The IBD Nurse Specialist Service at CUH GP education update evening Dee Braim Nurse Specialist 17/10/20
Background 2006-1 st UK-wide IBD audit performed within gastroenterology 2009 IBD standards were recommended 17/11/
IBD standards (2009) evolving from national audit Standard A: High Quality Clinical Care Standard B: Local Delivery of Care Standard C: Maintaining a Patient-Centred Service Standard D: Patient Education and Support Standard E: Data, Information Technology and Audit Standard F: Evidence-Based Practice and Research 4 rounds of audits are demonstrating continued improvement https://www.rcplondon.ac.uk/sites/default/files/ibd_audit_summary_report.pdf http://www.ibdstandards.org.uk/uploaded_files/ibdstandards.pdf
THE TEAM Specialist consultant Colorectal surgeon IBD CNS Stoma CNS Ward nurse Dietitian Nutrition team GPs Dermatology Ophthalmologist Rheumatologist Obstetrician Stoma nurse Continence nurse IV nurses Histopathologist Radiologist Smoking cessation nurse Psychologist/counsellor Enhanced recovery nurse Secretaries
Scope of practice of the IBD nurse specialist RCN 2009 Telephone /email advice line (600 contacts over 18mth) Follow-up clinics (6 7 patients per session) Rapid access clinics (within 5days) In-patient support Self management plans Prescribing medication. Immunosuppressive + biologic pre screening and counselling Managing an immunosuppression service (blood monitoring) Liaising with CCG for biologic approval Coordinating MDT meetings and facilitating follow ups Liaising with GP practice nurse (advice) Providing education and counselling to patients/families Providing teaching and support for staff Audits Cancer surveillance Internal /external referrals Providing nutritional advise Health promotion
Objectives Reduce A+E attendance Hospital avoidance Reduced length of stay Reduced admissions Patient safety Patient satisfaction
Point of contact My contact details on footer of each clinic letter Patient given IBD care card (email address + telephone answer phone no.) Patients given leaflet on IBD Service Patient given pack from Crohn's + Colitis UK
How far have we come as a service? IBD admissions down year on year
Biologic service growing
NO COMPLAINTS PATIENT SATISFACTON GOOD VERBAL FEEDBACK FRIENDS AND FAMILY TEST POSTIIVE COMMENTS AND SCORES SERVICE DEVELOPMENT EVALUATION OF A MULTIDISCIPLINARY ONE STOP CLINIC FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Introduced One stop clinic 2015 Cost savings for patient, less travel + expenses Pt. satisfaction Reduce clinic appointments Facilitate robust timely management plans Meet standard A. High quality clinical care (2009) Time off work
Clinic design Second Tuesday afternoon of the month. 4 Consultant Gastroenterologists. 2 Colorectal Surgeons I.B.D Nurse Stoma Nurse Dietician.
Evaluation of the clinic Literature Search very poor yield. None within IBD Other specialties offering similar HIV + liver, Pelvic floor clinic, etc. E Mailed to fellow I.B.D Nurses to see if they offered a one stop clinic.
What our colleagues are doing.
Questionnaire Inviting patients to answer 6 short questions and add comments
Q1. How long did you spend at the clinic
Q2.How many people did you see?
Q3. Where you given too much information or was it just right? I felt I wasn t given too much information. Just right Just right. Just right. Just right. Just about right. Took time to explain and answer questions and very thorough, for me at times a little confusing, but its difficult to get the balance right. Just Right. Enough information. Perfect balance for me.
Q4. What did you think about seeing all the clinical members of the team on the same day?
Q5.How does the one stop clinic suit you as an individual? Just right. I am very pleased. Simple, do not need to travel around. Prefer this clinic. It works well. Much more preferable for me. O.K Much prefer as I work. Save time. Such a good idea, works well for me.
Q6. Would you recommend the one stop clinic? 100%
Q7. Any other comments?
Recommendations for future practice? To continue to collect patient evaluations on the service we deliver at the one stop clinic, and to improve the patient experience. To publish our findings. To share our experiences with other units and share their experiences. To encourage our colleagues to work with their IBD nurses to improve the services available to IBD patients.
Patient panel Team approach to IBD management
Thank you for listening Dee Braim IBD Nurse Specialist Ph. 020 8 401 3000 ext. 34484 Fax. 020 8 401 3495 Email d.braim@nhs.net CH-TR.IBDCUH@nhs.net
Further reading and resources British Society of Gastroenterology www.bsg.org.uk Mowat et al (2011) Guidelines for the management of inflammatory bowel disease in adults, Gut, CORE (The Digestive Disorders Foundation) www.digestivedisorders.org.uk Crohn s & Colitis Foundation of America www.ccfa.org ia the Ileostomy and Internal Pouch Support Group www.the-ia.org.uk Crohns and colitis UK www.nacc.org.uk Royal College of Nursing www.rcn.org.uk Royal College of Nursing (2006) Telephone advice lines for people with long-term conditions. The RCN IBD Special InterestGroup IBD Passport
The IBD programme 4 th round ( 5 elements) 1. Inpatient care audit Assesses in-patient treatment on the first 50 patients admitted with ulcerative colitis in 2013. Data collection period: 1 January 2013-31 December 2013 Reporting: June 2014 2. Inpatient experience questionnaire Assesses in-patient quality of patient care (questionnaire) Data collection period : 1 January 2013-31 January 2014 Reporting: June 2014 3. Biological therapy audit Collects information about treatment, delivery, disease activity and quality of life in patients who are prescribed Infliximab or Adalimumab for IBD. Data collection period: Continuous Reporting: September 2015 4. Organisational audit A web-based self-assessment which enables hospitals to measure their organisation of care compared to national service standards. The tool identifies areas for improvement and facilitates change. Data collection period: 3 February 2014-31 March 2014 Reporting: August 2014 5. Quality improvement initiatives Peer support visits, where hospitals are paired up and meet to compare results and identify methods for improving the quality of care for patients. The IBD programme team supports the clinical teams to share best practice and explores new ways of working.