N-ECCO Travel Award Report - Goedele Dewitte
Goedele Dewitte, ECCO Member
General information
Name: Goedele Dewitte
Occupation: Nurse Consultant IBD
Observation period: 24–28 October, 2022
IBD location: St. Mark’s Hospital, Central Middlesex, London
Local Supervisor at St. Mark’s: Prof. Hart and ANP-IBD Nurse Madhoor Ramdeem
Supervisor at current IBD unit, Ghent University Hospital: Prof. Lobaton and Dr. Geldof
 Goedele Dewitte © Goedele Dewitte |
Background
St Mark's Hospital in London is the only hospital dedicated solely to gastrointestinal pathology. It includes a reference IBD unit, a world centre of excellence for endoscopy (Wolfson unit) and an intestinal failure/rehabilitation unit. Both the endoscopy and the intestinal rehabilitation unit work in harmony with the IBD unit to optimise the care for tertiary and complex IBD pathology.
This observational internship was intended to increase insight into the organisation of a tertiary, high-volume IBD reference centre from the nursing point of view.
Summary of observational internship
On Monday 24 October, I started the observership by following the ward round on the intestinal failure unit. During this round, a multidisciplinary team of doctors, a nurse specialist, dietitians and a pharmacist visited the admitted patients. All of the patients had been receiving parenteral nutrition (PN) for several years. I also joined the telephone clinics through which patients on home PN are followed.
On the subsequent three days, I joined the IBD team. Nine nurse specialists (six clinical nurse specialists and three advanced nurse practitioners) form the IBD nursing team. Four biologic nurses organise the transfusion unit and manage the induction, administration and follow-up of biologics. There are also specific IBD pharmacists who help with the funding of the biologics, problems with medications and follow-up of immunosuppressives.
There are some topics that I would like to discuss in more detail:
IBD advice line
St Mark's Hospital has an extensive telephone IBD advice line. All the nurses work on this. The patient calls the advice line and leaves a message on voicemail. The secretary does an initial triage of the messages and adds tags so that the nurses know the basic content of the message. Afterwards, the nurse does a telephone consultation during which he/she may autonomously make adjustments to the treatment plan.
IBD clinics
The IBD Nurse does his/her own consultation with patients who have a scheduled appointment. Most of the time these are patients in remission. The nurse can speak with one of the IBD specialists when there are problems with the patient.
Multidisciplinary approach
Each member of the IBD team knows exactly what they can and can’t do. There is a lot of confidence in the nurses, so they can work autonomously. When an MDT meeting is held, each member gives a summary of problems or changes. The MDT meeting involves not only the medical staff but also pharmacists, dietitians, etc.
Care of stoma patients
On my last day I had the opportunity to follow the stoma and pouch team, who have great expertise and knowledge on the surgical procedures and are well experienced in offering guidance to stoma patients. I learned a lot on how to support and guide patients. In the hospital you only see those patients who are having difficulties with their pouch/stoma, but with better guidance the size of that group can be reduced.
Conclusion
In general I cannot draw major comparisons between the IBD unit at Ghent University Hospital and that at St. Mark’s. In the UK there is a completely different organisation of the healthcare system. The nurses have their nursing degree but they have also had more training in making prescriptions and in nursing assessments, as well as specialist IBD training. Such special training is not available in Belgium.
Nevertheless, I had a wonderful time at St. Mark’s. I met amazing, talented IBD Nurses and I returned with a booklet and a head full of ideas. This observership will hopefully further strengthen the bond between the centres and contribute to the continuing cooperation between Ghent University Hospital and St Mark's IBD unit.
Finally, I would like to thank ECCO, St. Mark’s and the IBD unit of Ghent University Hospital for providing me with this opportunity.