endoscopy unit royal infirmary of edinburgh

Created by D.C/N Paul Hamilton. Reviewed May 2011. Next Review May 2012

Endoscopy Unit

Royal Infirmary of Edinburgh

Orientation and Induction Programme

Name .

Mentor .

Date commenced .


INDUCTION AND ORIENTATION PROGRAMME FOR

STAFF NURSES IN ENDOSCOPY

INTRODUCTION

The Endoscopy/Bronchoscopy Unit is based at the Royal Infirmary of Edinburgh. This is a busy

clinical unit that has strong links to other departments within the Lothian University NHS Trust.

The main links include the Department of Medical Physics (GI research), Department of Internal

Medicine, Department of Surgery, Department of Radiology (TIPSS insertions for variceal

bleeding), the Scottish Liver Transplant Unit and the GI & Endoscopy Unit at the Western General

Hospital and St. Johns Hospital in Livingston.

Every year, over 8,000 procedures are performed by Specialist Medical staff (Gastroenterologists),

Surgical staff, Respiratory Medical staff, and the Clinical Nurse Endoscopist, in 4 Endoscopy Suites

and the ERCP room (in the Department of Radiology).

A 24h emergency Endoscopy service is operational for acute cases, and is operated by an on-call

system with trained Nurses, and the GI medical staff on duty.

There are a number of Consultants involved with carrying out GI Endoscopy lists within the

Department, as well as covering different wards and clinics:

Dr Andrew Bathgate Consultant Gastroenterologist

Dr Carol Blair Consultant Gastroenterologist

Prof. Peter Hayes Professor of Hepatology

Dr Alistair MacGilchrist Consultant Gastroenterologist

Dr Ian Penman Consultant Gastroenterologist

Dr John Plevris Consultant Gastroenterologist

Dr Ken Simpson Senior Lecturer in Hepatology and Hon Consultant

Dr Ken Trimble Consultant Gastroenterologist & Lead for Endoscopy

Dr Nick Church Consultant Gastroenterologist

There are also a number of Surgeons doing GI Endoscopy, Respiratory consultants involved with

Bronchoscopy, and Cardiology consultants carrying out TOE’s within the Unit.

Departments within the Lothian University Hospitals Division are Tertiary referral centres and that

reflects on the complexity of procedures performed within the Endoscopy Unit. The Unit has active

scientific and clinical research interests. It enjoys the combined resources of the University and that

of the prestigious teaching hospitals situated in Edinburgh. Particular areas of expertise include

Endoscopic Ultrasound, the management of upper gastrointestinal/variceal bleeding, staging and

management of gastro-oesophageal cancer, and disorders of oesophageal dysmotility.


A variety of diagnostic and therapeutic Endoscopic procedures are being offered by the Unit as

follows:

Diagnostic:

Upper Gastrointestinal Endoscopy & High Definition Endoscopy

Enteroscopy & Double Balloon Enteroscopy

Colonoscopy & Double Balloon Colonoscopy

Flexible sigmoidoscopy

Endoscopic Ultrasound for cancer staging

Endoscopic Ultrasound with diagnostic FNA

ERCP (Diagnostic ERCP being replaced by MRCP)

Bronchoscopy

Bronchoscopic Ultrasound with diagnostic FNA

Trans-Oesophageal Echo

Colonic Capsule Endoscopy

Therapeutic:

Banding of oesophageal varices

Variceal Sclerotherapy

Oesophageal Dilatations

Oesophageal stents insertion

Pneumatic dilatations

Botulin injections for achalasia

Haemostasis of gastrointestinal bleeding, using adrenaline or heater probe.

Argon Plasma Coagulation

Placement of Percutaneous Endoscopic Gastrostomy tubes (PEGs).

Polypectomy of upper and lower GI tract.

Endoscopic drainage of pancreatic pseudocysts

Therapeutic ERCP (biliary stents, sphincterotomy/stone extraction)

Placement of nasojejunal feeding tubes

Other:

Oesophageal manometry

Oesophageal pH Monitoring

Oesophageal Impedance Monitoring

C13 urea breath testing

Glycose hydrogen breath test

Lactose hydrogen breath test

Small Bowel Capsule Endoscopy

Upper GI Capsule Endoscopy

Colonic Capsule Endoscopy


IMPORTANT PHONE NUMBERS

EMERGENCY PHONE NUMBER FOR CARDIAC ARREST/FIRE/MAJOR HAEMORRAGE IS

2222

SECURITY PHONE NUMBER IS

23999

GI REGISTRAR ON-CALL BLEEP NO.

