Nurses are involved in different preoperative, perioperative and postoperative phases of treatment with intradetrusor injections of OnabotulinumtoxinA (Onabot/A). Little is known about the nursing expertise needed to perform the procedure safely. Aim of the study was to assess the learning curve of a nurse team for the Onabot/A procedure in out- patient setting.

After approval by our Institutional Review Board, we performed a pilot, prospective study. Nursing team of our center was recruited. We recorded nurse’s demographic, the number of procedures performed, the nurse team's preoperative, perioperative, and postoperative surgical time at baseline and at 6- months of the procedures performed. Nurses filled out the Nurse Competence Scale questionnaire (NCS-q) for the self- evaluation of clinical competence and underwent also to the VAS scale to evaluate the difficulty of learning the procedure (0: worst, 10: best). Additionally, we compared the surgical times of the Nurse Team under study with one Onabot/A injections expert nurse.

Seven nurses were enrolled (mean age [SD]: 49.58.4). The mean(SD) procedures performed for each nurse was: 8.44.7. One experienced surgeon on Onabot/A injections completed all the 58 Onabot/A injections in out- patient clinical setting. Data on the time required for pre- and peri-operative preparation are reported in Table 1. The timelines show that work pattern stabilized after 7 Onabot/A injections but with a continued decrease in procedure time. VAS score: 3.22.1. The NCS-q domain category “Managing Situation” (8 items) showed a mean ( SD) of 8.10.3. The comparison of the time of the patient’s preparation between the expert nurse and the 6- month experience of the nurse team was: 111.9 vs 122.2 (p< 0.5).

To date, this is the first study assessing duration and efficacy of the nurses learning curve for Onabot/A injections in out-patient clinic. The threshold of procedures required to complete the learning curve was low and nurses achieved a high level of expertise within 7 procedures. After achieving this proficiency, a continuous decrease in times in all phases of treatment related to nurses was demonstrated. The strength of this study was to demonstrate for the first time, from a nursing perspective, how the learning curve for Onabot/A injections is simple and short for nurses.

The nurse's expertise in the Onabot/A procedure is important for a better performance in the treatment and proper support to the patient. For this reason, the training of the nurses who assist the procedure is an area to be followed with care.