working. Security Card Information Form Fill this form out and hand it in to the Clinical Manager when you start. Kiwi Saver Form More information on the benefits of Kiwi Saver available at: http://www.kiwisaver.govt.nz/ Kiwi Saver is optional and if you would like to apply please fill out the form hand it in to Phil Daly when you start.

IRD Number

When You Arrive In New Zealand

You can take the completed forms and required documents to any NZ Post Shop or for a fee of $10.00 you can take you application to any Automobile Association Office and they will Fax you application to the Department and you should receive your urgent application actioned within 24 hours. Bank Account Visit your bank to set up your account. You will need your IRD number and probably your passport (for ID) MRSA Clearance Come to the Radiotherapy department before you begin work to have your MRSA swabs done. The radiotherapy department is on the lower ground floor of the Oncology Building. Ask for the Clinical Manager or the Clinical Educator.

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Radiation Therapy General Information Welcome to the Department. STRUCTURE AND ORGANISATION OF THE DEPARTMENT The Canterbury Regional Cancer and Blood Service provides inpatient and outpatient care for patients with cancer. The Oncology Department is a purpose-built outpatient facility which houses the outpatient clinics, a Chemotherapy Suite and Radiation Oncology department. The service has 8 Medical Oncology Consultants, 7 Radiation Oncology Consultants and 1 Palliative Care Physician. In Radiation Oncology we have a wide bore CT simulator and Monaco for our planning system. There are 4 Elekta linear accelerators. A high dose rate brachytherapy unit is located in the brachytherapy suite on the second floor of Christchurch Women’s Hospital. There is full support from a palliative care team, medical radiation therapist, oncology trained enrolled and registered nursing, physics staff, and an oncology pharmacist located at the Hospital Pharmacy. THE GROUND FLOOR Clerical, administrative, medical and nursing staff offices are found on this floor. The registrars share an open plan office. The Clinic Area runs Radiation Oncology, Medical Oncology and Palliative Care new patient and follow-up clinics. The Oncology Chemotherapy Suite has 8 chairs and 3 beds where patients receive chemotherapy. Just down the corridor is the Medical Day Stay Unit where Oncology patients receive antibody and bisphosphonate infusions, blood transfusions and may undergo a variety of outpatient procedures. Adjacent to the Outpatient Waiting Room is the Information and Learning Centre incorporating a lecture theatre, tutorial room, library, kitchenette and a Cancer Society staff office. Many of the Oncology Staff meetings are held in the tutorial room or lecture theatre. THE LOWER GROUND FLOOR This floor houses the main reception, the CT simulator and planning area, the allied health room, several interview rooms, the radiation coordinators office, 4 linear accelerators, radiation therapy waiting area, mould room, 2 small clinic areas and the physics area. INPATIENT FACILITY The inpatient area is Ward 26 on the 3rd floor of the Riverside Block of Christchurch Hospital. It has 25 inpatient beds. The primary function of the ward is treatment of Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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acute, reversible complications of cancer and its treatment and administration of inpatient chemotherapy or radiotherapy (aggressive treatments or unwell patients). Patients are also admitted for palliative care and symptom control. SERVICES PROVIDED  Provision of non-surgical oncology services for cancer patients, including assessment of patients referred for opinion regarding management of cancer, subsequent investigation, and specific anti-cancer treatment (radiotherapy, chemotherapy, hormonal and/or biological therapy, non-specific symptom management, follow up and some terminal care).  Radiation Oncology (radiotherapy) and Medical Oncology (chemotherapy) work closely together. We manage all the solid tumours of adulthood (15 years and over) including lymphoma, but not chemotherapy for patients with leukaemia or myeloma (this is managed by the Haematology service).  Paediatric Radiation Oncology  HDR brachytherapy is for the treatment of gynaecological malignancies & prostate cancer. SERVICES NOT PROVIDED  Diagnostic service for suspected malignancy (unless it seems extremely likely patient has malignant disease, and a patient is likely to suffer imminent problems from this without expedient treatment).  Surgical treatment of malignancy. These services are carried out by general surgery, general medicine or the appropriate specialty service.  Terminal care (except for patients already treated by the service).  