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Bowel Management Patient Safety Alert (SPINE 01/19)

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Dear Oxford University Hospitals NHS Trust,

MY COLLEAGUES AND MYSELF ARE SENDING A DISCRETE AND SEPARATE FOI REQUEST TO EVERY NHS TRUST (BUT ARE ENSURING THAT NO DUPLICATE REQUEST IS MADE TO ANY ONE TRUST).

WE WOULD REQUEST THAT FOI OFFICERS SEND (VIA THE WHATDOTHEYKNOW WEBSITE PORTAL) A SIMILARLY DISCRETE AND SEPARATE RESPONSE FOR EACH INDIVIDUAL TRUST.

I work for the Spinal Injuries Association (SIA), the leading national user-led charity supporting spinal cord injured people and their families. Being a user led organisation SIA understand the challenges of living with a spinal cord injury (SCI). We strive to support all people living with SCI to access the services and support they need to stay healthy and live full, fulfilling and active lives.

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 about the recent NHS Improvement (NHSI) Patient Safety Alert “Resources to support safer bowel care for patients at risk of autonomic dysreflexia 25 July 2018”, Alert reference number: NHS/PSA/RE/2018/005

Q1. Does the Trust have a formal written policy for digital rectal examination, digital rectal stimulation and the digital removal of faeces in spinal cord injured and other patients with neurogenic bowel dysfunction?

(a) Yes
(b) No

Q2. Following recommendation of this patient safety alert, did the Trust “review your local clinical policy and guidance relating to bowel assessment and management”?

(a) Yes – produced a new policy
(b) Yes - revised an existing policy
(c) Yes – retained existing policy
(d) No – did not review an existing policy
(e) No – no bowel assessment and management policy in place

Q3. Is your policy based on the policy template that the Spinal Injuries Association circulated to your trust in August 2018?

(a) Yes
(b) No
(c) No bowel assessment and management policy in place

Q4. If admitted to the Trust will a person with neurogenic bowel dysfunction receive the following bowel care intervention – Digital removal faeces?

(a) Yes
(b) No

Q5. If admitted to the Trust will a person with neurogenic bowel dysfunction receive the following bowel care intervention –Digital rectal stimulation?

(a) Yes
(b) No

Q6. If admitted to the Trust will a person with neurogenic bowel dysfunction receive the following bowel care intervention –Trans anal irrigation?

(a) Yes
(b) No

Q7. Are staff available seven days a week to undertake these bowel care interventions?

(a) Yes
(b) No

Q8. Has the Trust “reviewed your local education and training provision for interventional bowel management” as recommended in the Patient Safety Alert?

(a) Yes
(b) No

Q9. As requested by the Patient Safety Alert, has the trust developed “an action plan to ensure patients have adequate and timely access to staff who are trained appropriately to carry out these procedures, including in the evening and at weekends”?

(a) Yes
(b) No

Q10. Has the Trust “shared your reviewed local guidance, advice on how to identify staff who can provide Digital Removal of Faeces, and the key messages in this alert with medical, nursing and other relevant clinical staff”?

(a) Yes
(b) No

Q11. Does the Trust have a policy that allows for the personal care assistants/carers of spinal cord injured patients to assist with this element of the patient's care?

(a) Yes
(b) No

Q12. As recommended in the Patient Safety Alert, have you identified “an appropriate clinical leader to co-ordinate implementation of this alert”?

(a) Yes (please answer Q13, but ignore Q14)
(b) No (please answer Q14, but ignore Q13)

Q13. What are the contact details for the “appropriate clinical leader”(ie name, position, telephone and email)?

Q14. Why has your Trust not appointed an “appropriate clinical leader”?

(a) Alert implemented without appointment of a clinical leader
(b) Took no action following Patient Safety Alert, as policy already in place
(c) Took no action. No existing policy in place
(d) Other

Q15. Are your newly registered nurses able to demonstrate the nursing procedures as required in Annexe B, section 6.5 of the Nursing and Midwifery Council’s document ‘Future Nurse: Standards of Proficiency for Registered Nurses’?

(a) Yes
(b) No

Technical Note – Relevant annexe reads:-

“Annexe B
6: Use evidenced based, best practice approaches for meeting needs for care and support with bladder and bowel health
6.5: Administer enema, suppositories and undertake manual evacuation when appropriate.”

If you have any queries or require clarification on any of these questions, please contact the Spinal Injuries Association at [email address]

Yours faithfully,

Andrew Smart

oxford@infreemation.co.uk, Oxford University Hospitals NHS Foundation Trust

This is an automated response and acknowledgement.

Thank you for contacting the Oxford University Hospitals NHS Foundation
Trust. If you have submitted a request under either the Freedom of
Information Act 2000 or the Environmental Information Regulations 2004,
your request will be considered and you will receive our response within
the statutory time limit of 20 working days.

