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Bowel Management Patient Safety Alert (SPINE 01/19)

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Dear Royal Surrey County Hospital NHS Foundation 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,

Jennifer Sims

FreedomOfInformation (ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST), Royal Surrey County Hospital NHS Foundation Trust

Request under Freedom of Information Act 2000

Thank you for your request under the Freedom of Information Act 2000. We confirm receipt of your request.

The unique reference number assigned to your request is included in the subject line of this email and should be quoted in all future correspondence.

We will process your request and confirm back with our information within 20 working days.

Kind regards

Freedom of Information
Email: [Royal Surrey County Hospital NHS Foundation Trust request email]
Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX

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FreedomOfInformation (ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST), Royal Surrey County Hospital NHS Foundation Trust

1 Attachment

Dear Requester,

Please find attached the response to your Freedom of Information request.

Kind Regards
Freedom of Information
Email: [Royal Surrey County Hospital NHS Foundation Trust request email]
Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX

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Dear FreedomOfInformation (ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST),

Spinal cord injured people may need in-patient or community care at any time in their lives.
Indeed, such care may be required many, many years after their original injury (and rehabilitation). Also, the primary reason why care is required might well be unrelated directly to the spinal cord injury.
For example, a spinal cord injured person may: have serious mental health issues which require in-patient treatment; be admitted to hospital following an accident or severe infection; or require ongoing care in the community.
Despite the above, you have advised that our bowel management freedom of information request is not applicable to your trust.
Please explain precisely why you believe that a spinal cord injured person could never require services from your trust in their lifetime.
It would be greatly appreciated if you could copy your WhatDoTheyKnow response to [email address]

Yours sincerely,

Jennifer Sims

FreedomOfInformation (ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST), Royal Surrey County Hospital NHS Foundation Trust

Dear Jennifer,

Thank you for your additional request under the Freedom of Information Act 2000. We confirm receipt of your request.

We will be using the same unique reference number assigned to your previous request, which is included in the subject line of this email and should be quoted in all future correspondence.

We will process your request and confirm back as soon as possible.

Kind regards

Freedom of Information
Email: [Royal Surrey County Hospital NHS Foundation Trust request email]
Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX

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FreedomOfInformation (ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST), Royal Surrey County Hospital NHS Foundation Trust

1 Attachment

Dear Requester,

Please find attached the updated response to your Freedom of Information request. Your request for further explanation and our response is included in the lower part of the attached letter.

Kind Regards
Freedom of Information
Email: [Royal Surrey County Hospital NHS Foundation Trust request email]
Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX

Dear Jennifer,

Thank you for your additional request under the Freedom of Information Act 2000. We confirm receipt of your request.

We will be using the same unique reference number assigned to your previous request, which is included in the subject line of this email and should be quoted in all future correspondence.

We will process your request and confirm back as soon as possible.

Kind regards

Freedom of Information
Email: [Royal Surrey County Hospital NHS Foundation Trust request email]
Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX

show quoted sections

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