Experimental therapy for unresponsive malignancies (except in certain defined research protocols).  Leukaemia and multiple myeloma is managed primarily by the Haematology Service of Christchurch Hospital with secondary referral to Oncology for specific therapies (e.g. radiotherapy). Lymphomas of all types are managed by Oncology and/or Haematology. Hodgkin’s lymphoma is exclusively managed by Oncology.  Paediatric malignancies (children 15 years and younger) are predominantly managed by the Paediatric Oncologists in the CHOC unit with secondary referral to Oncology for specific therapies.  Gynaecological cancers and ENT cancers are primarily managed by the respective gynaecological oncology and ENT surgical services, with involvement of Oncology staff for radiotherapy and chemotherapy. Patients on therapy are managed by Oncology at Christchurch Hospital. Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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ADMINISTRATION LINE OF RESPONSIBILITY: You are directly responsible to the operational section heads. HOURS OF WORK: Our hours of work are 80 per fortnight, worked over a 9 day fortnight. The normal department hours for Radiation Therapists are 0730—1650 with 30min for lunch. SALARY SCALES / CONDITIONS: A copy of the current Collective Employment Agreement can be found on the intranet under Human Resources SALARY: You are paid fortnightly (Thursday) by direct credit only. There are BNZ and Westpac ATM facilities on site within the hospital. OVERTIME: Overtime rates are paid at a rate of time-and-a-half. Shif work and overtime is done as required. See the Collective Employment Agreement for reimbursement details. LEAVE: (Refer to RT MECA) Annual Leave: RTs are granted (as per RT MECA) leave of absence on full pay in respect of each leave year as follows: Staff RT’s -- 22 working days Afer 5 years’ service then this increases to 25 days. All experience as an RT is counted but will require evidence of time served from your previous employer/s. Annual Leave application is now via “MAX” – the people & capability service portal which is found on the CDBH intranet. Professional Leave: Refer to the Collective Agreement Contract. Sick Leave: If sick, you are required to notify the Clinical RT Manager (3640754) by 7.30am. If absent on sick leave for 3 or more consecutive days, or at the request of the employer, a medical certificate must be produced. Please refer to the Collective Employment Agreement for sick leave entitlements Public Holidays: 1st and 2nd January Waitangi Day (6 February) Good Friday Easter Monday Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Anzac Day (25 April) Queen's Birthday (First Monday in June) Labour Day (Last Friday in October) Show Day (2nd Friday in November) Christmas Day Boxing Day If any of the above falls on a Saturday or Sunday, a substitute day is granted. ON-CALL & CALL-BACKS: There is an ‘on-call’ roster system in place over weekends and public holidays. If you aren’t unavailable, it is your responsibility to find a replacement. There are occasions when a RT who is not on call is required outside of normal work hours. Any call-back may be claimed along with a transport reimbursement as per the Collective Employment Agreement. PRACTICING CERTIFICATES: Every practicing qualified RT is required by law to be registered with the Medical Radiation Technologists Board (MRTB) and to hold a current practicing license. It is the responsibility of the RT to pay the initial registration and the annual practicing license fees, the latter of which will be refunded by the CDHB. It is also your statute responsibility to provide the MRTB with a current address and to be knowledgeable of Acts and Legislation which govern your work environment. N.Z.I.M.R.T.: All staff and students are strongly encouraged to become members of the N.Z. Institute of Medical Radiation Technology (NZIMRT). It is a requirement to be enrolled in a CPD program to gain your APC with the MRTB. The NZIMRT offers a program recognised by the MRTB. Your NZIMRT membership will be reimbursed by CDHB. For details see the department representative for the Institute (currently Amy K) or visit www.NZIMRT.co.nz. APEX APEX (Association of Professional and Executive Employees) is the union which Radiation Therapists can join if they wish to do so. For further information please contact the department’s APEX representative (currently Nat B or Carolyn K). RESIGNATION: As per the RT MECA, a minimum of four weeks written notice should be given to the Clinical manager. PERFORMANCE REVIEW Each RT has a 6 mthly interim and an annual performance review undertaken by their Head of Section or the Clinical Manager. Please note this is slightly different when you start employment or if you are on the new grad programme. DRESS: Please refer to the Uniform Guidelines.

