Learning from practice

The Urology Community Nursing Service was developed when Newcastle upon Tyne Hospitals Foundation Trust was asked to identify which common urological procedures traditionally performed in secondary care could be undertaken safely and effectively in patients’ own homes.

In 2000, the Trust began working with the local primary care trust (PCT) to develop a urology service in primary care, whilst ensuring patients still had access to specialist nursing care when they needed it.

A community nurse specialist who works out of Freeman Hospital’s department of urology now provides a comprehensive, community-based service to appropriate patients. This includes changing catheters, instructing patients in self-catheterisation (ISC), ultrasound measurement of residual urine volume and continence advice. In 2005, there were 900 patient treatment episodes provided in this way, of which 414 were for intravescial therapy (324 BCG and 90 intravesical chemotherapy).

Patients with bladder cancer would normally have to make frequent visits to hospital for surveillance. Those being treated with intravesical chemotherapy have the added inconvenience of attending hospital once a week for six weeks to receive their chemotherapy instillation. Under the community service, patients can receive maintenance BCG therapy in their own homes, undergoing an initial six week induction course followed by three further doses at three months and six monthly thereafter. Says Garrett Durkan, Consultant Urological Surgeon at Freeman Hospital;

“In general, patients with bladder cancer tend to be frail, elderly and are often without their own transport. The community-based intravesical therapy service has facilitated a significant decrease in attendances to the hospital in addition to reducing transport costs and inconvenience to the patients concerned.”

The service, although firmly based in the community, also has the advantage of being associated with a large urology department in a university teaching hospital. Continues Garrett; “Patients remain under the ongoing care of a named consultant for the purposes of endoscopic surveillance.

We also provide ongoing support and appraisal and are readily available to discuss complex cases or deal with occasional complications, which are thankfully rare. This structure ensures that the appropriate mechanisms for audit and clinical governance are in place and prevents the community nurse specialist from becoming isolated due to the nature of her work.”

Patient satisfaction with the community-based intravesical therapy service has been extremely high. Patients have welcomed the option to be treated in the privacy, comfort and convenience of their own home whilst being confident that they are still under the care of the hospital’s specialist urology team.

The urology community nurse specialist acts as an excellent specialist resource for community staff and has a key role in education. In addition to formal lectures and teaching at the University of Northumbria, student nurses also have the opportunity to work alongside the community nurse specialist as part of their clinical urology placement.

Firm links have also been established with the district nursing service and Social Services to allow for ongoing education and to help identify the patients who would most benefit from community-based urological treatment.

Future developments include examining how the service can facilitate a reduction in hospital admissions and earlier discharge for patients, but due to a lack of resources the service is currently run single-handedly and geographically limited. Concludes Garrett “Areas such as Gateshead and Northumberland have no community-based urological services despite high rates of bladder cancer. Expansion of the service would require the appointment of further urology community nurse specialists.”