A nurse’s perspective on the use of the RX biliary system Presented by Loraine Mahachi RGN, SP, BSc (Hons) Lead Practitioner, Endoscopy, South Warwick NHS Foundation Trust, England RX experience, ESGENA workshop UEGW Barcelona, Oct 2010
Overview • What is RX system • Why RX system • Who was involved in RX system • Challenges • Conclusion
Why RX system • DON’T LOOSE THE WIRE!!
Endoscopic Rectrograde CholangioPancreatography (ERCP) • ERCP used for patients with known or suspected biliary or pancreatic disease. Enables examination of Biliary tree/pancreatic duct using X-ray • Therapeutic procedure includes sphicterectomy, stent insertion, or stone retrieval (by baskets, balloon or lithotripsy) • ERCP is perhaps the most rewarding endoscopic procedure performed by gastroenterologists. It is also the most dangerous . (Cotton & Williams, 1996) • The overall complication rate of ERCP is 5%....sphincterectomy has 10-40%, similar to coronary artery bypass surgery. (Travis et al, 2005)
Why RX system ….cont • Advance in technology • Importantly! Quality of procedure • Easier device manipulation for the assisting nurse • multiple balloon trawls no need to manipulate wire on balloon withdrawal or advancement • One stop shop • reduced number of patient re-scopes due to higher success rate and thus impact on waiting lists • Time saving, minimal exchange, reduce loose of wire position
Why RX system ….cont • Reduced stress levels in room • user friendly for new Nurses • Improved communication between Endoscopist and Nurse • Changing existing culture –nurses frightened to assist in ERCP due to complex of equipment • Health and safety • Reduced fluoroscopy due to locked wire • No wires flicking in the air • Potential reduction of complication “Trained nurses/assistants required to assist the Endoscopist and manage the complex equipment. The quality of this assistance can make the difference between success and failure, triumph and disaster.” (Cotton & William, 1996)
Who was involved in RX system (Team Collaboration) • Endoscopy staff • Gastroenterologist • Purchasing and procurement • Management/ Finance • Boston Scientific Rep & Trainer course • Good Communication is essential
Challenges in using the RX system • Experienced ERCP nurses- deskilling • Training • Resistance to change • Finance and changing management’s perception
Conclusion • Why RX? Important to give patients quality procedures • Managing and facilitating change-Team leader to take role of change agent • Challenges in change but collaboration is important • Lastly…NO more you lost the wire!!
References • Travis, S.P.L., Ahmad, T., Collier, J and Steinhart, A.H (2005) Pocket Consultant Gastroenterology. Blackwell publishing ltd, Oxford • Cotton, P. and Williams, C. (1996) Practical Gastrointestinal Endoscopy. 4th Ed. Blackwell Science ltd, Oxford.
Any Questions? Endoscopy Unit Staff, Warwick Hospital