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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IDENTIFICATION BADGE: The CDHB supplies an ID badge which is to be worn at all times. Name badges are also supplied and are to be worn as well. See Uniform Guidelines re: lanyards. FILM BADGE: The film badge is to be worn at waist level at all times and is changed every month by Physics staff. A monthly report is displayed on the Notice Board. If you misplace your film badge (or leave it at home), please advise Christine Reed (or another Physics staff member) before reporting for any further duty. At the end of each working day, your film badge should be returned to the board outside of physics and collected prior to starting work the following day. RADIATION SAFETY OFFICER: The Oncology Radiation Safety Officer is Annalie Ronaldson. PAGING In order to contact someone who carries a pager, dial 22 followed by the 4 digit pager number and the extension number that you want them to call you back on followed by #. When the page has been successful you will hear 2 beeps. PERSONAL PHONE CALLS: Private phone calls are to be kept to a minimum. Each call made from the department is charged as a business call against the budget. Messages will be taken at reception for incoming calls, which should be returned during a break (i.e. tea or lunch break). DOCTOR / DENTIST APPOINTMENTS: These are to be made outside of normal work hours when possible. If in an emergency it is impossible to do this, please liaise with the appropriate Head of Section. FOOD / DRINKS ON THE TREATMENT UNITS Please note that open top drink containers and the consumption of food on the treatment units is not allowed. Closed drink containers such as bottles or sealed cups are allowed. CONSENT Written consent is required prior to any procedure that carries a significant risk of adverse event. This of course applies to chemotherapy, radiation treatment and Day Ward procedures. ON TREATMENT REVIEW CLINIC Our “on treatment review� clinic (clinic 6) is held on the lower ground floor. This clinic is for review of patients who are currently receiving (or have recently finished) radiation treatment, to monitor expected and unexpected side effects. A consultant or senior registrar and radiation nurse should be present. Changes to radiation treatment should be discussed with the consultant. The Registrar or Consultant will be called about unwell patients receiving Radiation Therapy by the RTs or the clinic nurses. STUDENT RTs

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Students are not employed by the CDHB, but are the responsibility of University of Otago, Wellington. Clinical access is per the agreement between the CDHB and UoO and whilst in the department the students are bound by the rules and codes of conduct of both parties. The clinical tutor is responsible for reporting absences due to sickness to the UoO – leave is as per the semester timetable with any exceptions being granted by the UoO. TRAINING AND EDUCATION CPD We actively encourage staff to attend and present at courses or conferences. If there is a course or conference that interests you then complete a CDHB conference leave form, found on the RT homepage and submit it to the clinical RT Manager. The CPD fund committee meets every quarter to review the applications that have been submitted. If your application is accepted then travel, accommodation and conference fees are usually funded but this can vary so check with the Clinical Manager. Post graduate education is supported. Limited funding and study leave is available and should be negotiated with the Clinical Radiation Therapy Manager. The CDHB also run a number of in-house training courses which you are able to attend. Please see the intranet for further details. RT MEETINGS: It is your responsibility to ensure you keep well versed with the contents of meetings (minutes are on Sharepoint). Likewise, it is your responsibility to be familiar with the Procedure Manuals on each machine and to read all notices on the department's notice boards. Some messages are displayed on the whiteboard next to the kitchen. Regular CPD sessions occur within the department, mainly on Thursdays