MP23-19 INTRODUCTION OF A NURSE LED STENT REMOVAL SERVICE USING THE SINGLE USE ISIRIS IN A TERTIARY REFERRAL STONE UNIT AND THE EFFECT ON PATIENT WAITING TIMES

Abstract

INTRODUCTION AND OBJECTIVES: JJ stenting represents one of the most significant causes for patient discomfort and dissatisfaction following ureteroscopy. At the author's institution, which is a large tertiary referral centre for complex stones, standard stent removal was undertaken with a flexible cystoscope (FC) in the Endoscopy Department by a doctor, and was prone to delays through meeting requirements for cancer investigations. The 'Isiris +/-' (Coloplast) is a single use stent removal system consisting of a 'camera on chip' disposable FC with integrated grasper. We examine the feasibility and impact on waiting times of a nurse led stent removal service using this system, which can be used in any clinical space. METHOD(S): A specialist stone nurse undertook training in FC approved by The British Association of Urological Surgeons (BAUS). Once competency was reached a nurse led service was offered to patients in the outpatient setting. The training time to competency was recorded. A prospective database from April to October 2018 reveals the nurse led service completed 94 stent removals. In comparison data between July and December 2016 showed 54 stent removals completed by a doctor in the endoscopy department. The delays in stent removal compared to the "ideal" stent removal date (plus or minus 3 days tolerance allowed) were compared between the two pathways. RESULT(S): The specialist nurse undertook BAUS theory training before going on to observe 14 FCs (recommended 10) followed by completion of 78 (recommended 40) FCs under supervision. A further 15 stent removals were completed using the Isiris cystoscope under supervision. Competency was reached after this time using an approved BAUS/BAUN competency package. 94 stent removals were booked in the nurse group, of which 87 were undertaken. In three of these the nurse was unable to remove the stent. In one case due to poor views in the bladder with debris, in one case because of encrustation, and in the remaining case due to inability to navigate through a tortuous prostatic urethra. 74 of 87 patients in the nurse removal ISIRIS group had their stent removed on time, whereas only 16 of 54 patients had their stents removed on time in the doctor stent removal group (p<0.0001, Fischer's exact test). Only 3 of 13 patients who had a delayed stent removal in the nurse led group had a delay of more than 21 days, but in the doctor led group this number was 12 out of 38. CONCLUSION(S): This study has shown that it is possible to introduce a nurse led stent removal service. Introduction of this service using the ISIRIS system has led to a reduction in delays of stent removal, which are likely to translate into significant quality of life improvements for patients. Further work is being undertaken to investigate comparisons of emergency department attendance and/or admission rates to identify if timely stent removals can reduce post-operative hospital episodes.