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A nurse-led peripatetic urology service

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To introduce a new service into a directorate requires motivation and also desire to make improvements to patient care delivery. These were demonstrated by Gary Musgrove, with support from the urology ward at City Hospitals Sunderland NHS Foundation Trust, when looking at patient groups who could be treated in their own homes rather than be admitted to hospital.

To introduce a new service into a directorate requires motivation and also desire to make improvements to patient care delivery. These were demonstrated by Gary Musgrove, with support from the urology ward at City Hospitals Sunderland NHS Foundation Trust, when looking at patient groups who could be treated in their own homes rather than be admitted to hospital.

It was identified that patients requiring trial without catheter (TWOC) could easily be treated in their own homes, as this group of patients were essentially fit and did not require intervention from doctors.

These patients had urinary catheters in place following either surgery or urinary retention following which were discharged home from hospital. Before this new innovation, this group of patients had to wait a number of weeks to be readmitted to urology ward, usually on a Saturday morning as this was the least busy time. Providing there was an available bed they would have their catheters removed.

Frequently this group of patients may have been admitted to a non-urology ward where urology experience was lacking, therefore patient care was potentially compromised. Patients then occupied an acute bed for 24 to 48 hours.

The nurse-led urology peripatetic service was established to assess and treat patients requiring TWOC in their own homes. This treatment was to re-establish bladder function for patients after surgery or episode of urinary retention.

The service was initially operated on a six-month pilot allocating just two days a week with no additional resources. Following successful treatment of patients and a positive evaluation/patient feedback, City Hospitals Sunderland NHS Foundation Trust introduced a full-time peripatetic urology nurse specialist from December 2005.

The service has now expanded in a short space of time to offer treatments to a wider group of patients with differing needs. The same identification process was applied to urology outpatient clinics and patients requiring bisphosphonate infusions for treatment of bone metastasis caused by prostate cancer, complicated urinary catheter changes and goserelin injections to treat prostate cancer were included into the peripatetic urology service.

Some of these patients with prostate cancer and bone metastases previously experienced discomfort travelling to hospital for treatment. The same patients now receive the same level of care and treatment in the comfort of their own homes.

The peripatetic urology nurse specialist Gary Musgrove leads the service and has developed closer links between acute based urology services at City Hospitals NHS Foundation Trust and primary care services in Sunderland that previously were compromised. District nurses contact Gary for advice on urology issues, which has assisted in improving patient care and experience.

The project has been promoted and awarded for its innovation with a highly commended at the Northumberland Tyne and Wear Strategic Health Authority Awards (November 2005) and won second prize in the service delivery category at the NHS Innovations North Awards (February 2006). It was also a finalist in the NT Awards 2006's 'Back to Basics' category. The work has also been presented at a local modernisation conference at the trust.

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