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

2. Nurse-led Ileo-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 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:
pouch/id ?ls=1&mt=11