Simon TurleyAdvanced Nurse Practitioner

Colorectal Nursing TeamOxford University Hospitals NHS Trust

NURSE-LED ILEO-ANAL POUCH

CLINIC’S

HISTORY OF THE CLINIC’S

• Established in 2003 by Angie Perrin• Identified clinical need• Pilot study• Wrote referral criteria / protocols• Identified training needs

REFERRAL CRITERIA – ACUTE & ROUTINE

• Established ileo-anal pouch patients (x1 Colorectal Consultant only)• New ileo-anal pouch patients following 8 wk

surgical review• Individuals contemplating pouch surgery• Ileo-anal pouch patients experiencing

difficulties

OTHER NURSE-LED CLINIC ACTIVITY

• Referral to other health care professionals

eg.dietician, gastroenterologist, physiotherapist

• Refer for investigations eg. Flexible pouchoscopy, Defaecating proctogram, MRI, CT

SURVEILLANCE PROTOCOLS – NURSE-LED CLINIC

• 10 year anniversary of UC diagnosis – 3 yearly flexible pouchoscopy including biopsies

• Individuals with history of dysplasia – 2 yearly• FAP & PSC – annual pouchoscopy and

gastroduodenoscopy• Annual bloods - FBC, U&E’s, LFT’s Vit B12 & Ferritin• Introduction of routine telephone follow-up in 2008

for established patients

POUCHITIS TREATMENT PROTOCOL• If patients have been experiencing pouchitis type symptoms for < 7

days commence Ciprofloxicin 500mg BD for 7 days and review by telephone at end of the course.

• If patients have been experiencing pouchitis type symptoms >14 days – Commence Ciprofloxicin, 500mg BD for 14 days.

• Treat symptoms of pouchitis with no more than 2 courses Ciprofloxacin before out-patient review, pouchoscopy +/- biopsies (when applicable).

• After a severe or prolonged attack of pouchitis consider reducing antibiotic with a titrating dose, rather than discontinuing immediately, or combination with metronidazole.

• If symptoms persist/recur consider referral Gastroenterologist

EVOLVING NURSE-LED CLINIC

• Telephone clinic• Ceased routine rigid pouchoscopy• Referrals from all Colorectal Consultants &

Gastroenterologists• Referrals from external sources – GP’s & CR

Consultants in other Trusts• Refining Nurse-led documentation• 10 years since initial concept

10 YEAR NURSE-LED CLINIC AUDIT

• 110 questionnaires sent• 37.3% response rate• 100% respondents reported that they felt able to

discuss concerns or questions• 100% respondents felt that any concerns were

addressed to their satisfaction

WHERE ARE WE NOW?

• OPD - 3 x month, Tuesday afternoonRun by Fran, Simon & Jo B

• Telephone – alternate weeks, Monday afternoonRun by Fran, Simon, Jo B & Jo P

• Kangaroo Club IA pouch booklet – ibook, link:https

://itunes.apple.com/us/book/the-ileoanal-pouch/id833673912?ls=1&mt=11