Clinical protocol



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CONTENTS
PAGE EXECUTIVE SUMMARY
2
1.0 INTRODUCTION
6
2.0 ROLES AND RESPONSIBILITIES
7
3.0 SCOPE
8
4.0 CONTRAINDICATIONS
8
5.0 TRAINING AND AWARENESS
9
6.0
MONITORINF COMPLIANCE AND EFFECTIVENESS OF THIS PROTOCOL
9
7.0 EQUALITY ANALYSIS
10
8.0 PROCEDURE
11
9.0 GLOSSARY AND ABBREVIATIONS
12
10.0 REFERENCES
13 Appendix 1 Bowel Intervention Assessment
14 Appendix 2 Bristol Stool Form Scale
18 Appendix 3 Competence Statement
19 Appendix 4 Care and Management of Autonomic Dysreflexia
22

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
1.0
INTRODUCTION
1.1 Bowel dysfunction is a common problem experienced by many adults. In 2006 the Royal College of Nursing (RCN) and Skills for Health (SfH) identified a need for competencies relating to bowel care. From this National Occupational Standards (NOS) were developed. These statements of competence describe good practice and can be used to measure performance outcomes and help to ensure safe delivery of care for patients and nursing staff. The relevant skills for bowel care are CC

Assess bladder and Bowel dysfunction CC

Care for individuals using containment products. CC

enable individuals to effectively evacuate their bowels. See appendix for local Competency Assessment tool.
1.2 The relevant Protocols and Competencies for this policy are Assessment of bowel dysfunction, Digital Rectal Examination, Digital Rectal Stimulation, Manual removal of faeces (chronic, Administration of suppositories and enemas, the use of an Anal Plug,
Peristeen Trans and Qufora anal Irrigation. New procedures to follow are the use of the Renew (anal device) and BBrun Irypump and Antegrade Continence Enema.
1.3 In some instances a clinician may need to work off label. If this is deemed necessary the relevant assessment and clinical records need to be completed. The patient has to be made aware that the product is being used off label. This should only be if the Professional decides this is in the patient’s best interest and further guidance can be found in the medicines policy.
1.4 Some patients may require manual removal of faeces (MRF) to aid defecation when other methods have failed.
1.5 A DRE should be performed prior to this procedure and a full bowel dysfunction assessment completed to meet the individual patients needs and to ensure continuity of care.
1.6
MRF should be performed to meet the individual patient’s needs and to ensure continuity of care. Please note that MRF should not be considered a primary treatment for patients with a bowel dysfunction.
1.7 Is an invasive procedure and should only be performed after completion of full assessment.
1.8 There is also a high risk of autonomic dysreflexia in some spinal cord injury patients. (Please see Appendix.
1.9


Clinical protocol
Executive summary
Governance arrangements
Related policies/procedures
Document tracking sheet
Ethnicity and diversity
Roles and responsibilities
Contraindications
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
Interpersonal
Appendix 3 care and management of autonomic dysreflexia
Common causes of autonomic dysreflexia.
Signs and symptoms
Specialist advice



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