The patient also requires consistent access to the care in real time. It is also important that there is an appropriate and regular forum to discuss patient care plans with input find more from the team members especially when a management plan is complex, has different alternatives and/or when the approach is controversial. To ensure functionality and success of the multidisciplinary care programme, the delivery of care must operate through reliable and dependable means of communication and clear documentary procedure. Finally, any such clinic requires solid administrative support and requires constant re-evaluation of its ability to deliver sound and secure care for women with IBD to ensure

its success over time. The role of the nurse coordinator in the multidisciplinary care of women with IBD is pivotal. The nurse, who is likely to be working

at an advanced practice level or with significant experience in the specialist area, is often the first point of contact for women who may be experiencing ongoing menorrhagia or other gynaecological symptoms, not resolved by visits to her general practitioner, MS-275 chemical structure or for those who are planning pregnancy or are newly pregnant and seeking advice about their obstetric care. The multidisciplinary approach to managing these women may involve many health care professionals as already described, and the haemophilia nurse is best placed to coordinate appropriate hospital visits and to facilitate the woman to attend as few visits as possible. For those presenting with menorrhagia or other gynaecological symptoms, haemophilia

nurses should Phosphatidylinositol diacylglycerol-lyase have the skills and knowledge to take a gynaecological history, to assess the main symptoms and to order the appropriate investigations, including blood tests and a pelvic ultrasound scan, in advance of the woman’s appointment in the multidisciplinary clinic. Teaching a woman to use the pictorial blood assessment chart (PBAC) [8] and to bring the completed chart to her clinic appointment offers a guide to the extent of menorrhagia. This coupled with the results of the investigations ensures that decision-making regarding treatment options, including medical management or the need for surgical investigations or interventions can take place at the first visit to the clinic [9]. The haemophilia nurse is able to offer regular monitoring of the outcomes of interventions in an ongoing relationship with the woman [10]. This does not necessarily have to involve visits to the haemophilia centre. Continued encouragement and education of affected women regarding evaluation of any medical/surgical interventions using the PBAC can be continued by telephone or mail. Lack of improvement in symptoms needs to be explored, as compliance with prescribed treatments is vital for the best possible outcomes.