nurse lithotripsy clinical guideline v1.0 december 2019

Nurse Lithotripsy Clinical Guideline

V1.0

December 2019

Nurse Lithotripsy Clinical Guideline V1.0 of 12

Summary

Start

Stage 1. Patient Referred for Extra Corporeal Shockwave

Lithotripsy (ESWL) by Urology Consultant

Stage 3 Patient Preparation

Check Patient Details

Confirm Side of stone (Patient/ X-Ray Images & Reports)

Check physiological observations

Patient is given information/ risks

Written consent is given by patient

Contra-indications are excluded

Analgesia is Prescribed and given

Patient gets changed into Gown.

Stage 2 Patient Attends for ESWL

Requirements for ESWL to be performed

Consultant Urologist readily available in the hospital

One qualified nurse to recover the patient

ESWL Contra

Indications AAA

Anti-coagulants Hypertension

(Diastolic >100) Pacemaker Pregnancy

UTI

Stage 4 Post Procedure

Check physiological observations

Ensure voiding satisfactorily

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1. Aim/Purpose of this Guideline

1.1. This guideline aims to provide the training and supervision infrastructure to allow a named nurse selected as appropriate, to run the Extracorporeal Shock Wave Lithotripsy (ESWL) clinic. 1.2. This version supersedes any previous versions of this document. 1.3. Data Protection Act 2018 (General Data Protection Regulation – GDPR) Legislation The Trust has a duty under the DPA18 to ensure that there is a valid legal basis to process personal and sensitive data. The legal basis for processing must be identified and documented before the processing begins. In many cases we may need consent; this must be explicit, informed and documented. We can’t rely on Opt out, it must be Opt in.

DPA18 is applicable to all staff; this includes those working as contractors and providers of services.

For more information about your obligations under the DPA18 please see the ‘information use framework policy’, or contact the Information Governance Team [email protected]

2. The Guidance

2.1. Background/ Introduction

2.1.1. Lithotripsy is currently performed on a 4 weekly cycle and requires the presence of a doctor to consent and prescribe for the patients. This role is often taken by a junior doctor but due to the vagaries of the junior doctor rota, and their frequent change over, cover is inconsistent, when it is actually provided. Unfortunately if there is insufficient junior doctor cover, then the Lithotripsy (patients/ list) is cancelled, causing a delay to treatment and the obvious inconvenience to the patients.

2.1.2. This guideline is designed to promote high quality, cost-effective care whilst providing continuity for this group of patients.

2.2. Definition ESWL under the supervision of a specialist nurse.

2.3. Scope of the guidelines

Patient referrals ESWL

Consultant Urologist referrals

Patients assessed by consultants in clinic or inpatients who are identified as requiring ESWL.

mailto:[email protected]


2.4. Staff The ESWL clinic can be overseen by a Specialist Nurse who has been deemed competent by a designated supervising Consultant Urologist after receiving appropriate training and supervision.

2.5. Qualification/Training & competencies

First level Registered Nurse working in Urology with experience of stone disease.

Assessed as competent in obtaining patient consent:

A registered Non-medical Prescriber.

Interpretation of radiology reports and there relevance to stone burden.

2.6. Contraindications Contraindications to ESWL

AAA

HTN

o Diastolic should be less than 100mmHg

Anti-coagulants

o stopped at appropriate time pre-procedure as per anti-coag guidelines

Pacemaker

UTI

o Confirmed by history taking or urine dipstick

Pregnancy

o Confirmed by history taking or pregnancy test

2.7. Patient information

2.7.1. Information is given to the patient as part of the consent form (Appendix 3) 2.7.2. Patient leaflet (Appendix 4)

2.8. Guidelines

2.8.1. The Nurse Specialist must ensure the following prior to commencement of the ESWL:

A Consultant Urologist is immediately available in the Hospital

There is one qualified nurse to recover the patient

2.8.2. Nurse and Patient Consultation

Check the patient details

Confirm side of stone (verify with patient & X-Ray reports)

Procedural Information – information about ESWL, why it is performed and the risks of the procedure.


Obtain written consent as per Trust Policy

2.8.3. Physical preparation as appropriate

Prescribe analgesia (paracetamol/ Co-codamol)

Check Physiological Observations

Patient to get changed into a gown (trousers/ skirts can remain on)

2.8.4. Post Procedure

Check that physiological observations are acceptable.

Ensure voiding satisfactorily.

2.9. Audit/Review arrangements

2.9.1. The CNS and the Supervising Consultant Urologist will be responsible for audit of practice and the protocol annually.

2.9.2. The audit will include:

Adherence to the protocol

Education and competence of staff

2.9.3. Untoward incidents:

Any untoward incidents arising from the nurse led Lithotripsy should be dealt with as an untoward incident, by completion of an DATIX form.

3. Monitoring compliance and effectiveness

Element to be monitored

ESWL outcome data and complication rate

Lead Mr Nic Munro

Tool Audit and review Tool using Appendix 3 “Review meeting template”

Frequency For first 12 months after training completed a 3 month review meeting with Lead (Nic Munro). Reverting to annual thereafter

Reporting arrangements

Nic Munro to Report to Urology Business Meeting (all consultants and Divisional manager) after each review meeting

Acting on recommendations and Lead(s)

Urology service lead upon consultation with Divisional director and Manager

Change in practice and lessons to be shared

Required changes to practice will be identified and actioned within the 3 month review cycle for the first year, and annually thereafter. However it is anticipated issues and concerns can be easily shared and actioned on an ad-hoc basis.


