SNAPSHOT of the Development of ANP Oncology Prostate

SNAPSHOT of the Development of ANP Oncology Prostate Cancer THE JOURNEY SO FAR Sheila Kiely C ANP Peri-Operative Directorate

DEVELOPMENT OF AN ANP ROLE FOR PROSTATE CANCER ØUrology as a medical speciality is continually developing in response to technological advances and there is a move among Urologists to subspeciality. ØUro-oncology nursing has mirrored this development with the emergence of urological advanced nursing roles following nurses gaining specific urological expertise. ØLike with other nursing specialities the role development occurs as a response to local workplace needs (White et al, 2009). ØRole development for ANP Oncology Prostate cancer arose as a result of service demand on the Rapid Access Prostate Service

RAPID ACCESS PROSTATE CLINIC Rapid access prostate clinics were developed as part of National Cancer Control Programme (NCCP) to provide a rapid diagnostics for men with a suspicion of prostate cancer. The service commenced in UHL in Dec 2010 Out-patients based service that provide men access to �Consultant assessment �TRUS biopsy �Radiological imaging Service is measured by Key performance indicators

RAPC SERVICES NEED Service needs analysis Solution: RAPC Services required 1. Increase access for new patients An advance Nurse practitioner to autonomously diagnose and treat an episode of care 2. Increase access to diagnostics Order and interpret tests 1. 2. Imaging Biopsy procedures Prescribe medications 3. Reduction in the number of return Perform medical procedures attendances that require surveillance 4. Solution to increase capacity for new prostate cancer diagnosis

TOTAL NUMBER OF ATTENDANCE RAPC 2017, 2018

NEW CANCER DIAGNOSIS FIGURES

NUMBER OF CLINICS PER MONTH

TREATMENT CHOICES 45 40 35 30 25 20 15 10 5 0 Surgery Radiotherapy Active surveillance

CURRENT SERVICE DELIVERY FOR RAPC UL Out patient based service delivered over two clinics per week �Thursday am �TRUS biopsy clinic �New patient review clinic �Returns patient �New diagnosis �Under PSA surveillance �Newly diagnosed �Decision – making about treatment plan �On active surveillance �Post surgical intervention POCU Tuesday am �One stop clinic for new patient + prostate biopsy if deemed needed �Patient return to the Thursday clinic for results

IMPACT OF RAPC CLINICS Impact Solution Increased number of prostate cancer Service need analysis diagnosis �Solutions needed to improve efficiency of Increased number of men living following a prostate cancer diagnosis Increase number of men under PSA surveillance Increased number of men on an Active Surveillance protocol service �Address the increase number of returns that require follow-up �Improve access for new referrals �Development of an advance Nursing role to manage a specified cohort of prostate cancer patient under stringent protocols �Governance structure to support role �Clinical – Consultant Urologist �Professional – Director of Nursing

ROLE DEVELOPMENT Identify key stakeholders Having consider the need for the role based on the service need- the role needs professional knowledge , clinical reasoning and clinical judgement at the highest level to safely manage this cohort of prostate cancer patients. Role is a collaborative process with stakeholders Benefits to service Enhance the service having a positive impact on patients and patients family on their experience with the RAPC service

IDENTIFY KEY STAKEHOLDERS • DON • ADON • Operational DON • CNS Prostate • CNS Uro-Oncology • ANP’s Peri-operative directorate • NMPDU • • Consultant Urologist’s Consultant Radiologist Consultant Pathologist Consultant medical oncologist • Consultant Radiation Oncologist • Business Manager • Data Manager • Urology secretarial support Medical Nursing Secretarial Facilities • OPD management • Out-patient clinical space • IT support

Clinical Governance- Mr. Garrett Durkan Consultant Urologist Professional Governance- Mr. Declan Mc. Namara DON Peri-Operative directorate ANP PROSTATE CANCER ROLE VISION Ms Carmel Hoey NPDU ANP development Coordinator PSA Surveillance Clinics • • • Stakehold ers Protocol Virtual V OPD Active Surveillance Clinics • • • Stakehold ers Protocol Virtual V OPD Referral process for repeat BX and imaging Post RRP & RALP Clinics Management of ED Clinics Survivorship clinics Preparation for discharge National Guidelines Protocols Policy/Guideli nes Protocols TRUS Biopsy Verse TP Biopsy • • Education – seek information from GUH service • OPD Survivo rship Stakeholders agreement Protocol Clinical Education Competencies Clinical Procedures

GOVERNANCE STRUCTURE Clinical Governance Continuous clinical Supervision • Clinical lead Urologist Professional Governance: Code of professional conduct /scope of practice • Director of Nursing Peri-Operative Directorate

STARTING WITH WHAT I CAN RESOLVE PSA Surveillance Protocol driven based on current evidence practice Virtual clinics verse attending OPD services Autonomy - What Gives me Meaning Professional autonomy means having the authority to make decisions and the freedom to act in accordance with one's professional knowledge base.

ACTIVE SURVEILLANCE CLINIC’S FOR PROSTATE CANCER • Valid treatment options for early stage PCa. • Require close supervision • Options to mix virtual/ actual clinics for follow-up • Close involvement with MDM team • Referral pathway needed for repeat prostate bx • Referral pathway for diagnostic imaging ( teething issue)

LEARNING’S SO FAR Start small.

REFERENCES: White, T. , Crowe, H. and Papps, E. , (2009). Defining urology nursing practice roles in Australia and New Zealand. International Journal of Urological Nursing, 3(2), pp. 69 -77. Nursing and Midwifery Board of Ireland (2017). Advanced Practice (Nursing) Standards and Requirements. Dublin NMBI.