Policy: Staff will have access to this policy, associated documents and relevant best practice guidelines to enable delivery of care that is evidence based.
Appropriate resources will be made available to allow for an effective programme of continence promotion. This will include: • Ensuring that continence aids are in adequate supply and stored appropriately with dignity and privacy in mind • Ensuring that continence aids are used correctly in accordance with the manufacturers' instruction • Only using continence aids to suit the Service User's needs • Monitoring the effectiveness of these aids for suitability and reliability • Disposing of these aids in line with legislative requirements and infection control principles
At the start of the service, Service Users will be assessed to identify if they need support with continence. This assessment will assist with maintaining independence and assessing for potential complications. From this assessment, the Service User will be referred to specialist support (e.g. Continence Nurse Specialists) for advice and guidance.
A Care Plan will be formulated and staff are responsible for ensuring that this is current, evaluated and completed in line with codes of practice.
All staff will have the required skills, knowledge and competence to appreciate the importance of promoting independence with continence and its effect on the Service User's well-being. Where possible, the Service User will be fully involved in the Care Planning process for promoting their independence with continence management. Where consent or Service User involvement is unachievable, decisions will be made with the best interests of the Service User considered in accordance with the Mental Capacity Act 2005. Procedure: Continence Assessment Assessments are made in relation to the Service User's level of understanding around elimination and the Service User should be involved in this process where possible. Assessments will reflect consideration of the personal, cultural and physical needs of the Service User. The Care Worker should refer to the Continence Assessment held within this policy. The level of independence will be noted and will form the basis of an individual plan of Care. It is important that the Care Worker can identify developing continence problems in the Service User early so that they can be helped to get prompt and fair access to medical or other healthcare resources. It is recognised that the Care Worker may be required to provide support, advice and health promotion in relation to promoting continence and this will include: • Healthy living, diet, hydration and mobility • Improving access to the toilet • Reviewing existing medication • Bladder and bowel training programmes • Pelvic floor exercises • Supporting with aids to manage incontinence Principles of Providing Continence Support Where it has been identified that the Service User requires the support of a Care Worker to meet continence needs, the following principles apply: • Where assistance is required to use the toilet, the Care Plan indicates the most appropriate way to achieve this, including the Service User's choice around any aids and equipment, timing, pace and prompts used • Where necessary, records of output or frequency are kept ensuring that confidentiality is maintained and dignity preserved Use of Continence Aids Where it has been identified that the use of continence aids is necessary to meet continence need, the following principles will apply: • Aids should be of a design and style that is discreet and not visible • There must be an adequate supply of aids at all times and these should only be given to the Service User they are prescribed for • Clothing should be chosen to assist in managing changing of continence products with ease whilst retaining the Service User's dignity • Continence products should be refreshed frequently to ensure good skin care and hygiene • Whenever possible, the use of continence products should be managed alongside the supported use of the toilet • Where Service Users need to have elimination monitored, assessment should be made of their level of independence and ability to achieve this • Advice should be sought from the local continence service if existing continence aids are not meeting the needs of the Service User Urine Sampling In the event of the need to obtain urine samples on the instruction of the GP or District Nurse, staff should refer to the Royal Marsden Manual of Clinical Nursing Procedures for current best practice. Principles of Promotion of Bowel Continence Where it has been identified that the Service User requires support with managing bowel continence, the following principles will apply: • Service Users with bowel management concerns will be assessed by competent and trained staff and a plan of care will be devised that promotes continence and includes diet, fluid intake, mobilisation and a review of medication • Compassionate Care Team Ltd will use a recognised tool to define stool type and characteristics (such as the Bristol Stool Chart available within this policy) as part of the ongoing assessment of the Service User • It may be appropriate to introduce the use of continence aids for temporary management whilst the plan of care is promoted • Following any episode of incontinence, the skin will be washed well and dried to prevent any break down of the skin. Where required, a timely referral to the prescribing GP will be made for emollients and barrier products Digital Rectal Examination, Stimulation and Evacuation Standards Digital rectal examination should only be undertaken by staff who have been trained and can demonstrate competence in accordance with their Code of Conduct and should only be carried out on the instruction of the GP. Local procedures should also support this procedure which is a delegated nursing activity. Manual evacuation carries risk to the Service User and must never be undertaken when there is a lack of consent from the Service User or when the GP has given specific instructions not to. Where Service Users need support with manual evacuation, this will be discussed with the GP in the first instance and a specific Care Plan will be put in place in conjunction with the Service User. Staff need to have awareness and knowledge of manual evacuation for spinal injury Service Users, who may have Autonomic Dysreflexia (AD). Staff must understand the condition and have a risk assessment and management plan in place that identifies signs, symptoms and treatment.