Download 1 RN PERFORMED FLEXIBLE SIGMOIDOSCOPY Role of the

RN PERFORMED FLEXIBLE SIGMOIDOSCOPY
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Role of the Registered Nurse in Performing Flexible Sigmoidoscopy
DATE APPROVED: 27 March 2014
REVISION DATE: 1 June 2015
Disclaimer
The Canadian Society of Gastroenterology Nurses and Associates (CSGNA) presents this
position statement for use in developing institutional policies, procedures, and /or protocols. The
Canadian Society of Gastroenterology Nurses and Associates assumes no responsibility for the
practices or recommendations of any member or other practitioner, or for the policies of any
practice setting. Nurses and associates function within the limits of provincial licensure and /or
institutional policy.
Background
In response to the changes in the field of gastroenterology and endoscopy the traditional
role of the gastroenterology nurse has changed. The traditional role of the nurse in
gastroenterology has always been as the patient advocate, whether in the administration of
medications, assistance in the advancement of the scope (in the case of a colonoscopy), care of
the specimen and as well assuring proper care and cleaning of the equipment. Registered nurses
in Europe, as well as the United States, have been training nurses to perform flexible
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sigmoidoscopies for over 25 years. In Canada this training was undertaken in 2006 with five
nurses in Toronto completing the training in 2006.
Appropriately trained Registered nurses in Canada are now able to perform routine
screening flexible sigmoidoscopies in an independent setting within a gastroenterology clinic
environment. Colorectal cancer is the second leading cause of cancer deaths in the US and
Canada every year.
Position
The CSGNA and current research and practice publications illustrate the safety and
accuracy of the performance of routine screening flexible sigmoidoscopies by trained registered
nurses. Associates (physicians involved in gastroenterology - whether a specialist in
Gastroenterology or Surgical specialist) support the position that appropriately trained registered
nurses are able to conduct the procedure independently for the purpose of colorectal cancer
screening. Nurses who have been chosen to participate in the training must have worked a
minimum of two years in endoscopy and have completed the training sessions held at the
Michener Institute of Applied Sciences which includes a one week period of classroom
instruction and simulator training. The education and training includes, but is not limited to
anatomy, physiology and pathophysiology of the colon, rectum and abdomen; indications,
contraindications and alternatives; potential complications of screening flexible sigmoidoscopy,
and manipulation of endoscopes.
The practical component of the training includes the observation of 25 flexible
sigmoidoscopies, withdrawal of 25 sigmoidoscopies and completion of 50 flexible
sigmoidoscopies in the endoscopy clinic setting under the supervision of a physician.
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Subsequent evaluation of each nurse’s competency level is evaluated by gastroenterologists who
are associated with each provincial initiative. Once the nurse successfully passes his/her
evaluation, they are able to perform the procedures independently, with support being provided
by an on-site designated back up physician for any unexpected events. This role is subject to the
approval of the Provincial Licensing Body, the Physician, and the Employer. The Task Force on
Large Bowel Endoscopic Services determined that the Ontario Regulated Health Professions Act
and the Nursing Act allowed the performance of flexible Sigmoidoscopy with biopsy by RN’s
(general class) for the purpose of assessment, to be within their scope of practice. The regulatory
framework requires a medical directive, an on-site physician for clinical back up support and
decision making when necessary.
Definition
Flexible Sigmoidoscopy is the examination of the rectum and the sigmoid and descending
colon using a flexible sigmoidoscope.
RN PERFORMED FLEXIBLE SIGMOIDOSCOPY
References
ASGE (2009). Endoscopy by nonphysicians. Gastrointestinal Endoscopy, 69(4), 767-770. doi:
10.1016/j.gie.2008.11.006
Canadian Partnership Against Cancer (2012). First Canadian guidelines for endoscopy
Services published: recommendations promote patient safety and quality care.
Retrieved form http://www.partnershipagainstcancer.ca/2012/01/23/first-canadianguidelines-for-endoscopyservices-published/
Cancer Care Ontario (2010). Canadian partnership against cancer: cancer workforce
symposium: forcing a new role in the cancer system: RN performed flexible
endoscopy model. Retrieved from
http://www.cancerview.ca/idc/groups/public/documents/webcontent/hhr-symp-presmpfsproject.pdf
Dobrow, M., Cooper, M.A., Gayman, K., Pennington, J., Matthews, J., Rabeneck, L.
(2007). Referring patients to nurses: outcomes and evaluation of a nurse flexible
sigmoidoscopy program for colorectal cancer screening. Canadian Journal of
Gastroenterology, 21(5), 301-308. Retrieved from
www.ncbi.nlm.nih.gov/pubmed/17505566
Enns, R., Romagnuolo, J., Ponich, T., Springer, J., Armstrong, D., & Barkun, A. (2008).
Canadian credentialing guidelines for flexible sigmoidoscopy. Canadian Journal of
Gastroenterology, 22(2), 115-119.
SGNA (2009). Guideline for performance of flexible sigmoidoscopy by registered
nurses for the purposes of colorectal cancer screening. Retrieved from
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http://www.sgna.org/Portals/0/Education/Practice%20Guidelines/FlexibleSigmoidoscopy
Guideline.pdf