Perspective 2019

4 PERSPECTIVE 2019  4-6 Weeks Wait for a Send Away Result Introducing Patient Home Tests for Calprotectin in a Routine District General Hospital Pearl Avery, Lead Inflammatory Bowel Disease Nurse, Dorset County Hospital and Gastrointestinal/IBD Nurse of the Year 2018 Pearl Avery is based at Dorset County Hospital in Dorchester. In 2018 she received the Gastrointestinal/IBD Nurse of the Year award from the British Journal of Nursing. Pearl’s nomination resulted from her strive to provide the best care possible for patients in her local service. This included her pioneering work to introduce a new IBD patient management system which has earned national recognition1. It incorporates the IBD registry and the BÜHLMANN IBDoc calprotectin home test. Pearl tells us about the impact that the introduction of IBDoc has had for both patients and staff. “Prior to the introduction of the IBDoc home test, all our calprotectin tests were sent to an external provider. So the stool samples were collected by the patient and then dropped off at the GP, who would send them to Dorchester Hospital on the transport run. The lab would then batch the samples and send them to the external provider for analysis. Due to this process it would take anything between 4 to 6 weeks before we received a result! Having the calprotectin result was good, but it was historic, relating to the clinical situation 6 weeks previously rather than currently. So the patient’s condition may have improved or got worse in the interim. Some patients can have high calprotectin levels whilst exhibiting few symptoms, but in our experience it is still a good indicator that they will relapse in the near future. These cases are a real worry as the patients that feel well but have a high calprotectin level can end up having a bowel perforation. If there is a delay between the rise of the calprotectin levels and the onset of symptoms, having test results available much sooner would give us the opportunity to take action. Without a Calprotectin Result Treatment Decisions are Difficult We have been introducing the IBDoc system slowly for the last six months and uptake has been really good. Originally we had planned to get patients to bring in a sample and we would do the tests in clinic. However, 95% of patients enrolled so far are doing the test themselves at home. The procedure is quite simplistic – I train the patients using the basic pictorial guide that is in the kit which roughly takes 10 to15 minutes. It really makes it very simple. If I have any advice for other IBD nurses it is to do this early on in the consultation so that you have time to complete it and you can manage your time more effectively. We currently have around 1300 patients who attend the clinic and in the 6 months we have been using the IBDoc we have rolled it out to 97, so it will probably take a couple of years to switch things over completely. The focus so far has been with the patients who are taking biologics and my next goal is those who are on azothiaprine as they also need close monitoring. The main group of patients on the biologics tend to be slightly younger and so you might expect this demographic to respond better to App technology. However, we do have some older patients who are quite techno-savvy and have smartphones. Obviously it won’t be for all, but it has surprised us how well some of the older patients have responded. There will be those who won’t want to do it as we expand the test out, but at the moment we are probably enrolling those who are more likely to want to be involved. Patient Self-Management Obviously a big reason for us to switch testing methods was the time frame for the availability of results, but there is also a growing patient voice that wants to be self-managed, less reliant on health care professionals and waiting for results. Being in control and getting immediate results reduces anxiety for them ■ We do have one patient who studies away and he has taken a few tests with him. One test has already been done because he didn’t feel well and it gave a positive result, although it was less positive than the previous result. This then allowed us to reassure him that the treatment plan was working and to persevere because he can see the progression in a tangible fashion. ■ One of the doctors wanted to stop the azothiaprine on a patient who had been on the drug for several years. The send away calprotectin had been normal and the colonoscopy was normal, but the patient was really nervous. We managed to persuade the patient that she can have an immediate test if she feels unwell, so it has been agreed she will stop the drug and do an IBDoc test in 7 weeks and see me a few weeks after that. She can take the test at home so that if she feels unwell then she can check her calprotectin level at any time. She went away much more reassured. Simple step by step pictorial guide instructs patients how to use the IBDoc calprotectin test Pearl Avery with her IBD Nurse of the Year 2018 Award