at 9:00am, for the Radiation Oncology teams and Tuesday at 12:30 for the wider Oncology team (medical oncology, nurses, ward 27 and Day Unit). Smaller half hour sessions occur for RTs on a semi-regular basis on Mondays and Fridays. BOOKS/JOURNALS ETC: The department receives many journals which may be borrowed. The most recent Journals are kept in the department – please see the RT Clinical Educator. SHAREPOINT: There is a link to sharepoint found on all computer desktops on the lower ground floor. It provides links to a variety of important information regarding staff leave, rosters, patient information, protocols, the various special working groups and links to other websites. PATIENT INFORMATION Every Oncology new patient undergoing radiation is given a blue “Information folder”. Patients having chemotherapy are given a red folder. Patients having combined treatment are given a green folder. This folder contains various information for the patient, including; the department, the cancer society, the patient’s treatment and possible side effects they may encounter. Please ask to view one. Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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RESEARCH AND CLINICAL TRIALS TRIALS There are always a number of clinical trials ongoing in the department. These range from Phase I trials of agents developed in NZ to large international Phase III studies. Trial protocols are available on the G: drive. You will be given an introduction to our research activities and current trials by the Q, R&D RT during your induction. FIRE AND OCCUPATIONAL HEALTH Emergency Procedure information such as FIRE Response Guidelines can be found in folders and wall charts within each separate area. Occupational health and safety guidelines can be found on the intranet site under O, and give advice on management of hazards and procedures for occupational health issues. ACCIDENTS: All accidents, however minor, involving staff or patients (including needle-stick injury), must be reported immediately to the Clinical RT Manager. An explanation of what happened, how, when and to whom should be given. There is an on-line “safety first� form located on the intranet that must be completed within 24 hours. FIRE ALARM: The hospital emergency number is 777. Ensure you are well acquainted with the fire alarm and emergency procedures (A major event emergency plan is included in this folder). You will have annual fire training. CLINICAL EMERGENCY ALARM: An alarm activation button is situated at the staff base on the lower ground floor and in the nursing base on the upper floor. The alarm should be activated immediately when an arrest is suspected. The alarm automatically alerts the crash team of the location of the emergency. The closest defibrillator is in the hyperbaric unit and is brought to the department by an orderly when the alarm is activated. Emergency trays, containing all the necessary drugs and equipment, should be collected from outside clinic 6. The hospital emergency number is 777. Each staff member will have CPR training annually. If you have questions or concerns relating to CPR then please contact the departmental CPR trainer (Erika Hampton.) NURSE CALL ALARMS IN TREATMENT ROOMS Each treatment room is fitted with a nurse call button. In the event of an emergency within the room, use this button to raise the alarm with other staff members outside. You must press the button three times in quick succession. The call buttons activate an alarm and a light on the control panels so that colleagues know where you are. The control panels are located in reception, outside of Clinic 6 and above the kitchen door. Please make sure that you are familiar with these panels. It is important to note that these buttons are not connected to the DHB so in the event of a cardiac arrest the clinical emergency alarm on staff base should also be activated. Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Finally, ensure you enjoy your time in the department. The work is demanding but, when we all work together as a team, it is rewarding and satisfying. Should you have any problem whatsoever, do not hesitate to discuss it with your RT Clinical Manager.