#6361

Sr. Helen Chisholm Charge Nurse ext. 21600/21602

D.C/N Paul Hamilton Deputy Charge Nurse ext. 21600

D.C/N Samantha Bow ERCP Specialist Nurse ext. 21614

Inpatient co-ordinator Nurses station ext. 21600

Inpatient recovery ext. 21601

Outpatient reception Reception area ext. 21831

Outpatient admission room ext. 21641

Outpatient recovery MDC ext. 21700/21839

Outpatient booking office WGH ext. 33892

Outpatient booking office mobile WGH 07795603519

Outpatient co-ordinators office RIE ext. 23674

Endoscopy Fax machine RIE ext. 21618

Procedure room 1 ext. 21612




ERCP room in X-ray Main X-ray ext. 23694

Scope cleaning room ext. 21610

Sarah Douglas GI Lab ext. 21605

Porters Patient movement ext. 21329

Porters Fax ext. 21344

Haden ext. 24242

WGH Endoscopy Unit WGH ext. 31695

St John’s Endoscopy Unit St.Johns ext. 53937


INDUCTION PROGRAMME

This programme has been designed specifically to give you a structured orientation to your new job

and will ensure you will receive the knowledge and skills to work safely within the Endoscopy

Unit.

When you start you will be assigned to a mentor who will give you the necessary support that you

will need to achieve your learning objectives.

Your learning is competency based, and is structured so that you will be able to achieve the desired

outcome of assessment within your induction programme.

It is expected that Registered Nurses will achieve competency in the diagnostic procedures within

the first 3 months and that you will be competent in common therapeutic procedures within 6

months of your commencement date, although this may not always be possible to achieve due to the

workload in the department, particularly for part-time staff.

The competence assessment framework scoring system comprises of seven levels from novice to

expert. Level 3 is the minimum standard for competence in a particular area.

These competencies should be scored by your mentor, in discussion with yourself, or by other

senior members of staff who have witnessed your performance during the various procedures

undertaken within Endoscopy.

MENTORSHIP

Your mentor will be primarily responsible for your orientation during your first three months. The

mentor should undertake ongoing assessments with you during the orientation programme, to help

assess your progress, and to give you the opportunity to discuss any performance issues, and raise

any problems or queries.

New staff will work alongside their allocated mentor, as much as possible, to ensure they have the

opportunity to learn new skills, in order to achieve competence on completion of the induction

programme.

During your first formal assessment, after approximately 2 weeks, please take the opportunity to

discuss any worries or concerns you may have.

At your second formal assessment, in your sixth week, you should be half way through this task,

and should be able to discuss your progress with your mentor.

By week twelve you should be orientated to a satisfactory level. You should take this opportunity to

discuss further professional development that you may wish to undertake.

The length of this programme is approximately 6 months for full-time staff, but may be longer for

part-timers. The training programme should be flexible in order to meet the needs of the individual

Nurse, and may be adapted depending on experience.

You will be encouraged to use books and articles, which are available in Sister’s office, and on the

Intranet and Internet and, wherever possible, teaching sessions will also be arranged.

At the end of both 3 and 6 months, the Charge Nurse and mentor should review your progress and

discuss any relevant points.


ENDOSCOPY UNIT PHILOSOPHY

The staff in the Endoscopy unit believe that patients have the right to receive specialized nursing

care that is research based and reflects the personal needs of the individual and is provided within a

safe and calm environment. To achieve our aim, we believe that:

• Each patient has the right to receive clear and comprehensive information at all stages of their

care.

• Each patient has the right to privacy, confidentiality and respect for individual religious, cultural

and personal beliefs.

We also believe that:

• Nurses should support and respect each other, and that their specialized knowledge and skills be

recognized and valued by all members of the healthcare team.

• Nurses have the right to work within a safe environment, where appropriate training and safety

equipment is provided.

• Nurses have a professional responsibility to maintain and update their own knowledge and clinical

skills.

• Nurses are professionally accountable for the care they provide and will therefore work within the

principle of the NMC Code of Conduct and the Scope of Professional Practice (June 1992).

All staff in the Endoscopy unit will work as a TEAM in providing high quality care to all patients

utilising the unit.


ORIENTATION

OBJECTIVE DATE

Geography of…

- Endoscopy Unit

- Medical Day Case

- X-ray

- ITU, HDU and Theatres.

Introduction to staff in unit.

- Nursing

- Medical

- Clerical

- GI Lab

Uniform policy for wearing scrubs.

Coffee room and payment for tea, coffee and milk.

Procedure in case of Cardiac Arrest.

List phone number…

Location of emergency equipment.

