rectal bleeder clinic as the majority of findings from flexible sigmoidoscopy are normal therefore is it more maleficence to do a procedure with risks for little gain to the patient .
It is part of the Nursing and Midwifery Code ( NMC , 2015 ) that nurses preserve safety at all times . Therefore , guidelines and policies must be developed to underpin the nurse ’ s practice when developing a rectal bleeding clinic . A good guide to follow is the quality assurance guidelines that were developed for the introduction of Bowel Scope by the BCSP that involves one of flexible sigmoidoscopy as a screening test for men and women aged 55 ( NHS BCSP , 2015 ). This gives the ACP guidance in how to manage abnormalities found , for example , if a polyp is less than 1cm , this should be removed and sent for histology , if a polyp is greater than a 1cm , photos must be taken and the patient offered a colonoscopy ( Public Health England , 2017 ). They further state that if no abnormalities are found the patients should be discharged . If a rectal bleeder clinic is to be there to assess both cancer pathway and benign pathway patients , the ACP must also be able assess haemorrhoids and treat if deemed necessary ( Badger et al , 2005 ). It may therefore by feasible to follow the Royal College of Surgeons ( 2013 ) commissioner ’ s guide that haemorrhoids should be banded , depending on the degree of prolapse and severity of symptoms . Guidelines and policies are needed to provide a safe pathway for patients undergoing a flexible sigmoidoscopy in a one stop rectal bleeding clinic .
In order to capture the effectiveness of the rectal bleeding clinic , audits must be conducted . A trial and clinical audit can be a way of showing that the service is being provided in line with current standards and highlight where improvements can be made ( NHS England , 2017 ). This is supported by Sykes ( 2017 ) who states that a change in any working pattern should begin with a trial and the results fed back to the wider team , including management and stakeholders .
It is clear that there are increased numbers of referrals into the fast track cancer pathway , including patients with rectal bleeding . Change is needed to meet the demands of the service however research to support the effectiveness of a straight- to – test rectal bleeding clinic is scarce . It is useful to look at the research that supports the BCSP ‘ bowel scope ’ service that offers a flexible sigmoidoscopy to men and women aged 55 ( NHS BCSP , 2015 ). A large study by Atkin et al ( 2010 ) proved that a onceonly flexible sigmoidoscopy between the ages of 55 and 64 can significantly reduce colorectal cancer incidence by a third by removing early adenomas . It highlighted that a flexible sigmoidoscopy is a safe and practical test and that two thirds of cancers found in this age bracket were located in the rectum and sigmoid ( distal colon ). However , this study only included men and women who would actively take part in a screening programme and may not be a true representation of the general public as uptake to the BCSP is generally low at around 50 % ( Cancer Research , 2017 ). A later study by Atkin et al ( 2017 ) highlighted that people having a one-off flexible sigmoidoscopy can reduce their risk of colorectal cancer by 35 % and a 40 % lower risk of dying from the disease . However , it again recognises that not everyone is taking part in this screening programme and further issues of people finding it difficult to take the time off work , it is resource intensive and there are limited trained endoscopists to perform this procedure ( Atkin et al , 2017 ). Therefore , the BCSP provides evidence that if people above the age of 55 undergo a flexible sigmoidoscopy , this can drastically reduce their risk of developing and dying from colorectal cancer . If the number of people having this procedure increases this may prove in greater statistics in its effectiveness .
Another important aspect to look at is patients not attending their GP with their symptoms early . This is recognised by Donnelly et al ( 2017 ) who highlighted that patients delay attending their GPs for fear of embarrassment or wasting GP ’ s time . They recommended that there should be an increase in early detection campaigns . A previous qualitative study by Hall et al ( 2010 ) is useful to understand people ’ s views of not going to the GP .. It showed that people often thought of their symptoms as normal and did not understand that their symptoms were red flags for colorectal cancer . Government agendas such as the Cancer Reform Strategy ( DOH , 2007 ) highlight that more health promotion is needed to encourage people to go to their GP with these symptoms . If a one