Bowel management with spinal cord injured people

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Dear Salisbury 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

Freedom Of Information, Salisbury NHS Foundation Trust

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Freedom Of Information, Salisbury NHS Foundation Trust

 

Salisbury NHS Foundation Trust
Salisbury District Hospital
Department of Information Technology
Salisbury
Wiltshire
SP2 8BJ

[1]www.salisbury.nhs.uk

22^nd February 2017

Reference No: FOI_3498
Dear Mr Tim Nicholson
Regarding your request for information that we received on the 19^th January
2017. We hope this information is satisfactory and meets your intended
request requirements. Should this information not answer your questions,
please contact us using the email address at the bottom of this email, or
you can write to us using the address above.
 
Question No. 1
please provide the following information on bowel management for spinal cord
injured people and others with neurogenic bowel dysfunction.
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 ?
If the Trust does, please supply a copy of this document.
 
Answer No. 1
For inpatients, the ward nurses on Avon and Tamar use the attached 7 day
assessment/management plan. The evidence base for this care plan is the
Guidelines for Management of Neurogenic Bowel Dysfunction in Individuals
with Central Neurological Conditions (attached) and the RCN Guidelines for
managing lower bowel dysfunction (attached). We refer to the Guidelines for
Management of Neurogenic Bowel Dysfunction in Individuals with Central
Neurological Conditions as our written policy and this is the guidance we
send out to Healthcare Professionals to help them formulate their own
policies and SOP's for bowel management in Spinal Cord Injury patients. The
Neurogenic bowel guidelines could be applied to other patients who have
similar neurological conditions such as Multiple Sclerosis, however our
client group and management therefore is purely spinal cord injury. The
outpatient bowel advice SOP is in development.
 
 
Question No. 2
If the Trust does not, how is bowel care managed in the above patient groups
who present with this care need?
 
Answer No. 2
Please see above answer. The spinal unit nurses also visit other wards
within the Trust (medical/surgical) to undertake bowel care on spinal injury
patients who require this intervention during their admission. There is also
an established training programme for non-spinal nurses who work on
medical/surgical wards to receive training and attain competency with bowel
management techniques.
 
 
Question No. 3
Does the Trust employ a specialist continence nurse(s)?
 
Answer No. 3
There are a number of bowel specialists within the spinal outpatient nurses
who liaise with continence nurses/District nurses/G.P's/carers/patients
throughout our catchment area (for the spinal unit) regarding bowel care
advice/needs. All spinal unit staff from nursing assistants to trained
nurses can undertake manual evacuation, digital stimulation and insertion of
suppositories.
 
 
Question No. 4
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'?
 
Answer No. 4
Please see answer to question 3
 
 
Question No. 5
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?
 
Answer No. 5
Please see answer to question 3
 
 
Question No. 6
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?
 
Answer No. 6
There is the provision for patients to access the use of Peristeen TAI
during their inpatient stay. This is assessed on a case by case basis and a
formal pathway is in development. The ward nurses have some experience in
this management option, the outpatient CNS has experience with
assessment/demonstration of equipment plus troubleshooting.
 
 
Question No. 7
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?
 
Answer No. 7
We run a bowel study day three times a year which covers all aspects of
neurogenic bowel management. This is a classroom based session which can be
attended by HCP's, relatives, carers. Delegates must then attain competency
through observed practice in their locality.
 
 
Question No. 8
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?
 
Answer No. 8
No. However, patients with their own P.A's do have inpatient stays and they
may help with some elements of care such as washing and dressing. However,
on the spinal ward, the ward nurses would undertake bowel care.
 
 
Yours sincerely

Information Governance Team
If you have any questions regarding this response, please contact us at
[2][Salisbury NHS Foundation Trust request email]
Visit the Freedom of Information website at
[3]http://www.ico.gov.uk/what_we_cover/free...

 

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