Simon Turley Advanced Nurse Practitioner Colorectal Nursing Team

1. Simon Turley Advanced Nurse Practitioner Colorectal Nursing Team Oxford University Hospitals NHS Trust

2. Nurse-ledIleo-anal pouch clinic’s

3. History of the Clinic’s • Established in 2003 by Angie Perrin • Identified clinical need • Pilot study • Wrote referral criteria / protocols • Identified training needs

4. 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

5. 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

6. 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

7. 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

9. 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. 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

11. WHERE ARE WE NOW? • OPD - 3 x month, Tuesday afternoon Run by Fran, Simon & Jo B • Telephone – alternate weeks, Monday afternoon Run 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