Transcript Document
Working as a Colorectal Nurse Specialist in Great Britain Liz Coni Colorectal Nurse Specialist Queen Alexandra Hospital Portsmouth Hospitals NHS Trust UK Aim To demonstrate how the roles and responsibilities of the Colorectal CNS contribute to the effective working of a multidisciplinary team (MDT) Introduction • • • • • • Service background Pre-operative/treatment phase Per-operative Post-operative Follow-up Future Service-1999 • • • • • • • Commenced post August 1999 Four surgeons One full time colorectal nurse specialist One part time MDT coordinator/research coordinator Two secretaries Three stoma care nurses Monthly MDT meeting held over lunchtime Service-2010 • • • • • • • • • Five surgeons Three full time colorectal nurse specialists One nurse endocopist One full time MDT coordinator One research coordinator Three secretaries Four stoma care nurses Weekly MDT meeting held in designated time Increase in number of core members Profile • • • • • 300 new patients per year 170 elective operations 70 emergency operations 50% of all patients require oncological treatment All major services on site, except TEMS and PET imaging • One surgical ward • Surgical high care unit • Laparascopic Colorectal Training Centre Role of MDT • • • • • • • • • • • Rapid and high quality diagnostic service Identify and review all new patients Patient information Advice Point of contact Appointment system Communication Audit Training Service improvement Adherence to local and national guidelines Role of Colorectal Nurse Specialist • • • • • • • • • • • Comprehensive service Effective management Efficient management Excellent communication Information, support and advice to all Audit User groups Service improvement Key worker Continuity MDT discussion Elements of role Colorectal Nurse Specialist • 30 hours per week • Colorectal Cancer and Stoma Care Manager Associate Nurse Specialist (2006) • 30 hours per week • Colorectal Cancer Associate Nurse Specialist (2009) • 37.5 hours per week • Role split between colorectal cancer and enhanced recovery Advanced communication skills course Psychological distress course Areas covered • • • • • • • • • • • MDT meeting Weekly diary meeting Two week wait clinics Outpatient department new referrals-colorectal, gastroenterology, bowel screening Endoscopy department Treatment centre Inpatients/enhanced recovery Virtual follow-up clinics Team meetings Phone calls Trouble shooting! Pre-operative/treatment phase New referrals • Meet patient and carers • Assess knowledge/understanding • Initial assessement • Support • Arrange diagnostic tests • Patient information • Questions/advice • Contact information MDT • MDT coordinator prepares agenda on spreadsheet, available to each prior to and at the meeting-35 approx • Hospital notes and Colorectal Nurse pack available on all patients • Surgeon presents patient • Discussed by team-surgeon, radiologist, oncologist, pathologist and nurses • Outcomes recorded by surgeons and nurses • Purple history sheet-surgeon • Proforma-nurse • Hand written notes of all patients by nurses Post MDT • Review outcomes for each patient • MDT coordinator notes tests/procedures and tracks for future meetings • Nurses identify patients to be seen in clinic • Arrange appointments • Telephone other patients discussed Patients to be seen • • • • For surgery For oncoloogical intervention and surgery For oncological intervention only Active monitoring Patients to be telephoned • Often already known to nursing team • Need further test/procedure • Awaiting treatment decision still MDT Clinic Proforma Colorectal MDT Clinic Proforma Patient Details: Name: DOB Hospital number Case Details: Site of tumour Stage/TNM Metastases? Histology MDT Meeting MDT Decision Resection / Stoma only / Stent / TEMS / Chemotherapy / Radiotherapy Other test / treatment Type of resection ?Extended / joint op ?Additional specialists Ureteric stents Metastases / indeterminates to be managed? Site of indeterminate lesions If yes, re-scan due Need to be examined by surgeon (e.g. for decision re APR /AR)? Need flexible sigmoidoscopy Referral to other MDT Specify team Date done Comments Date:…………………………………………………………………………………………………… Seen by: (delete as appropriate) CNS – Liz Coni Associate Nurse Specialist - Rosie Hopping Associate Nurse Specialist - Lesley Worrall OPD / WARD ATTENDER (delete as appropriate) DISCUSSION: (circle as appropriate) Surgery Radiotherapy Chemotherapy No intervention Other test / treatment PATIENT UNDERSTANDING MDT Assessment: nature and extent of disease? Treatment options MDT advice/decision PATIENT ACCEPTANCE proposed treatment FOR NON-OPERATIVE PATIENTS / MANAGEMENT WITH OTHER SPECIALITY Oncology OPA date OPA date for other consultant / team Comments Ye FOR OPERATIVE PATIENTS: Nature of operation proposed: Type Height Weight BMI Previous abdominal surgery: (excluding hernia repairs/caesarean sections) FITNESS: Fully independent? Limitations How far can you walk on the flat at normal pace Smoker Cardiac Angina • Frequency • What precipitates? MI Arrhythmia?: Valve disease / replacement?: Hypertension: CVA/TIA • If yes, details…………………………………………………………………………………………. Respiratory: Asthma COAD SOBOE? Diabetic?: Insulin / Oral agents / Diet controlled (delete as appropriate) Medications (NB Clopidigrel and Warfarin): ASPECTS OF OPERATION DISCUSSED: Major surgery discussed • Potential complications: • death • heart attack • pneumonia • ITU care • anastomotic leak • reoperation • stoma • abscess • infection • bleeding • blood clots • damage to nerves working bladder or sexual function • (please tick if discussed) Suitable for laparoscopic? Stoma: temporary or permanent Enhanced recovery programme FURTHER ASSESSMENT: Anaesthetic opinion: Referral date…………………………………………………………………………….. OPA date:………………………………………………………………………………... ECHO Referral date…………………………………………………………………………….. OPA date:………………………………………………………………………………... ITU opinion Referral date…………………………………………………………………………….. OPA date:………………………………………………………………………………... Stoma care Referral date…………………………………………………………………………….. OPA date:………………………………………………………………………………... SURGERY: PLANNED OPERATION DATE:…………………………………………………………………… SHCU / ITU?:........................................................................................................................... Admission procedure explained………………………………...……………………………….. Discharge planning:………………………………………………………………………………... Preclerking date…………………………………………………………………………………….. OPA WITH COLORECTAL SURGEON(specify):……………………………………………… (AS / DOL / ACP / JSK) Pre-operative phase • • • • • Pre-clerking to assess fitness Anaesthetic review if required Identify appropriate theatre list Allocated to consultant Consenting appointment Inpatient stay • • • • Admit on day Surgical high care unit post-operatively ERP nurse visits twice daily Home day 4-6 maximum Post-operative phase • Follow up appointment with colorectal nurses for histology results • Oncological referral, if required, completed by colorectal nurses together with consultant letter • Surgical follow up appointment with consultant, ideally at 6-8 weeks • Referred to Nurse Led Virtual Follow-up clinic, if appropriate Virtual Follow-up Clinic • • • • • • • • • Referred by consultant Usually colonic cancers Telephone clinic weekly 20 spaces at 10 minute intervals Follow imaging protocol Assess progress Book tests Symptom leaflet Contact details Future • • • • • User groups Feedback Amalgamate stoma care team Information-web based Develop Enhanced Recovery Programme