Objective: To evaluate the impact of introducing a nurse led advanced therapy service for patients referred for levodopa/carbidopa intestinal gel (LCIG).

Background: Leeds Teaching Hospitals NHS Trust (LTHT) is a regional neurosciences centre and a specialist centre for people with Parkinson’s disease (PwPD) requiring advanced therapies in the Yorkshire and Humber region (population 5.4million). We identified that our existing service had prolonged waiting times and patient feedback suggested this was increasing anxiety about LCIG.

Method: Following a retrospective review of the LCIG journey for PwPD and their carers, a nurse-led LCIG pathway was developed and implemented in October 2019, after multi-disciplinary team (MDT) working involving Parkinson’s specialist nurses, neurologists, gastroenterologists, percutaneous endoscopic gastrostomy (PEG) specialist nurses and dieticians.

Results: Key outcomes from the nurse-led LCIG pathway include:
A new patient information leaflet outlining all aspects of the procedure including pre-assessment, PEG-Jejunal (PEG-J) insertion, hospital admission, drug initiation and titration.
Advanced therapy nurse-led clinics, with regular availability for nurse-led LCIG titrations
Standardised eight-week referral for outpatient PEG-J, to ensure timely and efficient insertion prior to drug initiation and titration.
Preliminary feedback suggests increased satisfaction from PwPD and carers. Initial data shows a quicker initial consultation after referral for LCIG (appointment in the nurse led advanced therapy clinic within four weeks compared to average of ten weeks before initial review previously) and quicker time to LCIG initiation and titration (fourteen weeks from referral compared to average of 28 weeks).

Conclusion: A MDT review of the LCIG service in our Trust has led to the creation of a nurse-led LCIG pathway. Provisional feedback suggests this is more efficient and increases patient and carer satisfaction.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/nurse-led-intrajejunal-levodopa-pathway-for-a-regional-neurosciences-centre/