IBD inpatient care audit - Adult report - round three 2012

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This is the third round of national audit for inpatient care for adult patients. The full reports contain detailed information about the provision of inpatient care including how the situation has changed across the different rounds of the audit.

Key recommendations

  • All IBD patients with diarrhoea should have stools sampled for both Standard Stool Cultures and Clostridium Difficile Toxin testing.
  • All appropriate IBD patients should be given heparin to reduce the risk of thromboembolism.
  • Clinicians should consider the use of rescue medical therapy for patients that do not respond to intravenous steroids.
  • Where IBD Services have IBD clinical nurse specialist provision, the nurse should always be made aware of any IBD inpatient that is planned to commence Anti-TNF treatment to ensure appropriate counselling and screening is undertaken prior to the infusion.
  • Bone protection should be prescribed to all patients who receive corticosteroids
  • Further long term data is needed on the safety, efficacy and appropriateness of use of Anti-TNF drugs. IBD Services are encouraged to participate in the ongoing Biologics audit element of the UK IBD audit (www.ibdbiologics.org)
  • IBD Services are strongly encouraged to review the maintenance strategies for Crohn’s disease. Many patients with Crohn’s disease were admitted on 5-ASA drugs and there is no evidence that 5-ASA is superior to placebo for the maintenance of medically induced remission in Crohn’s disease.
  • The use of immunomodulators and biological therapies, in keeping with the 2011 BSG Guidelines for the management of inflammatory bowel disease in adults, will help to reduce long-term steroid use and the need for admission
  • Many IBD patients suffer from malnutrition. A dietician should see all Crohn’s disease inpatients and a multidisciplinary nutrition support team must be available to IBD Services to offer advice on those patients who may require more complex enteral and/or parenteral nutritional support.
  • Smoking cessation is an important factor in maintaining remission and reducing the risk of relapse in Crohn’s disease. IBD Services should do more to encourage patients with Crohn’s disease to engage with formal smoking cessation services.