Nurse Endoscopist New Model of Care -Colonoscopy Sonny Ward Project Officer, Nurse Endoscopist Pilot Project Office For Professional Leadership Debra Pratt Principal Nursing and Midwifery Advisor, Pilot Project Lead Public I1 – A1

Nurse Endoscopy Model of Care Pilot Project The driver for our business case to introduce a Nurse Endoscopy Model of Care Pilot Project that would provide an opportunity for three nurses to work towards the advanced level, and be trained under the supervision of medical specialists to perform low-risk non-complex colonoscopies as part of a multidisciplinary team was based on research evidence in regards to bowel cancer, the positive effects of bowel screening and the role of nurse endoscopists.

Drivers for Model of Care Pilot Project The National Bowel Cancer Screening Program (NBCBP) having commenced in 2006, has introduced biennial screening to cover all Australians aged 50 – 74 by 2020. It is estimated that around 2.5 million people will be offered free FOBT screening each year, preventing 300-500 deaths from bowel cancers.

Drivers for Model of Care Pilot Project Bowel cancer is the second most common cancer diagnosed in males (after prostate cancer) and in females (after breast cancer) in Australia. It is estimated that in 2020, the number of new cases diagnosed in Australia will be: Males 10,800 Females 9,160 In 2015, it was projected that 431 South Australians would die of bowel cancer and that 1,234 new cases would be diagnosed. Up to 90% of bowel cancers can be treated effectively if found early. Australia 2011 to 2020 Australian Institute of Health and Welfare, Canberra

Bowel Cancer 90% treatable if detected early Second most common cancer Stage IV expensive to treat SA aged population to grow Anyone over 50yrs at risk Risk increases with age NBCSP full roll-out in 2021 Current waitlists long

Nurse Endoscopy Model of Care Pilot Project The national incidence of bowel cancer is highest in people aged 65 and over.

Nurse Endoscopy Model of Care Pilot Project It is projected that the South Australian population aged 65 and over will increase by 80.7% between 2011 and 2041.

Nurse Endoscopy Model of Care Pilot Project It is estimated that the national demand for colonoscopies each year from NBCSP alone will be approximately 75,000 per year from 2020. 6284 Data obtained from National Bowel Cancer Screening Program Monitoring report 2013-14 and Australian Atlas of Healthcare Variation 2013-14.

Nurse Endoscopy Model of Care Pilot Project The majority of South Australians with a positive FOBT result currently wait more than 30 days with only 11.2 % undertaking colonoscopy within the required priority timeframe. Our investigation lead us to uncover a significant growing waiting lists for colonoscopy within SA Health. National Bowel Cancer Screening Program Register as at 31 December 2015

Nurse Endoscopy Model of Care Pilot Project Bowel Cancer can be treated effectively if found early however this relies on accessibility to colonoscopy in a timely manner. Growing number of waiting lists and waiting times. A solution with budget constraints and increased demand. Workforce innovation – new career pathway. Scope of Practice – Advanced Practice role. Equal or better outcomes* with greater consumer satisfaction**. Source: *Overview of the planned introduction of nurse endoscopy in Queensland; **HWA Expanded Scopes of Practice program evaluation: Advanced Practice in Endoscopy Nursing sub-project: final report

Nurse Endoscopy Model of Care Pilot Project Nurse Endoscopists have been an established role internationally since 1977 in USA, UK, Canada, Netherlands, China and more recently NZ. There is extensive international and national research and evidence regarding the positive impact of the role.

Nurse Endoscopy Model of Care Pilot Project In 2012 Health Workforce Australia (HWA) undertook research into an expanded scope and an advanced scope of practice nurse endoscopy pathway which they subsequently evaluated and reported on in 2014.

