Bowel management with spinal cord injured people

The request was successful.

Dear Royal Free London NHS Foundation Trust,

By way of introduction, I work for the Spinal Injuries Association. Part of my role is to assist the Head of Public Affairs with FOI requests, such as the one that follows.

As a request under the Freedom of Information Act, please provide the following information on bowel management for spinal cord injured people and others with neurogenic bowel dysfunction
1. Does the Trust have a formal written policy for digital rectal examination/check, digital rectal stimulation and the digital removal of faeces (manual bowel evacuation) in spinal cord injured and other patients with neurogenic bowel dysfunction ?
2. If the Trust does, please supply a copy of this document.
3. If the Trust does not, how is bowel care managed in the above patient groups who present with this care need?
4. Does the Trust employ a specialist continence nurse(s)?
5. If the Trust employs a specialist continence nurse(s) can they (a) undertake digital rectal checks, digital rectal stimulation and digital removal of faeces (manual bowel evacuation), otherwise known as 'intimate digital bowel care procedures' (b) provide instruction to other nurses to enable them to perform intimate digital bowel care procedures'?
6. If the Trust does not employ a specialist continence nurse, is there another health care professional who undertakes intimate digital bowel care procedures including manual bowel evacuation? If yes, who does this?
7. Does your Trust have a policy in place that will allow your staff to do trans-anal irrigation (TAI) of the bowel as a method of bowel care management for spinal cord injured patients? Do you train your staff to do TAI/ bowel irrigation?
8. Do you run bowel care courses for your staff that allows them to deliver the full range of bowel care required by spinal cord injured patients or others with a neurogenic bowel?
9. If yes, please provide details. If no, does the Trust have a policy which allows for the personal care assistants (PAs) of spinal cord injured patients to assist with this element of the patient's care?

Yours faithfully,

Tim Nicholson

FOI, rf (ROYAL FREE LONDON NHS FOUNDATION TRUST), Royal Free London NHS Foundation Trust

Dear Mr Nicholson

Thank you for your request under the Freedom of Information Act. The reference for this request is noted in the subject header above.

You will receive a response from us within 20 working days of receipt or an explanation as to why this is not possible.

Yours faithfully,

Freedom of Information Team
Royal Free London NHS Foundation Trust

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FOI, rf (ROYAL FREE LONDON NHS FOUNDATION TRUST), Royal Free London NHS Foundation Trust

1 Attachment

 

Dear Mr Nicholson

 

Further to your request for information please see the responses below in
red font.  The Royal Free London NHS Foundation Trust acquired Barnet and
Chase Farm Hospitals NHS Trust on 1 July 2014.  The policy is harmonised
across all sites as it covers patients other spinal cord injured people
and others with neurogenic bowel dysfunction.  The answers provided below
cover  the Royal Free Hospital only.

 

The neurosurgical department moved to  UCL Hospital a few years ago, and
therefore the number of spinal cord injured people with a bowel management
regime we see is significantly lower than previously.

 

 

As a request under the Freedom of Information Act, please provide the
following information on bowel management for spinal cord injured people
and others with neurogenic bowel dysfunction

 

1.            Does the Trust have a formal written policy for digital
rectal examination/check, digital rectal stimulation and the digital
removal of faeces (manual bowel evacuation) in spinal cord injured and
other patients with neurogenic bowel dysfunction ?  Yes

2.            If the Trust does, please supply a copy of this document.
 Please find attached

3.            If the Trust does not, how is bowel care managed in the
above patient groups who present with this care need Not applicable

4.            Does the Trust employ a specialist continence nurse(s)? Yes,
based at the Royal Free Hospital.

5.            If the Trust employs a specialist continence nurse(s) can
they (a) undertake digital rectal checks, digital rectal stimulation and
digital removal of faeces (manual bowel evacuation), otherwise known as
'intimate digital bowel care procedures' (b) provide instruction to other
nurses to enable them to perform intimate digital bowel care procedures'?
 Yes to both

6.            If the Trust does not employ a specialist continence nurse,
is there another health care professional who undertakes intimate digital
bowel care procedures including manual bowel evacuation? If yes, who does
this?  Not applicable

7.            Does your Trust have a policy in place that will allow your
staff to do trans-anal irrigation (TAI) of the bowel as a method of bowel
care management for spinal cord injured patients? Do you train your staff
to do TAI/ bowel irrigation? Ward staff are not generally trained in TAI.
The specialist nurse is trained in TAI and can support spinal cord injured
patients to  continue using TAI during their hospital stay; this may
involve training other staff to assist with or do TAI.

8.            Do you run bowel care courses for your staff that allows
them to deliver the full range of bowel care required by spinal cord
injured patients or others with a neurogenic bowel?   We have run
trust-wide bowel care courses.  Currently the lead nurse, continence and
gastrophysiology provides training with ward staff when required.

9.            If yes, please provide details. If no, does the Trust have a
policy which allows for the personal care assistants (PAs) of spinal cord
injured patients to assist with this element of the patient's care? The
trust’s policy is clear that spinal cord injured patients need to be given
every assistance to maintain their bowel care, allowing the patient and/or
carers to follow their normal routine, including allowing personal
assistants to deliver this aspect of care.

 

 

Your appeal rights

 

We hope that you will be satisfied with our response to your request, if
not you may ask us to review our decision in which case you should write
to Ms Emma Kearney, director of corporate affairs and communications,
Royal Free London NHS Foundation Trust, Pond Street, London  NW3 2QG,
explaining what you would like us to review and including your reference
number.  If you are not satisfied with the internal review, you can appeal
to the Information Commissioner.  The contact details are: Information
Commissioner's Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9
5AF, telephone 01625 545 700 or see [1]www.ico.org.uk

 

Yours sincerely

 

 

 

Alison Macdonald

Board Secretary

 

 

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