List location of Arrest Trolley…

Familiarise yourself with layout of trolley…

Procedure in case of Major Haemorrhage.


Location of Fire points and equipment.

List locations of…

- 4 Break glass points

- 4 Fire action notices

- 5 Fire extinguishers

- Fire exits

- Assembly point

Procedure in case of Fire.


Location of medical gases cut-off taps.

- 2 Cut-off taps

Contact for Security.



Location of Duty folder and A/L book.

Procedure for requesting annual leave or days off, and location of…

- Off-duty folder

- Annual leave request book

Procedure for absence reporting.

Understand and use phone and page system, and know location of numbers.

Use of Haden collection and Pod system for specimens.

Rubbish and dirty linen disposal.

Location of different policy and procedure manuals, including…

- COSHH

- Infection Control

- Manual Handling

- Policy Manual.

Computer Log-in.

X-ray badges.

Monthly staff meetings.

Trak training.

Internal training requests.

Identify and discuss the different procedures undertaken in Endoscopy…

- Endoscopy

- Enteroscopy

- Colonoscopy

- Flexible Sigmoidoscopy

- Endoscopic Ultrasound (EUS)

- Bronchoscopy

- Bronchoscopic Ultrasound (EBUS)

- Endoscopic Retrograde Cholangiopancreatography (ERCP)

- Double Balloon Enteroscopy and Colonoscopy

- Trans-Oesophageal Echo (TOE)

Identify drugs used within Endoscopy, their effects and any side effects.

Identify drugs used to counteract the sedation used in Endoscopy.


COMPETENCE ASSESSMENT SCORING SYSTEM

COMPETENCE SCORE

Cannot perform the activity safely in the clinical environment. 0

Can perform the activity, but not without constant supervision and direction from

an experienced Endoscopy nurse. 1

Can perform the activity satisfactorily, but requires some supervision and

assistance from an experienced Endoscopy nurse.

2

Can perform the activity satisfactorily without assistance or supervision from an

experienced Endoscopy nurse

3

(COMPETENT)

Can perform the activity satisfactorily without assistance or supervision with

acceptable speed and quality. 4

Can perform the activity satisfactorily with more than acceptable speed and

quality, and uses initiative and adapts to problem situations. 5

Can perform the activity satisfactorily with more than acceptable speed and

quality, shows initiative and adaptability), and can demonstrate the safe activity

to others, (staff/patients).

6

(EXPERT)


INFECTION CONTROL (KSF C3 level 2 & HWB5 level 2)

Score: 0, 1, 2, 3 – Competent, 4, 5, 6 – Expert

The Endoscopy Nurse is able to: - Competency level.

Date and mentors signature.

Explain the importance of infection control in Endoscopy.

Discuss the importance of hand washing and using alcohol

gel in the Endoscopy rooms and in other areas in the

department.

Discuss the different types of Personal Protective

Equipment (PPE) available in Endoscopy.

Discuss the precautions taken to prevent the spread of

MRSA in the Endoscopy setting.


Hepatitis in the Endoscopy setting.

Discuss the precautions taken to prevent the spread of CJD

in the Endoscopy setting.

Discuss the precautions taken to prevent the spread of TB in

the Endoscopy setting.


Clostridium Difficile in the Endoscopy setting.

Discuss the type and use of detergents and disinfectants in

an Endoscopy setting.

Discuss the functions and processes involved in the

decontamination of Endoscopic equipment.

Discuss the process of traceability of instruments, and

explain the system used in Endoscopy.

Identify the location of the Infection Control folder.


PROFESSIONAL VALUES AND INTERPERSONAL

EFFECTIVENESS (KSF C1 level 3 & C2 level 3)


The Endoscopy Nurse: - Competency level.


Presents self in a manner, which promotes a positive image

of the Endoscopy/Bronchoscopy Unit.

Respects patient’s dignity, privacy, autonomy and equal

rights as service users.

Respect patients cultural and spiritual concerns in relation to

health care needs.

Safeguards and maintains confidentiality of patients, carers

and colleagues.

Develops and manages professional relationships with

patients, carers and colleagues.

Co-operatives effectively with all members of the

Endoscopy team and other members of the multi-

disciplinary team.

Recognises ethical and legal implications and

responsibilities presented by particular situations in practice.

Acts as a healthcare advocate.

Demonstrates listening and reflection skills in interaction

with patients, carers and colleagues.

Spoken communication is clear, concise, accurate and

appropriate.

Written communication is clear, concise, accurate and

appropriate.

Reliable, honest and punctual.

Recognises roles, functions and skills of other members of

the Endoscopy/Bronchoscopy team.