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Oncology Lower Ground floor Organisation Structure

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Christchurch Oncology Equipment List RECORD & VERIFY SYSTEM MOSAIQ 2.6 (Elekta) The linear accelerators are linked to MOSAIQ workstations where all treatment data is transferred, entered or edited. MOSAIQ acts as our booking system and as a clinical record of on treatment notes and assessments. Workstations are located at staff base, the treatment units, dosimetry, CT, Clinic 6 and IPC. Backups are created automatically at the end of each day’s work. Mosaiq is also a record of the patient’s radiation treatment and images. SIMULATION / PLANNING Siemens SOMATOM Definition AS 64 Open RT Pro CT Scanner  64 slice, 80cm bore  Remove metal artifact with iMAR -metal artefact reduction algorithms (different ones for dental, hips, applicators)  Improved visualization with HD FoV Pro - extra dose reduction algorithms  Comprehensive motion management  dual energy scanning  large gap between gantry and bed (ease of making masks) Monaco 5.1 Monaco is a commercial IMRT planning system by Elekta. Monaco is used for all planning in the department. IMRT and VMAT are well utilised. Physics staff check all radical plans. Radcalc Programme allowing computerised calculations of time or MU’s for treatment fields not planned on XiO ie. Single or POP photon fields on linear accelerators (Blocked or Unblocked) that are planed with less than 10 fractions. Radcalc is used by IPC RT staff and for QA by physics staff. Mould Room Fast scan immobilisation devices and custom shielding is produced in this area using a wide range of tools both hand and powered. Custom shielding is produced using a low melting point alloy called "Cerrobend" that contains tin, lead, bismuth and cadmium. The individualised blocks are cast in high density polystyrene and then usually mounted on plastic trays for use on the treatment machines. Used rarely as MLC available on all treatment machines. Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Electron cutouts are made of cerrobend by using polystyrene cutouts and pouring moulds that are inserted into the electron applicators. Please note that Cerrobend contains cadmium and therefore should not be handled without taking the appropriate precautions. Equipment includes: Hot-wire cutter for divergent shielding blocks Straight-edged hot-wire cutter for electron cut-outs Cerrobend melting pot Vacuum former for polyester masks Bolus (wax/paraffin/bolux) Ancillary equipment (drill press, electric hand drill, hand tools etc.). FASTSCAN bust system Immobilisation Devices Head and Shoulders and Head Only Thermoplastic Shells ‘S’ type board Variable Axis Baseplate (VAB) Vac bags Civco Breast board TREATMENT UNITS T1 & T2 ELEKTA AGILITY VERSA HD  Dual modality, variable energy linear accelerator  T 1 Photon Energies:-6X +10X + 6X FFF  T2 Photon Energies:- 6X +10X + 15 + 6X FFF  Electron Energies: 6, 9, 12, 15 MeV  IMRT  VMAT  DCAT & FFF  Multi-leaf Collimation (MLC) - 160 fine-resolution leaves 0.5cm thickness  X jaw is primarily shielded by MLC leave, Y jaw by actual jaw  Integrity 1.2 elekta console  iview GT – electronic portal imaging MV  CBCT – XVI kV imaging system – 2D kV imaging / 3D cone beam T3 & T4 ELEKTA SYNERGY  Dual modality, variable energy linear accelerator  T4 Photon Energies:- 6X  T3 Photon Energy: - 6X  Electron Energies: 6, 9, 12, 15, 18 MeV  IMRT Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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 VMAT  T3 & T4 MLC -80 leaf – 1cm thickness  Integrity 1.2 elekta console  iview GT – electronic portal imaging MV  CBCT - XVI kV imaging system – 2D kV imaging / 3D cone beam Brachytherapy Procedures are carried out in Christchurch Women’s hospital by a multi disciplinary Oncology team, including RTs, ROs, nurses and physicists. Treatment is delivered using the Varian GammaMed Plus iX afer-loading brachytherpay machine. The source used is Iridium 192. Treatment is planned using Brachyvision sofware. Cervix patients are treated using a Fletcher or ring and tandem and are planned using MRI data. Vaginal vaults are treated using segmented cylinders and these are not planned using imaging although CT is used to ensure application fit. HDR is used for Prostate Brachy delivering a single fraction boost of 12.5Gy using the BrachyVision planning system. For further information about our brachytherapy practices please refer to the Brachytherapy Co-ordinator (Hayley Wooding.) ITEMS OF INTEREST 1. Treatment prescriptions are in units of Gray (Gy). 2. Field sizes are documented in centimetres (cm), Length by Width 3. Isodose distributions are normalised in accordance with ICRU 50/62/83 recommendations i.e. plans are normalised to a reference point (100%). 4. All dosimetry is performed by planning RT's. Physics are consulted for unusual or difficult techniques and QA all radical plans. 5. Patient information is entered into MOSAIQ by electronic transfer directly from Monaco by dosimetry RTs. 6. Final QA of plans done by a dedicated RT IPC (independent planning check) team

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Informed Consent What is Informed Consent?

GENERAL

Informed consent may be defined as the process whereby someone who has the capacity/competence to consent, having been given sufficient information, arrives at a reasoned decision as to whether or not to agree to a proposed therapy or procedure. Informed consent is not the act of filling out a form, but rather a process of exchange of information so that an informed decision can be made by that person. When is written consent required within the Cancer and Haematology Service? Consent must be given in writing where: 

There is significant risk of adverse effects for a patient

When either party requests it

The patient is to participate in any research

The procedure is to be undertaken in theatre or under general anaesthetic

If written consent is required, it should be given prior to any part of the treatment plan being delivered i.e. prior to planning scans or line insertions. Exceptions to this exist in emergency situations (see Point 4.0 of this policy). If there is any doubt as to whether consent should be in writing, written consent should be obtained. Regardless of whether written consent is obtained, the contents of what is discussed and the process which is completed should be documented in the clinical record.

