UK consensus on non-medical staffing required to deliver safe, quality-assured care for adult patients undergoing gastrointestinal endoscopy

Dunkley, Irene; Griffiths, Helen; Follows, Rachael; Ball, Alison; Collins, Mandy; Dodds, Phedra; Gardner, Richard A.; Jackson, Victoria; Rodgers, Claire; Simpson, Barbara; Taggart, Nicky; Tham, T. C. K.; Wilkin, Vivienne; Veitch, Andrew

doi:10.1136/flgastro-2017-100950

Cited by 14 publications

(24 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Currently, the standard of care for assessing BO and OVs is hospital-based C-OGD. This requires a fully equipped endoscopy department, complete with nursing support, recovery facilities, monitoring and decontamination rooms 9. Patients frequently require conscious sedation 10.…”

Section: Introductionmentioning

confidence: 99%

Acceptability to patients of screening disposable transnasal endoscopy: qualitative interview analysis

et al. 2019

View full text Add to dashboard Cite

ObjectivesScreening in selected high risk populations for Barrett’s oesophagus (BO) and oesophageal varices (OVs) has been proposed, but there are obstacles with conventional oesophagogastroduodenoscopy (C-OGD), including patient acceptability. Portable and disposable office-based transnasal endoscopy (TNE) is a feasible and accurate alternative to C-OGD that may have use in primary and secondary care. This article outlines a qualitative analysis of patient experiences of TNE and C-OGD in order to gain an insight into an acceptable delivery of an endoscopic screening service.DesignPurposeful sampling identified 23 participants who then underwent semi-structured interviews to determine their experiences of both procedures. Thematic analysis was conducted to derive meaning from their lived experiences.SettingA secondary care endoscopy unit, clinic room and interview room.ParticipantsPatients referred for BO or OV surveillance and for endoscopy to investigate dyspepsia underwent unsedated TNE using the EG Scan II device followed by C-OGD with or without sedation (patient choice), as part of a clinical trial.ResultsThe themes that arose from our analysis were: inclusivity in one’s own healthcare, comfort level and convenience, validity of the procedure and application to a screening population and a sense of altruism and reciprocity. Positive aspects of TNE included participant empowerment, reduced discomfort and avoidance of conscious sedation. Participants felt that if TNE screening was of proven efficacy it would be welcomed, though views on use in a community setting were mixed.ConclusionsMost patients preferred TNE to unsedated C-OGD and the reasons they gave featured strongly in the emerging themes. Preferences between TNE and sedated C-OGD were more subtle, with equivalent comfort scores but merits and drawbacks of both being discussed. This information identifies opportunities and challenges in establishing an endoscopic screening service. Trial registration number ISRCTNregistry identifier: 70595405; Pre-results.

show abstract

Section: Introductionmentioning

confidence: 99%

Acceptability to patients of screening disposable transnasal endoscopy: qualitative interview analysis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Five of these documents were updates of previously published guidelines 18,23,34 or position statements 43,45 -only the most recent versions were included 20,24,27,44,46 ; 2 citations were considered companion documents for each other and treated as a single result. 38,39 Therefore, 26 documents were included in the nal synthesis, including 19 guidelines [19][20][21][22][24][25][26][27][28][29][30][31][32][33][35][36][37]39,40 and 7 position statements. 41,42,44,[46][47][48][49] Characteristics of Included Documents A summary of the characteristics of the included documents is provided in Supplemental Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The majority (n = 22) of included documents scored <60% in the rigor of development domain. Of these, 15 were guidelines [19][20][21][22][25][26][27][28][29][30][31][32][33]35,37 and 7 were position statements. 41,42,44,[46][47][48][49] Only 9 documents 24,26,27,29,31,33,36,40,49 provided a grade or level of evidence in support of their recommendations, making it di cult to assess the evidentiary base for the reported recommendations.…”

Section: Resultsmentioning

confidence: 99%

“…Recommendations for the healthcare personnel required for monitoring sedated patients were discussed in 17 documents (12 guidelines [19][20][21][22]24,25,27,[30][31][32]36,37 and 5 position statements 41,44,[46][47][48] ); few documents detailed the level of evidence or the strength of these recommendations (n = 3) 24,31,36 (Supplemental Table 3).…”