Identifies, uses and accepts opportunities to learn from other

members of the Endoscopy/Bronchoscopy team.


COMMUNICATION AND PATIENT ASSESSMENT (KSF C1 level 3 & HWB2 level 3)




Obtain a full nursing history, identify actual and potential

problems and implement a plan of care for individual

patients.

Pre-assess patients for Endoscopic procedures including

information on procedure, sedation, preparation, after care

and follow up particular to individual patients.

Demonstrate effective communication skills when talking to

patients on the phone about pre-procedure care and advice

on follow up care.

Ensure all patients have the necessary information to make

informed decisions about their care.

Ensure the appropriate avenues are followed for those

patients unable to give informed consent.

Communicate effectively with the co-ordinator and

colleagues to ensure smooth running of lists.

Communicate effectively with individual patients pre-,

during and post procedure.

Ensure patients, relatives and carers are informed of the

patient’s progress through the Unit and are aware of any

delays.

Ensure all nursing documentation and Endoscopy records

are up-to-date, complete and filed in the appropriate place.

Explain the results of an Endoscopic procedure to a patient,

giving advice on minor ailments and discharge them safely.

Prioritise in-patient Endoscopy requests with senior support,

inform all relevant people and departments and complete

necessary documentation.

Give advice to diabetic patients for Endoscopy procedures.

Give advice to patients taking anti-coagulant therapy for

Endoscopy procedures.


EQUIPMENT TRAINING


The Endoscopy Nurse has been trained to prepare, use

and clean the following equipment: -

Competency level.


Endoscopes

- Gastroscope

- Twin Channel Gastroscope

- Colonoscope

- ERCP scope

- EUS scope

- EUS Miniprobe

- Bronchoscope

- EBUS

- Double balloon Enteroscope and Colonoscope

- TOE probe

Light source and processors

- Olympus

- Fujinon

- EUS

- Mini-probe

- On-call stack

Diathermy unit.

Argon Plasma Coagulation unit.

Smoke evacuator for APC.

Heater Probe unit.

Scope guide.

Leak tester.

Sterilox generator.

QED auto-disinfector.

Labcaire auto-disinfector.

Pulse oximeter and Dynamap.

Blood Glucose monitor.

Cardiac defibrillator and portable suction.


DESIGN AND FUNCTION OF ENDOSCOPY EQUIPMENT (KSF C3 level 2 & HWB7 level 3)




Discuss the design and function of GI Endoscopes (i.e.

air/water, suction and biopsy channels, light source and

camera chip).

Discuss the design and function of Bronchoscope (i.e.

suction and biopsy channels, light source and camera chip).

Discuss the function of the control wheels on the different

Endoscopes.

Explain the channel diameters on different scopes and know

where to obtain the information.

Explain how the air/water function works in GI Endoscopes.

Identify the correct water bottle for each Endoscope.

- Olympus

- Fujinon

White balances an Endoscope and gives rationale for doing

so.

Identify the different valves used in the different

Endoscopes.

- Olympus

- Fujinon

- EUS

- ERCP

- Bronchoscope

Set up a scope for use and check that it is functioning

correctly.

- Olympus

- Fujinon

- EUS

- ERCP

- Bronchoscope

Have knowledge for the use of specialist scopes (i.e.

variable stiffness, twin channel, EUS, ERCP).


CLEANING & DECONTAMINATION OF ENDOSCOPES (KSF C3 level 2 & HWB7 level 3)




Demonstrate the inspection of Endoscopes to ensure they

are ready for use.

Prepare auto-disinfector for the decontamination of scopes

including validation documentation.

- QED

- Labcaire

Initiate immediate pre-cleaning of the Endoscope after use

and give rationale.

Demonstrate and discuss the importance of leak testing

scopes.

- Olympus

- Fujinon

Manually clean scope in accordance with Decontamination

Policy.

Manually clean all ancillaries in accordance with

Decontamination Policy.

Correctly attach scope to the QED for and initiate correct

cleaning cycle.

Remove scope from auto-disinfector into tray and attach

valid documentation.

Explain the rationale for scope traceability and keeping an

accurate record.

Store Endoscopes correctly during and after Endoscopy

lists.

Apply Scope Protection System wipes to all Olympus

scopes.

Demonstrate the care and maintenance of ancillaries and

accessories, including traceability.

Prepare a scope prior to being returned for repair, and

complete appropriate documentation.


UPPER GASTROINTESTINAL ENDOSCOPY (UGIE)

(KSF C1 level 3, C3 level 2, HWB2 level 3, HWB5 level 3, HWB7 level 3)




Discuss the indications and risks associated with diagnostic

UGIE.

