OWE-036 Implementation of cytospongetm device training for nurses in primary care

Introduction The CytospongeTM device offers a less invasive way to test for Barrett’s oesophagus and early oesophageal cancer in patients with acid reflux symptoms. Due to the low cost compared with endoscopy, the device could have a direct impact on NHS spend. The procedure is safe, less time consuming, and should be straightforward for nurses to administer in a primary care setting. The BEST3 trial is a UK-wide randomised trial of CytospongeTM compared with usual care, which provides an ideal opportunity to determine the feasibility and roll out of the device for administration by Practice Nurses and Clinical Research Network Nurses. Methods A training module has been designed to ensure that nurses have background knowledge of Barrett’s and the clinical follow-up plan if a patient is given a positive diagnosis. Risks and benefits of having the procedure are explained and Standard Operating Procedures (SOPs) discussed to deal with any adverse events. Training is delivered in two stages: i) Centralised training where nurses attend in groups of between 2–10 individuals using a combination of videos, PowerPoint presentations and live clinical procedures. ii) Nurses observe at least one procedure and are then supervised until they feel confident. All nurses are then assessed by a trainer in their technique of safe delivery and withdrawal of the device. Once signed off they are able to carry out clinics independently with ongoing monitoring by the Trials Unit. Results 15 CRN Nurses and 8 GP Practice Nurses from 30 surgeries have been trained during the BEST3 trial. Following the training programme, the CRN nurses were generally deemed competent after 3 clinic sessions, whereas the Practice Nurses required 2 clinic sessions as they were more used to delivering clinical interventions. The nurses found that having the intense training close to the time of starting the clinics, and the extended supervision, enabled them to feel confident quickly. During the training phase, more patients required a second attempt to swallow the device before it was successful. Specifically, 9% of the patients received 2 CytospongesTM before the device was successfully swallowed and 4% (12 out of 331) were unable to swallow after two attempts. In comparison, 99% of patients received a successfully delivered device when administered by a Trainer. Conclusion The CytospongeTM device is suitable for delivery by nurses in the primary care setting. The feedback received on the training module was positive and therefore CytospongeTM training would be suitable to wider implementation in the NHS setting, with the added benefit of a potential cost reduction when compared with endoscopy.