Nurse education prior to intravesical instillation

9. Nurse education prior to intravesical instillation

To ensure patient and nurse safety, it is essential that all nurses administering the treatment meet specific prerequisites, maintaining a universal standard of education, understanding and competence. The nurse specialist administering intravesical treatment must be trained and assessed by a competent practitioner in accordance with local guidelines. It is also important that the nurse specialist keep their intravesical-treatment skills up to date to ensure continued competence, with a prerequisite that they be deemed competent in urethral catheterisation (Table 5) [50].

To ensure compliance with current safety regulations, all staff involved in handling MMC or BCG (including physicians, nurses and employees involved in receiving, transporting or storing these agents) must receive comprehensive information and training regarding the associated hazards. This training should be provided at the start of their assignment to areas in which the drugs are present. The employer should provide annual refresher information and training, which is essential to maintain awareness and adherence to safe handling practices [25, 26].

The initiation of intravesical treatment should be determined by the urological surgeon or through the multidisciplinary team meeting. In countries in which specialist nurses are licensed to prescribe medication, it continues to be good practice to make this decision in consultation with the urologist and multidisciplinary team.

Table 5. Nurse education for bladder instillation

Maintain knowledge/skill in:	Rationale
Bladder cancer pathway	To ensure treatment plans and further investigations take place as required
Indication for treatment	To ensure the patient meets clinical criteria for specific treatments To ensure the treatment offers potential benefits for the patient To help the patient understand the benefits of treatment for their disease
Data supporting use of treatment	To help patients understand the benefits of treatment where necessary, as some patients may not want this information
Importance of counselling the patient regarding the treatment	To help ensure patient preference, promote compliance and build trust and confidence, enabling the patient to take an active role in their care
Pharmacokinetics and pharmacodynamics of the agent being used	All nurses have a responsibility to understand medication they administer to patients to help the patient understand how the treatment works and how it affects their disease.
Contraindications of treatments	To ensure patient safety by avoiding treatments that could cause harm or adverse reactions
The physical and health hazards of MMC and BCG in the work area and the measures employees can take to protect themselves from these hazards.	To maintain patient safety To maintain nurse safety To maintain safety of others and the environment
Management of spillages and waste disposal	To maintain patient and nurse safety To maintain safety of others/environment and use spill kits specifically designed for cytotoxic and biohazard agents
Anatomy and physiology of the urinary tract	An understanding of the urinary tract anatomy and physiology ensures safe, effective care and management of urinary conditions and treatment
Competent in urethral catheterisation	To ensure patient-centred care while maintaining safe and effective administration of the treatment and reducing risk of side effects.
Side effects of the agent being used	To help patients manage and understand side effects To help improve engagement and compliance To identify side effects that require further management To counsel the patient effectively, maintaining safe practice and outcomes
Dose/schedule	To ensure the treatment is administered according to the summary of product characteristics (SmPC).
Personal protective equipment to be used when performing intravesical instillation	To maintain nurse safety using appropriate PPE To maintain safety of others/environment
The carcinogenic potential and reproductive hazards of these drugs	To understand the importance of avoiding drug exposure, especially early in pregnancy, ensures informed decision making about the hazards involved

9.1 Recordkeeping

The competent practitioner who educates the nurse should prepare training records, including the following information:

Dates of the training sessions
Contents or a summary of the training sessions
Names and qualifications of the persons conducting the training
Names and job titles of all persons attending the training sessions

Training records should be maintained for three years from the date on which the training was held [26].

Recommendations	LE	GR
All staff involved must receive training on handling hazardous drugs.	4	C
Intravesical therapies must be administered by a trained nurse and assessed by a competent practitioner.	4	C
The decision to initiate intravesical therapies must be made by a multidisciplinary team.	4	C
Training records must be maintained.	4	C