Bowel Management Patient Safety Alert (SPINE 01/19)

The request was successful.

Dear University Hospitals of Leicester 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,

Dave Bracher

FOI - Freedom of Information, University Hospitals of Leicester NHS Trust

1 Attachment

Our Reference: CK/FOI/40574

 

27 February 2019

 

Dave Bracher

[1][FOI #555805 email]

 

Dear Mr Bracher,

 

Request for Information

 

Thank you for your request for information, as received via email by
University Hospitals of Leicester NHS Trust on 25 February 2019.  Within
UHL NHS Trust, Freedom of Information Act requests are managed centrally
by the Corporate and Committee Services Team, and I confirm that your
request is now being handled under the Freedom of Information Act 2000.

 

The Trust will endeavour to provide a response within the required 20
working-day deadline.  I will, of course, keep you informed should this
not prove possible for any reason. If we require any clarification on your
request, we will contact you as soon as possible.

 

All requesters are advised that the Trust may make a charge for providing
the information to them, to cover the cost of photocopying, postage and
packaging etc – I confirm that where these costs are below £5.00 in total,
no charge will be made.  All requesters are also advised that there may
also be a charge payable to cover costs of locating the information they
have requested, as laid down in the Freedom of Information Act Regulations
published by the Government in December 2004.  Naturally, if such a charge
is to be applied to your request, you will be informed as soon as
possible.

 

Yours sincerely,

 

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Luke Saunders

Litigation/Corporate and Committee Services

* Belgrave House, Leicester General Hospital, LE5 4PW

(  0116 258 8932/8610

8   [3][email address]

 

Information contained in emails may be subject to disclosure under the
Freedom of Information Act 2000, and confidentiality cannot therefore be
guaranteed.  Please ensure that all emails are accurate and appropriate,
and are retained/deleted in accordance with good practice and any policies
of the Trust.  If you are not the intended recipient of this email, please
inform the sender, delete the email from your system and destroy any
copies you may have made

 

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FOI - Freedom of Information, University Hospitals of Leicester NHS Trust

Corporate and Legal Affairs – Corporate and Committee Services

 

Our Reference: CK/FOI/40574

 

25 March 2019

 

Dave Bracher

[1][FOI #555805 email]

 

 

Dear Mr Bracher,

 

Request for Information

 

Thank you for your Freedom of Information Act (FOI) request, as received
on 25 February 2019 and acknowledged on 27 February 2019. For information,
the University Hospitals of Leicester NHS Trust is one of the largest and
busiest NHS teaching Trusts in the country incorporating the Leicester
Royal Infirmary, Glenfield and Leicester General Hospitals. Our three
hospitals have around 15,000 staff serving around 1.2 million people
across Leicester, Leicestershire and Rutland, and a further two to three
million people from the rest of the UK who come to us for treatment from
one of our specialist services.  During 2017/18 we treated 1,410,500
patients - that’s 3,864 patients each day.

 

Following consultation with colleagues from the Musculoskeletal and
Specialist Surgery Clinical Management Group, I confirm that the
University Hospitals of Leicester NHS Trust holds information covered by
your FOI request.   In your Freedom of Information Act request, you asked
for the following information and the Trust’s response is provided below
following each section of your request:-  

 

 

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 – This is a policy for digital rectal examination (DRE) and
digital removal of faeces (DRF) of all adult patients but not specific for
patients with neurogenic bowel dysfunction. It mentions neurogenic bowel
and Spinal Cord Injured patients but does not go into detail.

 

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

(b) Yes - revised an existing policy.

 

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

(b) No

 

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

(a) Yes – via referral to the Spinal Specialist Nurses

 

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

(a) Yes – via the Spinal Specialist Nurses

 

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

(b) No

 

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

(a) Yes

 

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

(a) Yes – included in the updated DRE/DRF policy

 

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

 

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

 

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? 

(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)

 

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

Heather Leatham Assistant Chief Nurse

 

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

N/A

 

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.  UHL is a teaching hospital and provides placement or work based
learning for Pre- registration students such as Medicine, Nursing,
Midwifery, Paramedic, Radiography, Physiotherapy, Occupational Therapy and
Pharmacy and Trainees in the workplace such as Assistant Practitioners and
Nursing Associates. The DRE/DRF policy applies to these learners in the
following circumstances:

 

a.     If DRE/DRF is a specific competency requirement of their placement
or programme then the pre-registration student / trainee is able to
perform the skill under direct supervision of their mentor / supervisor
once they have received the relevant underpinning theory and passed a
simulated practice

b.    If the pre-registration student/trainee has passed an LCAT
competency assessment in practice they may be able to perform the skill
with indirect supervision at the discretion of their mentor/supervisor and
the Registered Professional delegating the task.

c.     If DRE/DRF is not a specific competency requirement of their
placement or programme then the pre-registration student/trainee must only
participate in the process as an observer.

 

 

 

I hope that this response is helpful and provides you with the information
requested (where available). If you require any further assistance please
do not hesitate to contact me.  If you are dissatisfied with the Trust’s
response, you can contact the Director of Corporate and Legal Affairs on
Tel. No. 0116 258 8615 to request a copy of UHL’s Freedom of Information
Act complaints procedure.

 

We must advise you that where we have provided information we have done so
subject to the provisions of the Re-use of Public Sector Information
Regulations 2005.  Accordingly you must not re-use this information
without having the consent of the Trust.  Where the Trust is prepared to
provide its consent then it may levy a charge for doing so. Should you
wish to re-use documents provided then you must make your request in
writing stating your name and your address for correspondence together
with the document that you wish to re-use and the purpose for which the
information is to be re-used.

 

In the event that you remain dissatisfied with the way in which the Trust
has handled any complaint that you may wish to make, we would advise you
of your right to complain to the Information Commissioner at the
Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow,
Cheshire, SK9 5AF.

 

Yours sincerely,

 

 

Helen Stokes

Corporate and Committee Services Manager

Belgrave House, Leicester General Hospital site

University Hospitals of Leicester NHS Trust

Tel: 0116 258 8590

 

Information contained in emails may be subject to disclosure under the
Freedom of Information Act 2000, and confidentiality cannot therefore be
guaranteed.  Please ensure that all emails are accurate and appropriate,
and are retained/deleted in accordance with good practice and any policies
of the Trust.  If you are not the intended recipient of this email, please
inform the sender, delete the email from your system and destroy any
copies you may have made.

 

 

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