Clinical protocol

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EXECUTIVE SUMMARY This protocol is intended for Kent Community Health NHS Foundation Trust (KCHFT) nursing staff who are involved in caring for adult patients with a bowel dysfunction who require digital manual removal of faeces as an acute intervention. This protocol gives guidance on how to undertake manual removal of faeces following a full bowel dysfunction assessment and after training by the Bladder and Bowel or Continence Nursing teams.
Scope and purpose of policy This protocol must be implemented Trust wide. The advice within this protocol is evidence based to achieve best practice as advised from Skills for Health, Royal College of Nursing, National Institute for Clinical Effectiveness and National Occupational Standards. This protocol must be used in conjunction with other bowel care protocols. This protocol will assist staff to Identify patients who require manual removal of faeces. Safely undertake the procedure of manual removal of faeces. Ensure patients with a bowel dysfunction are given/advised on the correct treatment or management plan. Ensure patients are referred to other professionals in a timely manner if required. Ensure staff are aware of where they can access further help and advice if required.
Risks Addressed. This protocol is to ensure a thorough and safe nursing practice with regard to manual removal of faeces to aid defecation in a patient with an acute episode of bowel dysfunction, where all other methods failed. There must also be reference to consent, mental capacity, patient safety, safeguarding, infection prevention, waste management and safe medicines management. This protocol is to assist nurses in delivering high quality nursing care to assist defecation by manual removal of faeces in an acute situation, including the safe and effective administration of medication (if required. This protocol aims to help nurses maintain the patients privacy and dignity with regards to bowel care (specifically manual removal of faeces) and ensure safe and effective bowel management/care. This protocol is to reduce the risk of complications from manual removal of faeces to aid defecation and for the nurse to act appropriately following the procedure. This protocol is to ensure nurses manage clinical risk such as faecal impaction, bowel perforation, incontinence and skin breakdown relating to bowel dysfunction. This protocol will ensure nurses identify and act on particular concerning issues for referral to the medical or safeguarding teams either urgently or for ongoing advice and support.

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 Patients must be given written and verbal information for the procedure. Issues of consent and mental capacity for all patients should be noted in accordance with the requirements of the Mental Health Capacity Act 2005. (MCA). The MCA applies to everyone who works in health and social care and is involved in care, treatment and support for people over the age of 16 years who are unable to make decisions for themselves. (Refer to mental capacity policy. The patient or their advocate is required to give verbal and written consent using the Department of Health consent form (Refer to Consent Policy.

Clinical protocol
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
Knowledge and
Performance criteria
Appendix 3 care and management of autonomic dysreflexia
Common causes of autonomic dysreflexia.
Signs and symptoms
Specialist advice

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