护士主导的缺铁性贫血规范化管理方法,实现2周癌症通路目标和减少住院:实用性和成功案例的经验教训

IF 2.4 Q3 GASTROENTEROLOGY & HEPATOLOGY Frontline Gastroenterology Pub Date : 2023-11-20 DOI:10.1136/flgastro-2023-102438
Pauline Reid, Kev Patterson, Emma McCulloch, Laura Walsh, Amal Murshid, William Kinsella, Andrew Moore, Thomas Skouras, Philip J Smith
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引用次数: 0

摘要

贫血最重要和最常见的原因是缺铁,当铁的吸收不能满足身体的需要时,由于生长、怀孕、营养不良、吸收不良或失血。据估计,在英国,11%的成年人患有缺铁性贫血(IDA),调查是必要的,以排除重大病理作为潜在原因。研究表明,IDA负责英国57000例住院病例,每年至少有10%的胃肠病学转诊。IDA是胃肠道癌的主要危险症状。在皇家利物浦大学医院,一个专门的护士主导的IDA服务于2005年开发,以帮助减轻两周的疑似癌症转诊途径所造成的临床压力。由于这项服务的成功,对缺铁的调查和管理已扩展到事故和急诊的转诊,目的是减少住院人数,并调查和优化术前患者的铁替代疗法。胃肠病学医疗团队提出以护士顾问为主导的服务方式提供这种服务,他们认为,作为一个具有完善的、已发表的调查算法的临床问题,IDA将适合在专门的护士领导的诊所进行管理。本文将重点介绍为获得足够的资源和诊所能力来有效地开展这项服务,发展强有力的护士教育和培训以及发展商定的调查途径所采用的策略。建立了一个强有力的结果审查过程,对异常结果进行快速管理,对结果正常的患者及时出院。优化铁替代疗法和验证持续的血液学反应是优先考虑的,因为这在所有专业中都被认为管理不善。包括一个持续审计结果的过程,以显示服务的成功并突出需要重新设计的领域。在这里,我们展示了护士主导的IDA服务的有效性,并建议将其作为英国及其他地区其他IDA服务的基础。
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Nurse-led approach to standardising the management of iron-deficiency anaemia, achieving the 2-week cancer pathway targets and reducing hospital admissions: practicalities and learnings from a success story
The most significant and common cause of anaemia is iron deficiency, which occurs when iron absorption cannot meet the body’s demands due to growth, pregnancy, poor nutrition, malabsorption or blood loss. It is estimated that in the UK 11% of the adult population have iron-deficiency anaemia (IDA) and investigation is essential to exclude significant pathology as the underlying cause. It has been shown that IDA is responsible for 57 000 hospital admissions in the UK, and at least 10% of gastroenterology referrals per annum. IDA is a major red flag symptom for gastrointestinal cancer. At the Royal Liverpool University Hospital, a dedicated nurse-led IDA service was developed in 2005 to help alleviate the clinical pressures created by the two week suspected cancer referral pathway. With the success of this service, investigation and management of IDA has been extended to referrals from accident and emergency, with the aim of reducing hospital admissions and to investigating and optimising iron replacement therapy in preoperative patients. Delivering this as a nurse consultant-led service was proposed by the gastroenterology medical team who felt that, as a clinical problem with well established, published investigative algorithms, IDA would be suitable for management in a dedicated nurse-led clinic. This article will focus on the strategies employed to achieve sufficient resources and clinic capacity to run this service effectively, develop strong nurse education and training, and the development of agreed investigation pathways. A robust results review process, with rapid management of abnormal results, was established with timely discharge for those patients with normal results. Optimisation of iron replacement therapy and verification of sustained haematological response was prioritised as this was identified as being poorly managed across all specialties. A process for ongoing audit of results was included to show the success of the service and highlight areas for redesign. Here, we demonstrate the effectiveness of our nurse-led IDA service and suggest it as the basis for other IDA services in the UK and beyond.
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来源期刊
Frontline Gastroenterology
Frontline Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.70
自引率
11.50%
发文量
93
期刊介绍: Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology and hepatology. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. Specifically Frontline Gastroenterology publishes articles in the domains of clinical quality, patient experience, service provision and medical education.
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