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Ulcerative colitis: Management in adults, children and young people [CG166]

Measuring the use of this guidance

Recommendation: 1.1.1

Discuss the disease and associated symptoms, treatment options and monitoring: • with the person with ulcerative colitis, and their family members or carers as appropriate and • within the multidisciplinary team (the composition of which should be appropriate for the age of the person) at every opportunity.

What was measured: Proportion of adult patients for whom the decision to treat was discussed at an MDT meeting.
Data collection end: December 2013
13%
Number that met the criteria: 573 / 4379
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for adults with ulcerative colitis: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of paediatric patients seen by a member of the IBD team.
Data collection end: December 2013
99%
Number that met the criteria: 294 / 298
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for young people with ulcerative colitis: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of all paediatric admissions where treatment was initiated and the decision to treat was discussed at a MDT meeting.
Data collection end: December 2013
62%
Number that met the criteria: 51 / 82
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for young people with ulcerative colitis: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of all paediatric admissions where the decisions to treat was discussed at a MDT meeting.
Data collection end: December 2013
47%
Number that met the criteria: 139 / 299
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for young people with ulcerative colitis: UK Inflammatory Bowel Disease audit.


Recommendation: 1.1.2

Discuss the possible nature, frequency and severity of side effects of drug treatment for ulcerative colitis with the person, and their family members or carers as appropriate. Refer to Medicines adherence (NICE clinical guideline 76).

What was measured: Proportion of adult respondents who said they were told about medication side effects to watch for when they went home or did not need an explanation.
Data collection end: August 2011
70%
Number that met the criteria: 730 / 1049
Data collection end: December 2013
65%
Number that met the criteria: 939 / 1435
Area covered: UK
Source: Royal College of Physicians. Experience of inpatients with ulcerative colitis throughout the UK: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of paediatric respondents who said they were told about medication side effects to watch for when they went home or did not need an explanation.
Data collection end: August 2011
81%
Number that met the criteria: 42 / 52
Data collection end: December 2013
89%
Number that met the criteria: 56 / 63
Area covered: UK
Source: Royal College of Physicians. Experience of inpatients with ulcerative colitis throughout the UK: UK Inflammatory Bowel Disease audit.


Recommendation: 1.2.11

For people admitted to hospital with acute severe ulcerative colitis (either a first presentation or an inflammatory exacerbation): • offer intravenous corticosteroids to induce remission and • assess the likelihood that the person will need surgery (see recommendation 1.2.16).

What was measured: Proportion of adult patients prescribed corticosteroids during their admission.
Data collection end: December 2013
90%
Number that met the criteria: 3519 / 3908
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for adults with ulcerative colitis: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of adult patients prescribed corticosteroids during their admission who were initially prescribed IV rather than oral corticosteroids.
Data collection end: December 2013
88%
Number that met the criteria: 3108 / 3519
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for adults with ulcerative colitis: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of paediatric patients who received corticosteroids during this admission.
Data collection end: December 2013
74%
Number that met the criteria: 183 / 246
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for young people with ulcerative colitis: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of paediatric patients who received corticosteroids during this admission who were initially prescribed IV corticosteroids.
Data collection end: December 2013
75%
Number that met the criteria: 138 / 183
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for young people with ulcerative colitis: UK Inflammatory Bowel Disease audit.


Recommendation: 1.2.13

Consider adding intravenous ciclosporin to intravenous corticosteroids or consider surgery for people: • who have little or no improvement within 72 hours of starting intravenous corticosteroids or • whose symptoms worsen at any time despite corticosteroid treatment. Take into account the person's preferences when choosing treatment.

What was measured: Proportion of adult patients in their first admission prescribed ciclosporin following failure to respond to corticosteroids.
Data collection end: December 2013
22%
Number that met the criteria: 268 / 1226
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for adults with ulcerative colitis: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of paediatric patients in which ciclosporin was started during admission owing to failure to respond to corticosteroids.
Data collection end: December 2013
23%
Number that met the criteria: 14 / 61
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for young people with ulcerative colitis: UK Inflammatory Bowel Disease audit.


Recommendation: 1.2.15

Ensure that there are documented local safety monitoring policies and procedures (including audit) for adults, children and young people receiving treatment that needs monitoring (aminosalicylates, tacrolimus, ciclosporin, infliximab, azathioprine and mercaptopurine). Nominate a member of staff to act on abnormal results and communicate with GPs and people with ulcerative colitis (and/or their parents or carers as appropriate).

What was measured: Sites that reported that patients receiving biological therapy are reviewed at least 3 monthly in person, to monitor efficacy and adverse effects.
Data collection end: December 2013
87%
Number that met the criteria: 27 / 31
Area covered: UK
Source: Royal College of Physicians. National audit of paediatric inflammatory bowel disease service provision: UK Inflammatory Bowel Disease audit.


Recommendation: 1.3.6

After surgery, ensure that a specialist who is knowledgeable about stomas (such as a stoma nurse or a colorectal surgeon) gives the person (and their family members or carers as appropriate) information about managing the effects on bowel function. This should be specific to the type of surgery performed (ileostomy or ileoanal pouch) and could include the following: • strategies to deal with the impact on their physical, psychological and social wellbeing • where to go for help if symptoms occur • sources of support and advice.

What was measured: Proportion of adult elective surgical patients who saw a stoma nurse during their admission.
Data collection end: December 2013
88%
Number that met the criteria: 280 / 401
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for adults with ulcerative colitis: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of adult non-elective surgical patients who saw a stoma nurse during their admission.
Data collection end: December 2013
88%
Number that met the criteria: 407 / 464
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for adults with ulcerative colitis: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of paediatric patients who underwent elective surgery who saw a stoma nurse.
Data collection end: December 2013
77%
Number that met the criteria: 27 / 35
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for young people with ulcerative colitis: UK Inflammatory Bowel Disease audit.

What was measured: Proportion of paediatric patients who underwent emergency surgery who saw a stoma nurse.
Data collection end: December 2013
87%
Number that met the criteria: 20 / 23
Area covered: UK
Source: Royal College of Physicians. National clinical audit of inpatient care for young people with ulcerative colitis: UK Inflammatory Bowel Disease audit.



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