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Simon Turley Advanced Nurse Practitioner Colorectal Nursing Team

Established in 2003, this clinic addresses clinical needs of ileo-anal pouch patients with comprehensive referral criteria, surveillance protocols, and treatment protocols. The clinic has evolved to include telehealth services, refined documentation, and high patient satisfaction, with ongoing advancements to provide exceptional care for patients.

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Simon Turley Advanced Nurse Practitioner Colorectal Nursing Team

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  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

  8. 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

  9. 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

  10. 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

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