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N010. A review of nursing consultancy to control patients with inflammatory bowel disease treated with thiopurines: Analysis and implementation of improvements

M. López-Parra, L. Moreno-Salas, A. Dosal-Galguera, M. Sánchez-Lloansí, A. Villoria-Ferrer, X. Calvet-Calvo, Hospital De Sabadell, Institut Universitari Parc Taulí, Digestive, Sabadell, Spain

Background

The nurse-driven outpatient clinic (N-DOC) for patients on thiopurine therapy was established in the Digestive Diseases Day Hospital in 2006 to improve follow-up and reduce medical visits. Results were analyzed by conducting a retrospective study three years after implantation of the programme. During the data collection process, aspects to be improved were detected and a more detailed analysis was conducted using the SWOT (Strengths, Weaknesses, Opportunities and Threats) [1]. SWOT analysis is the most widely used strategic planning tool to assess the current reality of organizations [2,3]. We applied it to the N-DOC in order to develop a strategic plan of improvement.

Methods

The SWOT is a qualitative methodology. The analysis was conducted by a group of experts who know the organization of the N-DOC and inflammatory bowel diseases (IBD).

Results

The SWOT analysis identified the following strengths: A better control of patients, with the easier access, timing flexibility, decrease of time required for analytical assessment and decision-making, reduction of medical visits, increased safety by detecting errors and loss of follow-up of patients who do not attend and/or eliminate controls. Identified weaknesses: increased nursing workload, increased incidence of patients who fail to attend controls, failure to apply the new circuit by some members of the healthcare team who are not aware of the details of the circuit of the N-DOC and continue with the previous circuit, limited work space, underestimation of the staff potential and experience, and barriers to the successful implementation of the new system (shortage of time and resources). Identified opportunities: an interesting project that manages to access to external funding, diffusion of this N-DOC may be an opportunity to introduce and apply it to other centres; a two-way project that enriches the team and patients, integrates individual experience with the best possible external evidence. Identified threats: the continuity of this N-DOC may be hampered by health budget cuts; some patients opt to have follow-up assessments in other centres (private primary care centres or laboratories); sensation of loss of power of other professional teams; use and abuse of trust of healthcare team by patients. Following this analysis, a strategic plan was designed to improve diffusion between the team, and apply changes to reduce workload, increase patient adherence and ensure continuous assessment.

Conclusion

The SWOT analysis allowed us to analyze our working system and suggest improvements, thus striving for excellence.

1. González de Dios, J., (2008), Análisis DAFO (Debilidades, amenazas, fortalezas y oportunidades) de la medicina basada en la evidencia, Bol SPAO, 2 (1): 34–40.

2. Filkins, J., (2003), Nurse Directors' jobs - a European perspective. Journal of Nursing Management, 11: 44–47.

3. Kalisch BJ and Curley M, (2008), Transforming a Nursing Organization, JONA, 38(2): 76–83.