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10/11/15 Adherence to ‘Immediate’ Instillation: Intravesical Mitomycin C post TURBT Sheila Doyle Wrexham Maelor.

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Presentation on theme: "10/11/15 Adherence to ‘Immediate’ Instillation: Intravesical Mitomycin C post TURBT Sheila Doyle Wrexham Maelor."— Presentation transcript:

1 10/11/15 Adherence to ‘Immediate’ Instillation: Intravesical Mitomycin C post TURBT Sheila Doyle Wrexham Maelor

2 Bladder Cancer 10,000 patients newly diagnosed p/a Many require TURBT Intravesical Mitomycin C (MMC) significantly reduces recurrence European Association of Urology guidance recommends 'immediate' instillation i.e. within six hours Local case reports of delayed doses 1. Cancer Research UK. Bladder cancer incidence statistics. Available from: http://www.cancerresearchuk.org 2. Babjuk M et al. Guidelines on Non-muscle-invasive Bladder Cancer (Ta,T1 & CIS). European Association of Urology. 2014.

3 Aim To assess compliance with European Association of Urology guidance. Instillation Definitions 'Immediate': < 6 hours post-TURBT 'Late': > 6 hours post-TURBT but < 24 hours 'Missed': > 24 hours or not administered

4 100% will receive MMC within six hours post-TURBT 100% will have reason documented if MMC late, omitted or contraindicated Audit Standards

5 Methodology Patients identified retrospectively via 'HostAccess' Case notes audited via Patient Records Time to MMC administration calculated Comparison with EAU guidance

6 Results Data for 50 patients 92% received MMC (n=46). 70% (n=35) had sufficient data to calculate timeframe 30% had insufficient data (n=11) or MMC was CI (n=4)

7 Graph 1: Time Elapsed from TURBT to MMC instillation per patient (n=46)

8 0% Graph 2: Percentage of patients (n=46) who received MMC immediately (n=29), late (n=6), missed (n=0), or not documented (n=11).

9 Figure 2: Reasons for late MMC administration (n=6) Graph 3: Reasons for late MMC administration (n=6)

10 Discussion 37% doses failed to meet EAU guidance Areas for improvement: Documentation issues Standardisation of ordering process UROLine devices Theatre administration

11 All doses within historical 24 hours post-TURBT 63% doses comply with EAU guidance No omitted doses! Short-term → standardise ordering system, staff education Long-term → theatre administration, UROline devices Conclusion 10/11/15 sheila.doyle@wales.nhs.uk

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