Discuss the indications and risks associated with therapeutic

UGIE.

Explain the procedure and the risks involved to a

patient/carer.

Perform a risk assessment on a patient undergoing UGIE,

and anticipate individual risks to each patient.

Explain the choices of sedation or throat spray, and the

associated risks.

Set up procedure room for UGIE.

Assist with UGIE looking after the patient’s airway.

Assist the Endoscopist with diagnostic and therapeutic

Endoscopy.

Safely care for and monitor a patient during UGIE.

Take and record biopsies for

- Histology

- -CLO.

Control UGIE bleeding by

- Banding

- Injection therapy

- Clip fixing

- Heater probe

Use Argon Plasma Coagulation

- Switch on and check APC machine

- Connect APC probe

- Ensure settings are correct for use

- Use smoke evacuation system

Assist with Oesophageal Dilatation

- Savary Gillard

- CRE balloons

Take and record brushings for cytology.

Assist with removal of food bolus from oesophagus.


COLONOSCOPY & FLEXIBLE SIGMOIDOSCOPY (KSF C1 level 3, C3 level 2, HWB2 level 3, HWB5 level 3, HWB7 level 3)




Discuss the indications and risks associated with

colonoscopy and flexible sigmoidoscopy.

Explain the procedure and risks involved to a patient/carer.

Perform a risk assessment on a patient undergoing

colonoscopy or flexible sigmoidoscopy and anticipate

individual risks to each patient.

Give advice on bowel preparation for colonoscopy and

flexible sigmoidoscopy.

Explain the sedation and analgesia used, and the associated

risks.

Set up procedure room for Colonoscopy.

Set up and use scope guide

Olympus

Fujinon


Colonoscopy.

Safely care for and monitor a patient during Colonoscopy.

Take and record biopsies for histology.

Take and record Hot biopsies.

Snare and retrieve Polyps.

- Snare

- Graspers

- Suction trap

Control Colon bleeding by

- Injection therapy

- Clip fixing

- Heater probe

Use Argon Plasma Coagulation

- Switch on and check APC machine

- Connect APC probe

- Ensure settings are correct for use

- Use smoke evacuation system


BRONCHOSCOPY

(KSF C1 level 3, C3 level 2, HWB2 level 3, HWB5 level 3, HWB7 level 3)




Discuss the indications and risks associated with

Bronchoscopy.


patient/carer.

Perform a risk assessment on a patient undergoing

Bronchoscopy, and anticipate individual risks to each

patient.

Explain the sedation, throat spray and lignocaine used, and

the associated risks.

Set up procedure room for Bronchoscopy.

Assist with Bronchoscopy looking after the patient’s airway.


Bronchoscopy.

Safely care for and monitor a patient during Bronchoscopy.

Take and record biopsies for histology

- Bronchial

- Transbronchial

Take and record bronchial washings.

Take and record brushings for cytology.


Endoscopic Retrograde Cholangiopancreatography (E.R.C.P.) (KSF C1 level 3, C3 level 2, HWB2 level 3, HWB5 level 3, HWB7 level 3)





ERCP.


ERCP.


patient/carer.

Perform a risk assessment on a patient undergoing ERCP,

and anticipate individual risks to each patient.


risks.

Set up procedure room for ERCP.

Explain the risks associated with a procedure undertaken

with x-ray guidance, the protection available for staff, and

precautions taken by staff and patient.

Assist with ERCP, looking after the patient’s airway.


ERCP procedures

- Sphincterotomy

- Stone crushing and removing

- Biliary stenting

- Biliary brushing and biopsy

- Drainage of pancreatic pseudocyst

Assist with dilatation/oesophageal stenting under x-ray

guidance.

Safely care for and monitor a patient during ERCP.


Endoscopic Ultrasonography (E.U.S.) (KSF C1 level 3, C3 level 2, HWB2 level 3, HWB5 level 3, HWB7 level 3)





EUS.


EUS.


patient/carer.

Perform a risk assessment on a patient undergoing EUS, and

anticipate individual risks to each patient.


risks.

Set up procedure room for EUS.

Assist with EUS, looking after the patient’s airway.

Assist the Endoscopist with diagnostic and therapeutic EUS

procedure.

Take and record biopsies for

FNA

Quickcore

Assist the Endoscopist with Radio Frequency Ablation

(RFA)

Halo 360

Halo 90

Assist The Endoscopist with Endoscopic Mucosal Resection

(EMR).

Safely care for and monitor a patient during EUS.

endoscopy unit royal infirmary of edinburgh

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