Please see OS08.09 Canterbury Regional Cancer and Haematology Service Informed Consent Policy for further information

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Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Uniform guidelines

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Check Lists First Day Check List:

Canterbury Regional Cancer & Blood Service

The aim of this checklist is to familiarise you with your surroundings. It also highlights safety aspects and procedures relevant to your department. Ideally, the clinical educator/buddy will help you complete this checklist. However, feel free to ask any member of staff in the department for help. ACTIVITY

Meet with :    

Clinical Manager/Clinical Educator Provide overview of day Provide uniform, locker key, film badge, stationary Point out location of toilets / lockers / film badge board / photo board

Discuss orientation folder Inc.:         

Vision & values How to request annual leave, CPD leave, study leave How to report sickness / absence Conduct & expectations Structure of dept. Emergency procedures / incident reporting / code of rights Employee responsibilities Inc. confidentiality & data protection Orientation timetable / weekly roster / overtime / on-call Performance appraisal

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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25 Orientation & Training:

Confirm the orientation they will attending and dates and times for completion Orientation Date to complete  Health System Orientation  Essential Online Orientation  Area / Role specific orientation Role specific computer training  Mosaiq  PMS  HCS  Conflict management  Tikanga Maori course (overseas staff)  Health & Safety & Fire checklist

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Tour of Hospital including :  CWH / Great Escape Café / Shop /Pharmacy / ATM / bike racks / parking Tour of department including: Staff Facilities (lecture theatre, tutorial room, staff changing room, toilets etc.) Introduction to immediate colleagues Introduction to buddy Location of emergency equipment (O2 & crash trolley), fire alarms & extinguishes, fire exits, Emergency meeting point, clinical emergency alarm, emergency call buttons  Show how printer works    

Security:  Get ID photo taken & pick up badge  Get photo board picture taken Heath:  Get MRSA swabs taken if not done previously Computer & intranet  Introduction to the intranet e.g. HR courses / staff benefits / i-perform  Introduction to the RT home page  Set up email / contacts list

Signed: Date: When you have completed this worksheet please email to the Clinical Manager –to place in personal file

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Canterbury Regional Cancer & Blood Service Week 1 – 2 Check List: ACTIVITY

Roster:  Staff are aware of roster including on call Staf:  Staff have been introduced to key people within the dept., and sources of help/advice Communication: Staff are familiar with communication systems, (bleeps, telephones, txt, intranet, RT home page, online policies  Staff are aware of referral systems and useful contacts. MOSAIQ 

 Overview of MOSAIQ, basic training and password Meetings  Staff know what meetings they are expected to attend and when. Photo  Photo for board taken

Signed: Date: When you have completed this worksheet please email to the Clinical Manager – to place in personal file

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Canterbury Regional Cancer & Blood Service First Month Checklist: ACTIVITY

Interim:  Interim has taken place with HOS / supervisor with objectives discussed/set Orientation:      

Health system orientation completed Essention online orientation completed Role specific computer training completed Health & safety & fire checklist completed Relevant learning modules completed Specific area clinical training checklists completed

Incidents:  Staff aware of reporting system for adverse clinical incidents and accidents and how to access forms. Manual Handling:  Training in the use of equipment for lifing and handling. (via Manual Handling discussion) Appointments:  Understanding of triage process and patient bookings  How to locate an Oncology file

The following Hospital policies have been read and understood: Policies & Procedures

Date

Signature

Health & Safety OSHH Infection Control Risk Management

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Complaints

Confidentiality Data Protection Annual Leave and Expenses Special Leave Uniform and Dress Code Oncology Department Emergency plan Radiation Safety plan Discrepancy reporting protocol Missed tmt guidelines Patient correct procedure protocol Informed consent protocol Small changes protocol On call procedure

I hereby agree to adhere to above policies. Signed …………………………………………………………………………. When you have completed this worksheet please email to the Clinical Manager – to place in personal file

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Canterbury Regional Cancer & Blood Service Second Month Checklist: ACTIVITY Interim:  Interim has taken place with HOS / supervisor with objectives discussed / set

Third Month Checklist: ACTIVITY Progress:  Manager meets with employee to check progress Review:  Employee fills out attachment survey

Signed …………………………………………………………………………. When you have completed this worksheet please email to the Clinical Manager – to place in personal file

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Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Skills & tasks during orientation CT Have you been shown……? AREA

TASK

CT

Overview (discussion)

Console

Patient demographics / Selecting a protocol

Operation CT QA Session Prep.

