Degarelix administration technique optimisation: Consensus findings of an international Delphi nurse panel

What steps involved in degarelix (Firmagon®, Ferring Pharmaceuticals) administration and patient care do specialist nurses consider most important to reduce the risk of associated injection site reactions, and are there any variations in administration and materials used to support optimal injection technique? Degarelix is a GnRH antagonist indicated for the first-line treatment of advanced prostate cancer that effectively suppresses testosterone production in the testes without an initial testosterone surge and possible subsequent disease flare—both typical features associated with GnRH agonists. However, injection site reactions can occur after subcutaneous injection of degarelix, which are unpleasant for patients and may represent a limiting factor for its use by healthcare professionals. The objective of this study was to reach consensus on key steps involved in degarelix administration and patient care to minimise injection site reaction risk. Injection site reactions have been associated with subcutaneous injection of degarelix in several published studies; they are usually transient, mild-to-moderate, and occur mainly with the initial dose. Information on prevention is limited, one research group suggesting that the injection method may contribute to injection site reaction risk, and another describing specific injection techniques and strategies developed by Canadian nurses and physicians aiming to prevent degarelix injection site reactions. An online pre-meeting survey regarding degarelix administration and injection site reactions was conducted to gather insights from 11 international specialist nurses. Survey results supported the development of 25 best practice consensus statements for the in-person Delphi meeting (Warsaw, Poland), attended by 15 international specialist nurses. Statements focused on degarelix reconstitution, administration and patient care. Participants voted anonymously and collated responses were discussed after each voting round to understand if consensus could be achieved. If no consensus was reached after the first voting round, up to two more voting rounds were considered. Consensus was defined as “agreement” or “disagreement” by ≥75% of nurses, with ≤15% having the opposite opinion. In the pre-meeting survey, nurses reported that they observed injection site reactions in up to a third of treated patients after degarelix injection, and all agreed that the administration technique was, to some degree, related to the development of injection site reactions; a variety of materials were being used as guidance. In the Delphi study, consensus was reached on 5 of 9 statements related to reconstitution steps and 14 of 16 statements related to administration steps and patient care, all of which were considered to be important in the prevention of injection site reactions. This study confirmed country-specific variations in the degarelix administration technique and highlighted pivotal steps that may potentially contribute to injection site reactions. Importantly, all nurses agreed that technique optimisation holds the potential to reduce the occurrence of such reactions (“yes,” 45%; “possibly,” 55%; “no,” 0%). The findings should be considered along with other available materials and guidance to help reduce the risk of injection site reactions in patients with advanced prostate cancer treated with degarelix

The role of the urology clinical nurse specialist in the multidisciplinary team meeting

Multidisciplinary teams (MDTs) are increasingly the preferred method of cancer care in many specialties, including urology. MDTs provide a means of improving communication between health care professionals and patients and provide co-ordinated and timely care. As MDTs have developed, so too has the role of the specialist cancer nurse, though the concept of the clinical nurse specialist (CNS), or their involvement in the MDT are not globally universal. There is increasing evidence that the presence of the CNS in the MDT improves patient satisfaction and team effectiveness. The MDT meeting is the focal point for decision-making about patients' care, but the roles of health care professionals in the MDT meeting are variable and poorly defined. In this paper, we examine the evidence for the role of the CNS in the urology MDT meeting, which includes communicating with colleagues and patients, co-ordinating care, as well as facilitating research and clinical governance. We discuss the challenges faced by CNSs and how their role in MDT meetings can be strengthened to enhance their effectiveness in the MDT in general. © 2011 The Authors. International Journal of Urological Nursing © 2011 BAUN and Blackwell Publishing Ltd

Developing and centralising a nurse‐led local anaesthetic transperineal biopsy service during COVID

Abstract Introduction Transperineal (TP) biopsy has recently replaced the transrectal ultrasound (TRUS) approach as the ideal method of biopsy in the United Kingdom with growing trends to adopt. To minimise transmission of COVID‐19 during the first wave of the pandemic, the British Association of Urological Surgeons Section of Oncology issued guidelines reducing general anaesthesia (GA) procedures and initiate COVID‐secure ‘green’ site diagnostics. As a result of these guidelines and reduction in clinical diagnostics trust‐wide, we ceased all TRUS diagnostics and implemented a centralised, nurse‐led LA TP biopsy service. Materials and methods A waiting list was developed for those awaiting prostate cancer diagnostics across the network. A COVID‐secure ‘green’ site was quickly identified with TP biopsies starting soon after. Quality improvement methodology was utilised and a run chart was used to show if changes were sustainable. Results Successful implementation and centralisation of a TP biopsy service occurred with TRUS guided biopsies ceasing across all sites on 12 May 2020. The procedures were carried out by urology advanced nurse practitioners under local anaesthesia with a select few occurring under GA. Centralising the service in a COVID‐secure manner freed up dedicated theatre sessions and personal leading to increased efficiency elsewhere. The service was robust and was maintained upon lifting of COVID restrictions. Conclusions A centralised, nurse led LA TP biopsy service in a procedural unit was implemented successfully. The service has remained resilient upon lifting of restrictions and return to business as usual. This led to improved performance across trust by freeing up valuable resources and staff to undertake more duties. The service remains highly valued trust‐wide