Clinical protocol

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Knowledge and
Understanding You will need to
1. Have a working knowledge of Policy and procedure Manual Removal of faeces acute) (ANG CP )
2. Have a working Knowledge of the importance of working within your sphere of Competence and when to seek advice if faced with situations outside your Sphere of Competence RCN 2008, NMC 2015)
3. Have a working Knowledge of your professional responsibilities and accountability in relation to the current European and national legislation, national guidelines and local polices and procedures. (RCN 2008,
NMC 2015) Technical Knowledge
1. Discuss the rational for performing Manual Removal of faeces (acute) and contraindications. Discuss and have an in depth understanding of the anatomy and physiology of the male and female lower gastrointestinal tract in relation to lower bowel function and continence status. (RCN 2008)
3. Discuss the implication for care of your patients with altered gastrointestinal function.
4. Discuss when it is appropriate to carryout the procedure.
5. Discuss when it would be necessary to stop during the procedure and what action to take.
6. Discuss the appropriate alternative use of medication, suppositories and enemas or trans-anal irrigation.
7. Discuss when an appropriate referral to another professional is necessary and be aware of differential diagnosis
Clinical Knowledge
1. Explain what equipment is used in the procedure and the significance of each piece of equipment.
2. Demonstrate the correct procedure to prepare a patient for Manual Removal of faeces (acute) and acquisition of gaining consent using DOH Consent form 1. See Consent Policy )
3. Demonstrate effective communication to include the patient in the conversation.
4. Demonstrate safe and effective techniques for the procedure including assessment for anal tone / sensation faecal matter consistency and amount using the Bristol Stool Form Scale and appropriate use of rectal medication.
5. Demonstrate the practice to prevent cross infection and effective hand washing.
6. Demonstrate knowledge of safe disposal of equipment according to policy.
7. Is able to discuss Autonomic Dysreflexia in the Paralysed patient (Spinal cord injury T and above) and knows how to take appropriate action if this occurs To consider the impact of other health conditions and differential diagnosis
8. Identify and complete appropriate Documentation inpatients notes. (Bowel Intervention Assessment tool) relative to the procedure including the presence of faecal matter in the rectum, the amount and consistency according to the Bristol Stool Form Scale.
9. Discuss and demonstrate the continued care required for the patient.
10. Demonstrate an in depth knowledge and understanding of how lifestyle, diet and fluids can affect bowel function.
11. Demonstrate an in depth knowledge and be able to interpret results of further

Kent Community Health NHS Foundation Trust Protocol for manual removal of faeces (acute) In adults over the age of 18 years V Page of July 2016 investigations and how they can inform a diagnosis and aid treatment or management options for individual patients with bowel dysfunction.
12. Demonstrate an in depth knowledge and understanding on how certain categories of medication may effect bowel function and continence status.

Clinical protocol
Executive summary
Governance arrangements
Related policies/procedures
Document tracking sheet
Contents page
Ethnicity and diversity
Roles and responsibilities
Training and awareness
Monitoring compliance and effectiveness of this policy
Monitoring matrix:
Equality analysis
Glossary and abbreviations
Appendix 2 bristol stool form scale
Performance criteria
Appendix 3 care and management of autonomic dysreflexia
Common causes of autonomic dysreflexia.
Signs and symptoms
Specialist advice

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