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P458 Multidisciplinary working when developing the UK inflammatory bowel disease standards and IBD audit

A. St. Clair Jones*1, S. Murray2

1Brighton and Sussex University Hospitals NHS Trust, Pharmacy, Brighton, United Kingdom, 2Royal College of Physicians, Clinical Effectiveness and Evaluation Unit, London, United Kingdom

Background

Chronic diseases entail high requirement of care, particularly when dealing with relapsing-remitting conditions such as inflammatory bowel disease (IBD). The first round of the UK IBD audit in 2006 demonstrated a marked variation in resources and quality of care for IBD patients across the United Kingdom.A multidisciplinary working group developed national standards, embedding and improving best practice through national audit.

Methods

The UK IBD Audit Steering group consisted of experts in the field of IBD practice and included doctors, nurses, a pharmacist, dietitian, and patient representative. Their primary role was to support the development and implementation of a national audit that would facilitate improvements in the quality and safety of care for UK IBD patients. Because the group met regularly and developed an intimate knowledge of and respect for each other’s role, they were able to consider the strengths and limitations of each profession, and they identified overlaps of professional responsibilities. The group supported the development of audit tools using professional judgement to negotiate the content, balancing the priorities of each profession with the practical demands of an acceptably sized audit. The UK IBD standards 2009 document updated in 20131 describes 6 standards of high quality care and underpins the NICE IBD quality standard 2015.2 This provided the framework to develop the UK IBD audit tools. Consequently 4 elements of audit were developed which included in-patient care, in-patient experience, biological therapy usage and organisational service provision that assessed and benchmark services against the IBD standards.

Results

The key findings from 3 of the audits demonstrate improvements of care and changes in practice.

Examples of improvementsFirst round 
2006Fourth round 2014
Sites with at least some (> 0 WTE) IBD nurses provision (%)5686
The IBD service is routinely supported by a named pharmacist with a special interest in IBD or gastroenterology (%)47**59
Sites with an identifiable gastroenterology ward on site (%)6795
Sites with guidelines for the management of acute severe ulcerative colitis (%)4784
Biologics pretreatment Harvey–
Bradshaw Index (median HBI score)9*7
Concomitant immunosuppression at initial treatment (%)5834
Patients seen by IBD nurse during admission (%)27*48
Prophylactic heparin prescribed (excludes elective surgical admissions) (%)7390
(Second round data, 2008–
2010 *) (Third round data, 2010–2012 **)

Conclusion

Assuring quality and improvement

The collaboration of disciplines was key to the development of high quality standards and the success of the UK IBD audit being adopted into the UK Health Quality Improvement (HQIP) audit programme. The UK IBD audit and the development of the UK IBDQIP tool have shown marked improvement of patient care at each round. Regional workshops showcased best practice models and peer review site visits have further supported the implementation of standards. A national registry and biologics data base are being rolled out.

References

[1] IBD Standards Group, IBD Standards, Oyster Healthcare Communications Ltd. 2013. http://www.ibdstandards.org.uk/uploaded_files/ibdstandards.pdf. Accessed Jan. 10, 2016.

[2] National Institute for Health and Care Excellence (NICE). Inflammatory Bowel Disease, NICE Quality Standard 81, NICE. 2015. https://www.nice.org.uk/guidance/qs81/resources/inflammatory-bowel-disease-2098903535557. Accessed Jan. 10, 2016.