The Scalpel's Blog

11.07.19

Urology nurses are leading the way in adoption of prostate cancer biopsy technique

Jonah Rusere, Advanced Nurse Practitioner for South East London Accountable Cancer Network, outlines an opportunity for urology nurses to make a difference to prostate cancer pathways.

jonah-rusere IMAGE (SMALL)

What is TRexit and why is it great news for prostate cancer patients all over the country?

Let me explain.

TRexit is the name given to a national initiative for hospitals to phase out TRUS biopsies and replace them with transperineal biopsies under local anaesthetic (LA TP).

The roots of the initiative are in the South East London Accountable Cancer Network, where hospitals set a date of 29 March to eliminate TRUS procedures.

It’s a deadline that, unlike our politicians, we’ve met: TRUS biopsies have left the building, and in their place, LA TP biopsies are being safely carried out by nurses and clinicians in outpatient settings.

It’s a great story – and it’s one that once again underlines the important role that urology nurses play along the prostate cancer pathway. Ultimately, greater adoption of LA TP paves the way for Advanced Nurse Practitioners to provide even greater value in the delivery of safe, timely and efficient care, fuelling a better patient experience and better patient outcomes. For urology nurses, ever passionate about patient care, this is our opportunity to drive positive change and make a difference. These are exciting times for the profession.

The urology pathway story at South East London (SEL) Accountable Cancer Network is a great example of collaborative, multi-disciplinary change management. I’m proud to be playing my part.

Last November, having been a urology Clinical Nurse Specialist (CNS) in London for many years, I took on a new role as an Advanced Nurse Practitioner (ANP) for the network on a one-year secondment to establish fully operational LA TP clinics across all our hospitals; Guy’s & St. Thomas’, King’s College, Queen Elizabeth Lewisham & Greenwich, Beckenham Beacon and the Princess Royal University. The appointment, championed by consultant urologist and NHS Innovation Accelerator Mr Rick Popert, made me the first ANP to work for the whole Network, rather than a single trust. Mr Popert is a leading advocate of LA TP biopsies and has done much to raise awareness of their clinical and operational benefits.

READ MORE: The cost of demanding savings mustn’t be patient choice

It’s increasingly recognised that there are risks in traditional TRUS biopsies compared to LA TP; there’s evidence that TRUS biopsies can yield inaccuracies in identifying potential cancer cells, while the nature of the procedure brings an increased likelihood of infection. Uptake of the alternative, transperineal (TP) approach - while providing a more thorough sampling of the prostate with less risk of infection - has historically been hampered by its need to be conducted under a general anaesthetic, leading to increased costs, longer waiting lists and subsequent delays in diagnosis. Patients whose biopsies are delayed are more likely to breach. 

However, advances in transperineal biopsy techniques means the procedure can now be performed under local anaesthetic through a freehand approach with certainty for targeted and systematic biopsies. It represents a safer and more accurate method to detect potential cancer cells at an earlier stage of progression, with lower costs and fewer side effects including sepsis. The technique has been operational at St. Guy’s & St. Thomas’ Hospital for over a year and has transformed clinical practice. The opportunity to spread this innovation – and all its inherent gains – across the NHS is something we cannot afford to squander. 

A major advantage of the technique is that it does not need to be carried out by doctors or surgeons – it can also be conducted by nurses in outpatient settings. As such, the emergence of LA TP biopsy presents a fantastic opportunity to put clinical nurse specialists at the forefront of clinical practice to add huge value to a cancer pathway that – at the national level – is under increasing demand. To make the most of it, urology nurses – particularly those already well-versed in TRUS guided biopsies – require specialist training in LA TP techniques. This training is at the heart of my role as ANP for the network.

VIEW MORE ARTICLES ON THE SCALPEL BLOG

My work to date has been varied, challenging but highly rewarding. At the SEL network level, all trusts had agreed to make the move away from TRUS, so my first priority was to establish the infrastructure and processes for LA TP in each Trust.

This required conducting comprehensive needs assessments that looked at everything from equipment, staffing, clinical workflows, diagnostic pathways and training requirements – and addressing those needs in line with the 29 March deadline.

