title: Creation of a treatment protocol for nurse-led management of anal fissure.
abstract: OBJECTIVE
  To create a protocol for colorectal nurse-led management of patients with idiopathic anal fissure.
  
  
  METHODS
  The outcome of 135 patients with anal fissure presenting over a 3-year period to one (half time equivalent) Colorectal Surgeon in a District General Hospital, in whom initial management was centred on the use of 0.2% glyceryl trinitrate (GTN) was audited. Patients unavailable for complete follow-up, those with fissures of a specific aetiology and those in whom GTN was contra-indicated were excluded. 44% of patients were initially seen by a suitably trained and supported Nurse Practitioner (NP).
  
  
  RESULTS
  Success rates for fissure healing with 0.2% GTN were similar to those reported in other studies. There were no differences in outcome between those patients managed by the NP and those managed by the Consultant/Specialist Registrar. As a result of the audit, a treatment protocol for use by Nurse Practitioners (as well as surgical staff), a patient information leaflet, and policy documents relating to NP management of anal fissures have been developed.
  
  
  CONCLUSIONS
  It has been possible to construct a treatment protocol allowing rational management of patients with anal fissure by suitably trained and supported nurse specialists within their own clinic. This may be adapted to encompass future treatment developments.
authors.affiliation: Department of Medical & Surgical Gastroenterology, The Homerton Hospital, Homerton Row, London E9, UK.
authors.forename: T
authors.initials: T
authors.lastname: Porrett
authors.forename: C H
authors.initials: CH
authors.lastname: Knowles
authors.forename: P J
authors.initials: PJ
authors.lastname: Lunniss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy / Q000451:nursing* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use*; D009722:Nurse Practitioners; D010349:Patient Compliance; D013041:Specialties, Nursing; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin