Policy for the digital rectal examination and manual removal of faeces in adults


Exclusions: Staff caring for children Purpose



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Exclusions: Staff caring for children
Purpose: To ensure staff are trained and assessed as competent to undertake digital rectal examination and removal of faeces for adult patients who have an established need for the procedure
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Manual removal of faeces by nursing staff for adult patients who have an established bowel management plan
Musgrove Park Hospital is part of Taunton and Somerset NHS Foundation Trust Page 2 of 10
1.2 Nursing staff need to be aware that some people with established spinal cord lesions are dependent on manual evacuation as their routine method of bowel care. Evidence shows that failing to support such individuals can place them at risk of developing autonomic dysreflexia (Appendix C. This syndrome usually occurs in people with a spinal cord lesion above the level of the sixth thoracic vertebra. If left unresolved autonomic dysreflexia could have damaging outcomes such as cerebral haemorrhage, seizures and cardiac arrest (RCN 2006, 2008, NPSA 2004).
1.3 Nursing staff have felt uncomfortable undertaking this procedure fearing that the patient maybe at risk of physical harm and that they themselves could be accused of abuse.
1.4
These guidelines outline the indications for this procedure, who should undertake it and how training and competence should be assessed and recorded. It is compiled inline with RCN guidance (April 2008).


Introduction
Indications for manual evacuation of faeces
Exclusions / contraindications
Circumstances when extra care is required
Appendix ab btraining and competence assessment
Action rationale



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