COMPLETED

Use of lasers (discussion) Emergency procedures/interlocks (discussion) Assessments- RT Care Path Patient education and information – observe a variety

Mosaiq

Quality Check lists, images, setup note, CT assessments, RT

Patient

care path Tattoo procedure

marking DOSIMETRY Have you been shown……? AREA Routine Protocols

RadCalc Monaco QA

TASK Welcome to Dosimetry Dosim Workflow/chart locations (discussion) Management of missed tmt guidelines Using QCL’s in Mosaiq Radiation Therapy triage process General Info Workflow General information Dosim QA process

COMPLETED

TREATMENT Have you been shown……? AREA Housekeeping

TASK Morning RT staff meeting (discussion) OTR Process

COMPLETED

QCL process Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Order form Emergency

Alarms, Crash Trolley/Suction, Emergency OFFs, Nurse

Procedures Console Patient Info.

call buttons (discussion) Beam ON – interrupt/terminate - Elekta NP education

Chemo/RT

NP checklist NP instructions Finishing instructions Process/bookings Chemo-RT Side effects screening tool

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MOSAIQ Have you been shown……? Area Module Basics

Task

Completed

Open MOSAIQ / Login/Logout (discussion) Change Password

CT

General

Customise Homescreen Search by NHI or Name (discussion) Scheduling Open Schedules for different areas and understand the columns (discussion) Bookings QCLs Using QCL’s in MOSAIQ Checklist

CT assessment checklist

Monaco

Import a plan

Rad Calc

Create a course

Pre - Treatment

Export & import of RadCalc RTP Export of RadCalc MU report to TX plan Dosimetry Images

Export DRR’s

Attach DRRs to fields Import CT data

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Imaging checklists

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Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Performance review & job description

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Education Course / Conference Application Form Name: Position:

Date: Ward: FTE Status:

Service: For Nursing Applicants

Intends to OR apply for PDRP? If no, reason?

PDRP Level: If yes, timeframe ?

Yes

No

Course/Conference Information

Title: Organiser: (CDHB, Dept) Provider: Dates:

Are you presenting a paper?

Location/Venue:

Course Duration:  Yes

 No

Please attach a copy of course/conference information Leave & Funding Requested

     

Leave with pay (hours) Leave without pay (hours) Registration fees Travel Accommodation Expenses (meals etc)

Total assistance requested ($NZ) Reimbursement of expenses from other Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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sources? Supporting Information

What are your reasons for attending?

What other course/conference assistance have you received in the last 12 months?

Are other colleagues in your service attending the same course/conference? (Give details)

How do you intend to apply knowledge gained from this course/conference in your practise/workplace?

What form will your feedback take? Timeframe? To be completed by Line Manager

Do you support this application:

 Yes

 No

Comments

Cost Centre to be charged: Signed:

Date:

To be completed by Clinical Manager/Senior Manager (Where approval at this level is required) This request is:

 Approved

 Approved in part

 Declined

Comment     

Leave with pay (hours) Leave without pay (hours) Registration fees Travel Accommodation

$ $ $

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Expenses (meals etc)

Total funding approved ($NZ)

$ $

Total leave approved (hours) Cost Centre to be charged Signed:

Date:

To be completed by CEO or General Manager (Where approval at this level is required)   Comment Comment:

Recommended as approved/not approved Recommendation amended as follows:

Signed:

  

Date:

Return copy to applicant Copy to personnal file Copy for data entry and filing

NB: In all cases were a CDHB Attendance Record Sheet is completed, individual Course Conference Application forms are not to be entered in the Training Database.

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Education Links MRTB NZIMRT REIMBURSEMENT OF ASSOCIATION FEES CONFERENCES / COURSES INTERESTING PAPERS EDUCATIONAL RESOURCES CURRENT JOURNALS

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Learning Modules RT LEARNING MODULES CT Breast Markup CT Daily runup CT on Call IV contrast

DOSIM Peer Reviews SBRT planning

IPC Manual MU Calculations Rad Calc

TMT 2D image review MOSAIQ 3D image review - offline XVI 3D image registration – online 4D Symmetry Image Review DIBH Loading Ref data Geometric verification part 1 Geometric verification part 2 Treatment calendar Treatment finish New patient QA Pelvic Instructions Prostate sof tissue match SBRT treatment Weekly chart check procedure OTHER Brachytherapy Humidification Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Must read Protocols AD1.4 LGF Oncology Incident Plan

