A UK TRAINING-PROGRAM FOR NURSE PRACTITIONER FLEXIBLE SIGMOIDOSCOPY AND A PROSPECTIVE EVALUATION OF THE PRACTICE OF THE FIRST UK TRAINED NURSE FLEXIBLE SIGMOIDOSCOPIST

Background-Flexible sigmoidoscopy is a technical skill that has been s uccessfully performed by suitably trained colorectal nurse practitione rs in the USA. However, no recognised training course exists for nurse practitioners in the UK. Aims-To design and evaluate a training progr amme for nurse endoscopists. Methods-A multidisciplinary committee of nurses and clinicians developed a structured programme of study and pr actice. This involved a staged process of observations, withdrawals, a nd ultimately, full procedures. Once training had been completed the n urse practitioner was permitted to practice independently. Patients wi th colorectal symptoms referred for flexible sigmoidoscopy were examin ed for the final stages of training and independent practice. A prospe ctive evaluation of the training and practice of the first trained nur se flexible sigmoidoscopist was performed. Barium enema, video, clinic al follow up, and histology were used to validate the results of the f lexible sigmoidoscopies. Results-The training programme required that 35 observations, 35 withdrawals, and 35 supervised full procedures wer e performed prior to the development of independent practice. Subseque nt to the completion of this programme 215 patients have been examined independently by the nurse practitioner. Ninety three per cent of the examinations were judged successful and pathology was identified in 5 1%. The nurse endoscopist successfully identified all ''significant'' pathology whereas barium enema failed to identify pathology in 12.5%. There were no complications. Conclusion-With suitable training nurse e ndosocopists are able to perform flexible sigmoidoscopy safely and eff ectively.