4. Equality and Diversity

4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Inclusion & Human Rights Policy' or the Equality and Diversity website.

4.2. Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2.

http://www.rcht.nhs.uk/GET/d10268876

http://www.rcht.nhs.uk/GET/d10268876

http://intranet-rcht.cornwall.nhs.uk/shelf/equality-and-diversity/


Appendix 1. Governance Information

Document Title Nurse Lithotripsy Clinical Guideline V1.0

Date Issued/Approved: 31.10.2019

Date Valid From: December 2019

Date Valid To: December 2022

Directorate / Department responsible (author/owner):

Tim McEvoy RN Surgical Care Practitioner

Contact details: 01872 252562

Brief summary of contents Guidance on the change of service from junior doctor to nurse led Extra Corporeal Shockwave Lithotripsy

Suggested Keywords: Urology, Lithotripsy, ESWL, Renal Calculi, Ureteric calculi, Extra Corporeal Shockwave Lithotripsy,

Target Audience RCHT CFT KCCG

Executive Director responsible for Policy:

Medical Director

Date revised: Initial version

This document replaces (exact title of previous version):

New Document

Approval route (names of committees)/consultation:

Urology Governance Meeting.

Care Group General Manager confirming approval processes

Charlotte Timmins.

Name and Post Title of additional signatories

Not Required

Name and Signature of Care Group/Directorate Governance Lead confirming approval by specialty and care group management meetings

{Original Copy Signed}

Name: Suzanne Atkinson

Signature of Executive Director giving approval

{Original Copy Signed}

Publication Location (refer to Policy on Policies – Approvals and Ratification):

Internet & Intranet Intranet Only


Document Library Folder/Sub Folder Clinical / Urology

Links to key external standards None required

Related Documents:

References: https://www.nice.org.uk/guidance/ng118/chapter/Recommendations#surgical-treatments-including-shockwave-lithotripsy

Training Need Identified? No

Version Control Table

Date Version

No Summary of Changes

Changes Made by (Name and Job Title)

31.10.2019 V1.0 Initial version

Tim McEvoy, Theatre Practitioner and Matthew Hotston, Consultant Urologist

All or part of this document can be released under the Freedom of Information

Act 2000

This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing

Controlled Document

This document has been created following the Royal Cornwall Hospitals NHS Trust Policy for the Development and Management of Knowledge, Procedural and Web

Documents (The Policy on Policies). It should not be altered in any way without the express permission of the author or their Line Manager.

https://www.nice.org.uk/guidance/ng118/chapter/Recommendations#surgical-treatments-including-shockwave-lithotripsy




Appendix 2. Initial Equality Impact Assessment Form

Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Unsure Rationale for Assessment / Existing Evidence

Age X

Name of the strategy / policy /proposal / service function to be assessed Nurse Lithotripsy Clinical Guideline V1.0

Directorate and service area: Urology

New or existing document: New

Name of individual completing assessment: Nicholas Munro, Consultant Urologist

Telephone: 01872 250000

1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at?

Breaking up of Renal/ Ureteric Stones

2. Policy Objectives*

Breaking up of Renal/ Ureteric Stones

3. Policy – intended Outcomes*

Achieving a reduction in stone burden/ clearing the stone burden

4. *How will you measure the outcome?

Imaging- X-Ray/ Ultrasound (abdominal) or. Determined by consultant preference.

5. Who is intended to benefit from the policy?

Persons with renal/ ureteric stones.

6a Who did you consult with b). Please identify the groups who have been consulted about this procedure.

Workforce Patients Local groups

External organisations

Other

X

Please record specific names of groups Urology Governance Meeting.

What was the outcome of the consultation?

Agreed

7. The Impact Please complete the following table. If you are unsure/don’t know if there is a negative impact you need to repeat the consultation step.


Sex (male,

female, trans-gender / gender reassignment)

X

Race / Ethnic communities /groups

X

Disability - Learning disability, physical impairment, sensory impairment, mental health conditions and some long term health conditions.

X

Religion / other beliefs

X

Marriage and Civil partnership

X

Pregnancy and maternity

X

Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian

X

You will need to continue to a full Equality Impact Assessment if the following have been highlighted:

You have ticked “Yes” in any column above and

No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or

Major this relates to service redesign or development

8. Please indicate if a full equality analysis is recommended. Yes No X

9. If you are not recommending a Full Impact assessment please explain why.

‘Not indicated’

Date of completion and submission

31.10.2019

Members approving screening assessment

Policy Review Group (PRG) ‘APPROVED’

This EIA will not be uploaded to the Trust website without the approval of the Policy Review Group. A summary of the results will be published on the Trust’s web site.


APPENDIX 2. Nurse Led External Corporeal Shockwave Lithotripsy Review Meeting Document

Date

Meeting Number:

Attendees:

Review Period:

Complications:

Positive incidents:

Negative Incidents:

Reflection:

Areas for development:

Next review date:

Signatures:


Appendix 3. ESWL Consent Form (CHA3243 V1)

The form can be uploaded by selecting the link below using Ctrl+Click to follow the link:

http://doclibrary-rcht-intranet.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Forms/ConsentForms/ProcedureSpecificConsentForms/Urology/ExtraCorporealShockWaveLithotripsyCHA3243.pdf