RT2.1 Ensuring Correct Patient, Correct Procedure in Radiation Therapy

TR5.1.1 Management of small changes

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Reflective Journal Journal writing has been recognised by educators for many years as an effective strategy to promote reflective thinking and learning. It is by making connections between our experiences that we create meaning and internalise our learning. Reflective learning journals enable us to create a record of the connections and meanings we are making as we engage in learning experiences. The purposes of the record of learning are: *0

To record experience

*1

To facilitate learning from experience

*2

To support understanding and the representation of that understanding

*3

To develop critical thinking or the development of a questioning attitude

*4

To increase active involvement in, and ownership of, learning

*5

To increase ability in reflection and thinking

*6

To enhance problem solving skills

*7

To enhance reflective practice

*8

For reasons of personal development and self-empowerment

*9

For therapeutic purposes or as means of supporting behaviour change

*10

To foster communication; in particular reflective and creative interaction within a group

*11

As a means of communication between one learner and another

HOW TO GET STARTED 1. Spend about 10 minutes each day writing up your journal. 2. It should not be just descriptive, that is, what you've learnt, but what you thought about what you learnt.

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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3. Some questions include: What did I learn today? What did I find interesting? What did I find puzzling unexpected problems or issues? What do I feel about the way I am approaching the issue, subject or topic? How can I improve my learning techniques? What do I need to know more about? 4. Make a few notes during an event by capturing a few thoughts that go fleeting across your mind as you witness or observe the event. 5. Note the name of the event, the date and the time of each entry to provide a sense of continuity and a reference point. 6. Reread your Journal entries. They will provide more to connect with in your reflections. REF: www.ucd.ie/teaching/good/lea.htm

Objective guidelines for Returning Practitioners Listen effectively, and speak clearly and concisely. Respond to others in a tactful, courteous manner; modifying communication to take into account the needs of others. Use effective written communication. 

Show an enterprising approach to your work. Become resourceful and self-reliant in finding the answers to problems.

Complete documentation correctly and within the required time-frame according to medico-legal and quality assurance requirements.

Identify, analyse and anticipate problems. Make decisions, which are timely, realistic and decisive.

Apply technical knowledge of radiation therapy in practical situations in the day functioning of the department, keeping mechanical and patient limitations in mind.

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Prioritise daily and long term tasks so that they are completed to the required standard within the appropriate time frame.

Demonstrate concern for both physical and psychosocial requirements of the patient and carer.

Ensure own professional development and involvement.

Maintain quality of work and meet deadlines during times of increased workload or unfavourable conditions.

Contribute to the achievement of the unit's objectives. Show a willingness to help others while taking into consideration the workload and capacity of others in the group. Contribute to the maintenance and enhancement of morale while providing quality patient care.

Cope with changing circumstances, and adopt a flexible approach to situations, problems, and patients conditions. Be open to better methods of completing tasks.

Demonstrate and understand radiation safety and the application of safe working procedures as outlined in the machine/equipment safety notes and the emergency procedures manual.

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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60 _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _________________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Please create more pages as necessary Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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Evaluation Please complete this evaluation at the end of your orientation programme. We are constantly looking for ways to ensure that new staff settle into the department quickly and are made to feel welcome. As such we would like your feedback to tell us what we are getting right and where you think we could improve the orientation experience. Please try to be completely honest – your responses will remain confidential and will help us to continue developing our orientation programme. 1. Did you think that the orientation booklet contains (please tick a box): □ too much information □ the right amount of information □ too little information 2. Is there any information which you feel should be included in the future? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 3. What did you think of the induction timetable? Did you feel that you had enough time in each of the areas? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 4. Did you find the inclusion of area specific task checklists useful? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 5. Was there any part of your orientation that you felt was particularly good / useful? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 6. Are there any areas that you think could be improved? _____________________________________________________________________________ _____________________________________________________________________________ Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 7. How would you rate your orientation overall? Please circle 1= Poor, 5= Excellent 1 Poor

2

3

4

5 Excellent

Please feel free to add any additional comments below. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Thanks for taking the time to complete this evaluation. Please return the completed form to the Clinical Educator.

Author: Dianne Locke: Clinical Educator Radiation Therapy Ref: G:\Division\ONC\Common\Radiation Therapy\Staff Information\Orientation Paperwork \Folder Paperwork

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CDHB Radiation Therapist Orientation Booklet  

Orientation

CDHB Radiation Therapist Orientation Booklet  

Orientation

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