Nurse Endoscopy Model of Care Pilot Project In Australia nurses have been performing colonoscopy in: South Australia between 2004 – 2010 RGH 2010– 2014+ FMC (Upper GI Endoscopy) Queensland since 2015 Nurse Practitioner Model Victoria since 2013 Advanced Practice Model State Endoscopy Training Centre, Austin Health, Victoria

Comparison of Training Models - Colonoscopy

Nurse Endoscopy Model of Care Meetings Weekly pathology meeting Weekly endoscopy office meeting Attend gastroenterology conferences Patient Education Provide pre-and post-operative supportive care Develop and update patient education materials Health promotion and health education of National Bowel Cancer Screening patients Facilitate onward referrals Provide assistance to gastroenterology patients with general queries Nurse Endoscopy list Manage and perform nurse-led colonoscopy lists Provide reports on endoscopy procedures Maintain procedural log book Follow up histology Nurse Pre-Assessment Clinic Assess GP referral patients in clinic and consider for endoscopy procedure Pre procedure assessment for patients from the National Bowel Cancer Screening Program Nurse Post Endoscopy Review Clinic: Review patients after endoscopy in clinic Review histology reports Onward referral to other services Monitoring and Evaluation Develop and maintain bowel cancer screening and follow-up patients Translating evidence into practice Training Provide education to staff Provide resources such as patient information pamphlets at request Support and guidance for Nurse Endoscopist trainees Participate in Professional Development Nurse Endoscopy Service Inter-professional Patient education Monitoring Evaluation Nurse post endoscopy review clinic Nurse Pre-assessment clinic Nurse Endoscopist list

Benefits of the model Nurse Endoscopists work within multi-disciplinary teams under the supervision medical specialists. Allows nurses and other professionals to work to their full scope of practice. Uses a patient centred model. The team approach combines varying talents to maximise the efficiency and effectiveness of the health care team in its delivery of health services to support consumers and families. A credentialing system already in exists in SA Health to credential nurse endoscopists. Reduce the waiting list for colonoscopies for SA Health. Timely service delivery.

Nurse Endoscopy - Colonoscopy Training Pathway

Nurse Endoscopy Trainee Entry Requirements (Colonoscopy) Current registration as a Registered Nurse with the Nursing and Midwifery Board of Australia. Minimum of 5 years full-time equivalent FTE clinical experience as a Registered Nurse (post registration). Of which, minimum of 3 years clinical experience within gastroenterology specialty. A relevant post graduate qualification is desirable.

Evaluation Key Performance Indicators No. Category Performance Indicator 1.1 Efficiency Throughput volume 1.2 Patient flow time (minutes) 1.3 Wait time for colonoscopy services 2.1 Proficiency Number of colonoscopies performed per annum 2.2 Caecal intubation rate determined by photo-documentation of caecal landmarks 2.3 Mean colonoscope withdrawal time 2.4 Adenoma detection rate 2.5 Polyp retrieval rate 2.6 Percentage of adverse events and complications 2.7 Consumer (Patient) feedback 3.1 Access Incremental number of endoscopic procedures completed within the Endoscopy Unit Reduced length of procedure waiting times 4.1 Sustainability Acceptability by other health care professional and key staff 4.2 Scope of Advance Practice 4.3 Economic analysis

Nurse Endoscopy Model of Care Pilot Project The research and evidence strongly support that the benefits of an advanced practice nurse endoscopist model of care, with nurses trained to perform colonoscopies, would allow the different professionals to work to their full scope of practice, within a person-centred model of care that combines the various talents and maximises the efficiency and effectiveness of the health care team, improve endoscopy services, and most importantly patient outcomes.

Nurse Endoscopy Model of Care Pilot Project Pilot Project Status: Business case endorsed in late 2016 with funding confirmation in early 2017. Host pilot site - TQEH (Surgical Division). Three nurse endoscopist trainees commenced in June 2017. Training partnership: State Endoscopy Training Centre, Austin Health, Victoria. Graduate Certificate in Endoscopy Nursing, University of Hull (UK). Evaluation partner: University of Adelaide. Picture: Director of Endoscopy Dr Rhys Vaughan with Nurse Endoscopist Jomon Joseph, Austin Health

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