The bulk of my work, however, has looked beyond ‘set-up’, focusing on training staff and, in particular, giving nurses the confidence to carry out the procedure. This manifests itself in a daily experience that sees me journey from hospital to hospital across the network, working – quite literally – hand-in-hand with urology nurses to demonstrate, train and guide them in performing LA TP on real-world patients. 

LA TP training is not a one-off activity where clinical staff – encompassing nurses, registrars and doctors – are upskilled overnight. Urology nurses – even those well-skilled in traditional TRUS biopsies – are understandably nervous when introduced to the new technique. On average, it takes around six weeks, or between 18 and 25 biopsies, to train a nurse. However, by the third or fourth biopsy, many are controlling the procedure by themselves and require only verbal guidance and support. It’s hugely rewarding for both parties.

At the local level, my goal is to ensure that all SEL hospitals (and teams) are self-sufficient when my secondment concludes in November 2019.  But the move away from TRUS biopsies is not limited to South East London – it’s a national initiative, designed to support and drive adoption of LA TP across the NHS. As such, we’ve also developed a BAUN accredited national training programme to increase the number of NHS nurses skilled in LA TP. I know from personal experience that nurses’ training needs differ from those of other HCPs.

READ MORE: Government announces £135m health research investment

We’ve therefore worked hard to tailor a learning experience that’s personalised for nurses and flexes to suit varied levels of experience and knowledge. It’s a testament to the effectiveness of that training – and the determination, passion and talent of the nurses that have undertaken it – that we’ve managed to achieve rapid change across our hospitals in South East London.

The challenge now is to push that innovation out to all corners of the NHS. Fortunately, with the consensus and support of leading urologists, clinical nurse specialists and thought leaders in prostate cancer diagnosis, the move to adopt LA TP is building a national momentum that will hopefully help other hospitals replicate that SEL success.

Fundamentally, my work as ANP has only reinforced my belief that nurses can play a significant role in prostate cancer care. The emergence of LA TP is a big opportunity for nurses to cement their place at the heart of that pathway. The LA TP technique is a skill that can be learned – and up and down the country, we’re showing that nurses can do it at a very, very high level. 

For the nursing profession, it’s a platform for career progression. For the NHS and – most important of all – its patients, it’s an opportunity for quicker, safer and more cost-effective prostate cancer care, and better patient outcomes. 

Best of all, it’s urology nurses leading the way.

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

NHS supported resources launched to help older generations use digital

18/10/2019NHS supported resources launched to help older generations use digital

As we celebrate the twelfth annual Get Online Week, the largest digital inclusion campaign in the UK, the Good Things Foundation have published a... more >
NHS Confederation responds to proposed Brexit deal.

18/10/2019NHS Confederation responds to proposed Brexit deal.

Boris Johnson’s proposed Brexit deal that emerged this week has been met with mixed feelings, but NHS Confederation has today (Oct 18) stat... more >
RSPH want you to ‘look after your self-ie’ with launch of online resource

18/10/2019RSPH want you to ‘look after your self-ie’ with launch of online resource

Royal Society for Public Health (RSPH) had launched a free online e-learning resource called ‘Looking after your self-ie’ as a contin... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us through your career in healthcare? My parents both worked in the NHS on the frontline. My mum was a GP, and my dad was a nephrologist in inner city L... more > more last word articles >

the scalpel's daily blog

Providers are delivering – and here’s how

09/10/2019Providers are delivering – and here’s how

It has been a challenging few years for healthcare providers, yet they have continued to deliver high quality care despite the conditions. Adam Brimelow, director of communications at NHS Providers, outlines just how providers are managing to deliver despite the financial squeeze.   It is inevitable that the NHS’ fun... more >
read more blog posts from 'the scalpel' >
332 304x150 NHE Callout banner.

comment

NHS England dementia director prescribes rugby for mental health and dementia patients

23/09/2019NHS England dementia director prescribes rugby for mental health and dementia patients

Reason to celebrate as NHS says watching rugby can be good for your mental health and wellbeing. As the best rugby players in the world repr... more >
Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >

health service focus

View all News

interviews

NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >