4.0 TRAINING 4.1 Every nurse who is required to perform manual evacuation will have to undergo training and competence assessment, (Appendix A. Central training will be provided and cascade trainers will be identified in clinical areas undertaking this procedure Appendix B. Clinical areas that rarely undertake this procedure must ensure that an arrangement is made with other areas so the procedure can be delivered if required. 4.2 The main areas of expertise for DRE and manual removal of faeces are Conservators, Somerset Neurological rehabilitation Centre (SNRC), Gould, ITU/HDU and Montacute. 4.3 Each nurse who undertakes this procedure will be responsible for maintaining his/her competence. This should be reviewed yearly, to ensure competence while recognising that this procedure will be carried out in rare circumstances only. 4.4 The Sister/Charge Nurse for each area with regular need will be required to maintain a register of all nurses who are competent to undertake this procedure.