Adult Bladder

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Adult Bladder Bowel Care Service
Lee OHara Clinical Service Lead Hertfordshire
Community NHS Trust
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Introduction

• Hertfordshire wide service
• 13 clinical staff covering allocated geographical
  area
• Administrative centre Park Drive Health Centre,
  Baldock
• Patient care clinics/home visits
• Education/training
• CAUTI lead for HCT Quality Priority
• Clinical policies for HCT staff Trust wide
• Management of continence product supply

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Definition of Incontinence

• The International Continence Society define this
  as
• The involuntary loss of urine and/or faeces
  that is a social or hygienic problem (2012)

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Policy Statement

• Hertfordshire Community NHS Trust believes that
  every adult has the right to advice and support
  to achieve continence.
• Where continence is not possible the most
  appropriate management plan should be instigated.

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Prevalence

• Urinary faecal incontinence increases with age
• More common in women than men
• Higher numbers of residents in care settings are
  affected. Between 30-50 are incontinent. (Bale
  2004)
• 12 have faecal incontinence
• 3.4 of incontinent older people have
  Incontinence Dermatitis (ID).(Zimmaro 2006)

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Referral Criteria

• Adults with bladder bowel dysfunction not on a
  core staff caseload
• Complex patients requiring specialist support,
  advice and treatment
• Patients with problematic urinary catheters
• Patients within residential care settings
  requiring assessment and/or continence products

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Care Pathways

• Genuine Stress Incontinence females/males
• Overactive bladder
• Neurogenic bladder
• Obstructive bladder symptoms
• Bowel care constipation/faecal incontinence
• Mixed symptoms

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Patient Care

• Clinics 15 sites across Hertfordshire
• Home visits own homes, residential care

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Assessment (i)

• Incontinence is a symptom, not a diagnosis
• Assessment of the individuals incontinence is
  crucial so that effective management can take
  place

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Assessment (ii)

• Holistic assessment to include
• Mobility
• Dexterity
• Dietary and fluid intake
• Family/carer support
• Sexual relationships
• Cultural issues

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Assessment (iii)

• Cognitive ability
• Medical/Surgical/Obstetric history
• Quality of life
• As well as bladder and/or bowel symptoms

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Assessment (iii)

• Bladder/Bowel diaries
• Pre and post void bladder scan
• Flowmetry
• Vaginal/pelvic floor muscle assessment
• Urinalysis

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Treatment/Management options

• Lifestyle advice
• Biofeedback therapy pelvic floor muscle
  physiotherapy
• Bowel care anal irrigation
• Intermittent self catheterisation
• Indwelling catheter management
• Medication
• Appliance management (pads, sheaths)

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Education/Training

• Formal/Informal training
• HCT clinical staff through the Learning
  Development Department
• Residential Care training programme for staff
• Local groups e.g. New Mums, Age Concern

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CAUTI

• Catheter Associated Urinary Tract Infection
• Part of the NHS Safer Care programme
• Aim to reduce the numbers of infections in
  catheterised patients
• Adopted by HCT as a Quality Priority
• Bladder Bowel Service lead this important piece
  of work through education, competency framework,
  clinical policies

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Clinical Policies

• Assessment of Bladder Bowel Dysfunction
  Adults
• Urinary Catheter Management
• Autonomic Dysreflexia
• Supply of Continence Products

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Product Supply

• 10,000 adults children in receipt of continence
  products throughout Hertfordshire
• 1.9 million spent annually on products
  delivery
• Assessment based on clinical need currently
  working with residential care staff
• Policy is in place to ensure those requiring
  products are given a contribution to their needs
  supported by HCT Executive Board
• Close monitoring of spend with regular updates to
  Board
• Queries/Complaints dealt with on individual basis

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Patient Experience

• Comment cards monthly submissions to Patient
  Experience Team
• Surveys Hertfordshire wide schedule for the year
• Complaints product related
• You said, We did reflect changes made from
  patient comments

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• Thank you for your attention.
• Any questions?