Yours sincerely,

         Oxford University
Hospitals

NHS Foundation Trust
Freedom of Information Team
John Radcliffe Hospital  
* Email: [1][Oxford University Hospitals NHS Trust request email]
Headley Way

Headington

Oxford OX3 9DU

 

References

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1. mailto:[Oxford University Hospitals NHS Trust request email]

oxford@infreemation.co.uk, Oxford University Hospitals NHS Foundation Trust

1 Attachment

Dear Andrew Smart

The Oxford University Hospitals NHS Foundation Trust is writing to respond
to your request, F19-2138, sent 21/02/2019.  We are sorry our response is
so late.

Please see below your request underlined and in italics, the Trust’s
response bold.

 

Please provide the following information about the recent NHS Improvement
(NHSI) Patient Safety Alert “Resources to support safer bowel care for
patients at risk of autonomic dysreflexia 25 July 2018”, Alert reference
number: NHS/PSA/RE/2018/005.

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

 1. Yes
 2. No

 2.  Following recommendation of this patient safety alert, did the Trust
review your local clinical policy and guidance relating to bowel
assessment and management?

 1. Yes - produced a new policy
 2. Yes - revised an existing policy
 3. Yes - retained existing policy (which is available on the Trust
intranet under Continence and Catheter care).
 4. No - did not review an existing policy
 5. No - no bowel assessment and management policy in place

 3.  Is your policy based on the policy template that the Spinal Injuries
Association circulated to your trust in August 2018?

 1. Yes
 2. No
 3. No bowel assessment and management policy in place.

 4. If admitted to the Trust will a person with neurogenic bowel
dysfunction receive the following bowel care intervention - Digital
removal faeces?

 1. Yes
 2. No

 5. If admitted to the Trust will a person with neurogenic bowel
dysfunction receive the following bowel care intervention - Digital
rectal stimulation?

 1. Yes
 2. No

 6.  If admitted to the Trust will a person with neurogenic bowel
dysfunction receive the following bowel care intervention -Trans anal
irrigation?

 1. Yes.  (We offer training and staff have access to the Spinal Cord
Injuary Guidelines and RCN guidelines via the Continence and Catheter
Care Trust intranet site.)
 2. No

 7.  Are staff available seven days a week to undertake these bowel care
interventions?

 1. Yes
 2. No.  It depends who is on duty and whether they have attended
training.

 8. Has the Trust “reviewed your local education and training provision
for interventional bowel management” as recommended in the Patient
Safety Alert?

 1. Yes
 2. No

 9. As requested by the Patient Safety Alert, has the trust developed “an
action plan to ensure patients have adequate and timely access to
staff who are trained appropriately to carry out these procedures,
including in the evening and at weekends”?

 1. Yes.  Information and training are available.
 2. No

10.  Has the Trust “shared your reviewed local guidance, advice on how to
identify staff who can provide Digital Removal of Faeces, and the key
messages in this alert with medical, nursing and other relevant
clinical staff”?

 1. Yes.  We did share this with matrons etc. at the time of the alert. 
It was sent also to Clinical Governance.
 2. No

11. Does the Trust have a policy that allows for the personal care
assistants/carers of spinal cord injured patients to assist with this
element of the patient's care?

 1. Yes
 2. No.  Training for this care would be patient-specific for care
assistants/care.

12.  As recommended in the Patient Safety Alert, have you identified “an
appropriate clinical leader to co-ordinate implementation of this
alert”?

 1. Yes (please answer Q13, but ignore Q14)
 2. No (please answer Q14, but ignore Q13)

13.  What are the contact details for the “appropriate clinical leader”
(ie name, position, telephone and email)?

The information is exempt from disclosure, under section 40(2) of the
Freedom of Information Act 2000, as it concerns personal data falling
outside of section 40(1) of the Freedom of Information Act 2000 and/or
would contravene the data protection principles and/or would contravene
other relevant provisions within the General Data Protection Regulations
and the Data Protection Act 2018.

14. Why has your Trust not appointed an “appropriate clinical leader”?

 1. Alert implemented without appointment of a clinical leader
 2. Took no action following Patient Safety Alert, as policy already in
place
 3. Took no action. No existing policy in place
 4. Other

15. Are your newly registered nurses able to demonstrate the nursing
procedures as required in Annexe B, section 6.5 of the Nursing and
Midwifery Council’s document “Future Nurse: Standards of Proficiency
for Registered Nurses”?

 1. Yes
 2. No

Technical Note - Relevant annexe reads:-

“Annexe B

6: Use evidenced based, best practice approaches for meeting needs for
care and support with bladder and bowel health

6.5: Administer enema, suppositories and undertake manual evacuation when
appropriate.”

 

Information about requesting a review of our response to your request can
be found in the PDF attachment.

Provision of this information does not constitute permission for its
commercial re-use in terms of the Re-Use of Public Sector Information
Regulations 2015.  You are free to use the information for your own use,
including for non-commercial research purposes.  The information may also
be used for the purposes of news reporting.  However, any other type of
re-use will require permission from the Oxford University Hospitals NHS
Foundation Trust.

Yours sincerely,

Freedom of Information Team
Oxford University Hospitals NHS Foundation Trust
John Radcliffe Hospital
Headley Way
Headington
Oxford
OX3 9DU

We don't know whether the most recent response to this request contains information or not – if you are Andrew Smart please sign in and let everyone know.