Bone Marrow Biopsy Training For Nurses Louise McNamara Matron / Nurse Practitioner for Haemato-Oncology

1. Bone Marrow Biopsy Training For NursesLouise McNamaraMatron / Nurse Practitioner for Haemato-Oncology

2. Background • Incidence of haem malignancies in Europe • ~230,000 / year • Routinely need bone marrow biopsies • Diagnosis, staging, disease evaluation • Settings • Haematology • Oncology • Breast, lung, neuroblastoma • General Medicine • Unexplained low blood counts, fungal disease, miliary TB

3. Benefits of nurse advanced practice • Nurse led services in the UK encouraged • Dissatisfaction with traditional models • Junior doctors hours • Treatment waiting times • Nurses’ willingness to adopt advanced roles • NHS clinicians not competing for income • Attempts to improve patient experience / quality of care • Increased patient satisfaction • Increasing patient numbers Need new ways of working / professional boundaries blurred

4. Low-risk areas / narrow spectrum of high tech care e.g. nurse endoscopist Improves efficiency Enhances care Little difference in performance Higher patient satisfaction Best opportunities for nurse-led services

5. The Haem-Onc setting • BM’s traditionally performed by physicians • Better scheduling can reduce waiting times • Positive correlation between volume of procedures undertaken and patient outcome • Trainee doctors rotate • Senior nurses bring holistic approach • Nurses implement quality framework • Operations, training, care package, consent, information, documentation

6. Removal of haematopoietic tissue from medullary cavity of bone Involves 2 specimens: Aspiration Cytologic preparation cell morphology Trephine assess overall marrow architecture bone marrow cellularity fibrosis infections infiltrative diseases Definition

7. The RM experience • Nurses perform • ~80 - 100 BM’s / month • Nurse-led service • Started by a NP • Trained by physician • Developed workbook • Underpin practice with theory • Enquiries from nurses at other UK hospitals • BM training course for nurses

8. Theoretical knowledge Practical experience Ensure safe and confident practitioners 2 days of theory and simulated practice 1 day observing clinical practice Course aim

9. Workbook Key learning outcomes Self assessment to benchmark knowledge Theoretical worksheets Indications Anatomy and physiology Legal and professional Patient preparation and aftercare Problem prevention and resolution Dealing with complications Theory RM manual of clinical nursing procedures (2011) Additional reading list Practice assessment guide Practice supervisor and clinical manager Theoretical framework

10. Competency • Core competencies set out in workbook • Trainee retains workbook as evidence • Manager maintains central register • Maintain ongoing competency against procedure guideline • Peer review • Annual audit • Annual appraisal

11. Course content

13. Advanced nursing care policy? Stakeholders? Potential resistors How will they agree competence? Job description? Service cover? Contingency? Succession planning? Environment Job plan Administrative support Further role development Non-medical prescribing / ALS Administration of medication with consideration to the law Practical issues to consider

14. Course evaluation • To date • 3 courses • 15 delegates • Feedback positive • Translating theory into practice • Ensuring they acquire competency to protect patients and practitioners • Being trained by nurse colleague who understands role • Simulated training • Helps overcome fear and enables transition from assistant to practitioner

15. Conclusion • Nurses can be supported to undertake BM’s and obtain specimens of satisfactory quality • Motivated staff • Structured training programme • Nurse-led services are likely to be holistic • Able to identify patient needs not met in the past • Likely to consider broader aspects of health care • Service management • Justification of any new service must be thoroughly explored • Primary aim to improve patient care

16. Questions?