IBD Nurse-Led Clinical Pathways to Optimize Patient Safety in Advanced Therapies: A Narrative Review

BACKGROUND AND AIMS: The increasing complexity of advanced therapies in inflammatory bowel disease (IBD) requires structured, safe, and reproducible care pathways. Although international guidelines define standards of care, they provide limited operational guidance for implementation in routine clinical practice. This narrative review aimed to synthesize clinical, organizational, and nursing evidence on the management of advanced IBD therapies and to organize the available evidence into clinically relevant domains of specialist IBD nursing practice. METHODS: A structured narrative review was conducted to synthesize clinical, organizational, and nursing evidence related to advanced IBD therapy management. Evidence from major databases and international guidelines from the European Crohn's and Colitis Organization (ECCO), British Society of Gastroenterology (BSG), and American College of Gastroenterology (ACG) was integrated using an interpretative approach to identify key processes and translate them into clinically applicable care domains. RESULTS: The narrative synthesis identified seven interrelated domains of specialist IBD nursing practice: pretreatment assessment, therapy preparation, intravenous infusion management, self-administered therapy management, clinical and laboratory monitoring, critical event management, and core knowledge of biologic and small-molecule therapies. An additional complementary section addresses emerging therapies and special clinical contexts. The identified domains encompass protocol-driven safety processes, patient education, remote monitoring, and predefined escalation pathways relevant to consistent and proactive care. CONCLUSION: This narrative review provides an evidence-informed synthesis of key nursing activities across the advanced IBD therapy continuum. The identified domains highlight areas relevant to patient safety, monitoring, education, and continuity of care and may inform future development and formal evaluation of structured nurse-led clinical pathways.