caring for you...closer to home adult bladder & bowel care service lee o’hara clinical service...

Caring for you ...closer to home

Adult Bladder & Bowel Care Service

Lee O’HaraClinical Service Lead

Hertfordshire Community NHS Trust


Introduction

• Hertfordshire wide service• 13 clinical staff covering allocated geographical area• Administrative centre – Park Drive Health Centre,

Baldock• Patient care – clinics/home visits• Education/training• CAUTI lead for HCT Quality Priority• Clinical policies for HCT staff Trust wide• Management of continence product supply


Definition of Incontinence

• The International Continence Society define this as:

“The involuntary loss of urine and/or faeces that is a social or hygienic problem” (2012)


Policy Statement

• Hertfordshire Community NHS Trust believes that every adult has the right to advice and support to achieve continence.

• Where continence is not possible the most appropriate management plan should be instigated.


Prevalence

• Urinary & faecal incontinence increases with age• More common in women than men• Higher numbers of residents in care settings are

affected. Between 30%-50% are incontinent. (Bale 2004)

• 12% have faecal incontinence• 3.4% of incontinent older people have Incontinence

Dermatitis (ID).(Zimmaro 2006)


Referral Criteria

• Adults with bladder & bowel dysfunction not on a core staff caseload

• Complex patients requiring specialist support, advice and treatment

• Patients with problematic urinary catheters• Patients within residential care settings requiring

assessment and/or continence products


Care Pathways

• Genuine Stress Incontinence – females/males• Overactive bladder• Neurogenic bladder• Obstructive bladder symptoms• Bowel care – constipation/faecal incontinence• Mixed symptoms


Patient Care

• Clinics – 15 sites across Hertfordshire• Home visits – own homes, residential care


Assessment (i)

• Incontinence is a symptom, not a diagnosis• Assessment of the individual’s incontinence is crucial

so that effective management can take place


Assessment (ii)

Holistic assessment to include:• Mobility• Dexterity• Dietary and fluid intake• Family/carer support• Sexual relationships• Cultural issues


Assessment (iii)

• Cognitive ability• Medical/Surgical/Obstetric history• Quality of life

As well as bladder and/or bowel symptoms


Assessment (iii)

• Bladder/Bowel diaries• Pre and post void bladder scan• Flowmetry• Vaginal/pelvic floor muscle assessment• Urinalysis


Treatment/Management options

• Lifestyle advice• Biofeedback therapy – pelvic floor muscle

physiotherapy• Bowel care – anal irrigation• Intermittent self catheterisation• Indwelling catheter management• Medication• Appliance management (pads, sheaths)


Education/Training

• Formal/Informal training• HCT clinical staff through the Learning &

Development Department• Residential Care training programme for staff• Local groups e.g. New Mums, Age Concern


CAUTI

• Catheter Associated Urinary Tract Infection• Part of the NHS Safer Care programme• Aim = to reduce the numbers of infections in

catheterised patients• Adopted by HCT as a Quality Priority• Bladder & Bowel Service lead this important piece of

work through education, competency framework, clinical policies


Clinical Policies

• Assessment of Bladder & Bowel Dysfunction – Adults• Urinary Catheter Management• Autonomic Dysreflexia• Supply of Continence Products


Product Supply

• 10,000 adults & children in receipt of continence products throughout Hertfordshire

• £1.9 million spent annually on products & delivery• Assessment based on clinical need – currently working with

residential care staff• Policy is in place to ensure those requiring products are given a

contribution to their needs supported by HCT Executive Board• Close monitoring of spend with regular updates to Board• Queries/Complaints dealt with on individual basis


Patient Experience

• Comment cards – monthly submissions to Patient Experience Team

• Surveys: Hertfordshire wide schedule for the year• Complaints – product related• ‘You said, We did’ – reflect changes made from

patient comments


Thank you for your attention.

Any questions?

caring for you...closer to home adult bladder & bowel care service lee o’hara clinical service...

Documents