Section: Personnel Responsible For Monitoring Sedated Patientsmentioning

confidence: 99%

“…Two documents 20,25 made recommendations for monitoring patients under general anesthesia; however, recommendations in these documents differed. A guideline from Joint Advisory Group on Gastrointestinal Endoscopy (JAG) 25 recommended that an anesthesiologist be present to monitor patients under general anesthesia, whereas a guideline from GESA 20 recommended that both an anesthesiologist and an individual dedicated to assisting the anesthesiologist be present. Documents providing recommendations for monitoring patients sedated with propofol were generally in agreement that use of propofol sedation requires an individual dedicated to monitoring the patient who has no other responsibilities, necessitating a second individual to assist the endoscopist with the procedure.…”

Section: Personnel Responsible For Monitoring Sedated Patientsmentioning

confidence: 99%

See 2 more Smart Citations

Sedation Practices for Routine Gastrointestinal Endoscopy: A Systematic Review of Recommendations

Dossa

Megetto

Yakubu

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures. Methods We systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded. We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. Results We identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations. Conclusions Recommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency. Registration Number CRD42019141076

show abstract

LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19

et al. 2021

View full text Add to dashboard Cite

The UK's response to the pandemicThe UK has recorded one of the highest death rates associated with COVID-19 globally, whether measured as deaths that are directly attributable to COVID-19 or by excess mortality. The reasons for this high rate are complex and not yet fully understood, but elements of the UK Government response have been criticised, including delayed implementation of physical distancing measures, poor coordination with local authorities and public health teams, a dysfunctional track and trace system, and an absence of consultation with devolved nations. The role of the National Health Service (NHS) and relevant national executive agencies in relation to testing capacity, availability of personal protective equipment (PPE), the cancellation and postponement of many aspects of routine care, and decisions around discharge from hospital to care homes should also be critically examined. Conversely, aspects of the response by the NHS and relevant national executive agencies deserve recognition. In only a few weeks, capacity for critical care was mas sively expanded, many thousands of staff were reallocated, and services were reorganised to reduce transmission of SARS-CoV-2. The NHS also collaborated with academic institutions to share knowledge about clinical characteristics of the disease and to establish world-leading clinical trials on vaccines and treatments.The response to COVID-19 brings to attention some of the chronic weaknesses and strengths of the UK's health and care systems and real challenges in society to health. Failures in leadership, an absence of trans parency, poor integration between the NHS and social care, chronic underfunding of social care, a fragmented and disempowered public health service, ongoing staffing shortfalls, and challenges in getting data to flow in real time were all important barriers to coordinating a comprehensive and effective response to the pan demic. More positively, the high amount of financial protection that was provided by the NHS and an allocation of resources that explicitly accounted for differing geographical needs have, to some extent, mitigated the already substantial effect of the pandemic on health inequalities. The London School of Economics and Political Science-Lancet Commission on the future of the NHSThis UK-wide London School of Economics and Political Science (LSE)-Lancet Commission on the future of the NHS provides the first analysis of the initial phases of the COVID-19 response as part of a uniquely comprehensive assessment of the fundamental strengths of and chal lenges that are faced by the NHS. The NHS has long been regarded as one of the UK's greatest achievements, providing free care at the point of delivery for over 66 million people from birth to death.Against this backdrop, and considering international evidence, this Commission sets out a long-term vision for the NHS: working together for a publicly funded, integrated, and innovative service that improves health and reduces inequalities for all. This Commission makes seven reco...

show abstract

UK consensus on non-medical staffing required to deliver safe, quality-assured care for adult patients undergoing gastrointestinal endoscopy

Cited by 14 publications

References 6 publications

Acceptability to patients of screening disposable transnasal endoscopy: qualitative interview analysis

Acceptability to patients of screening disposable transnasal endoscopy: qualitative interview analysis

Sedation Practices for Routine Gastrointestinal Endoscopy: A Systematic Review of Recommendations

LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19

Contact Info

Product

Resources

About