This article looks at a telephone triage assessment clinic that was set up to improve the bowel, bladder and pelvic floor service in the authors’ locality. A pelvic floor triage questionnaire was developed to identify patients’ faecal, urinary and prolapse symptoms then, between April and December 2013, patients were referred to the colorectal pelvic floor clinic via telephone triage assessment. Investigations could also be requested directly from the telephone triage assessment clinic. The need for any investigations and patient responses to the telephone triage assessment clinic questionnaires were reviewed in the pelvic floor multidisciplinary meeting. Previously, the wait for a new pelvic floor appointment was four months and this has been reduced to two weeks (or five weeks for a new consultant appointment). The telephone triage assessment clinic has led to a reduction in waiting times, an improvement in patient experience and more efficient referral. It is also more cost effective as
it can replace a new consultant appointment.
Urinary tract infection (UTI) is caused by the presence and multiplication of bacteria in the urinary tract, with associated tissue invasion. It is most common in women but can be more complicated in male and catheterised patients. This article highlights the importance of the correct diagnosis of UTI, which will identify ‘red flags’ to aid community nurses’ choice of management options and avoid the unnecessary prescription of antibiotics. In addition, the author makes recommendations for reducing catheter-associated UTIs (CAUTIs) in the community.
Caring for patients with indwelling catheters is common in nursing practice in all settings (Foxley, 2011), despite being the last resort for patients with long-term bladder control problems. Community nurses in particular will regularly encounter patients with indwelling catheters, ranging from those with nerve damage such as spina bifida, multiple sclerosis (MS), stroke or spinal injury; those with debilitating or terminal illness with loss of mobility; to those who may lack the cognitive ability or sufficient awareness to use the toilet. Catheterisation carries a high risk of infection, resulting in an increased burden of care and cost to healthcare providers. It can also negatively impact on patient wellbeing. Providing for these patients 'around the clock' can be a particular problem in the community, with carers and patients requiring education in how to manage both the catheters themselves, as well as the accompanying equipment at night. This article provides a background to long-term catheterisation, before looking at ways of preventing infection as well as the techniques and equipment that can better enable 24-hour care.
It has been estimated that around 4% of patients on community caseloads have long-term indwelling catheters (Pomfret, 2000). Healthcare professionals have a responsibility to be aware of the different closed drainage systems available, so that they can offer patients choices to suit their lifestyle and preferences. Leg bags are one option, which can be customised to maximise patient comfort and dignity. This paper discusses the impact that urinary incontinence can have on patient quality of life, and one range of leg bags that has been developed to meet patients’ specific needs.
This article aims to explore the perception that treatment of sacral pressure ulcers is costly and time-consuming, especially when faced with faecally incontinent patients with loose stool. The authors’ tissue viability service used a faecal management system to prevent faeces from coming into contact with the wound bed for 12 weeks, while simultaneously allowing a conventional dressing to perform to its maximum ability. A total cost and wound-healing comparison was carried out in two community patients who were faecally incontinent and bed-bound. One patient was managed with a faecal management system and the other with incontinence pads. The authors found that although the purchase of the faecal management system was initially costly, the frequency of dressing change was reduced, the patient felt more comfortable and fewer visits from the community nurses were necessary. Also, faster healing rates were demonstrated by reductions in wound size. This technique requires further studies with a larger sample size to ascertain its true benefits, particularly around wound healing.
Constipation is one of the most common gastrointestinal problems experienced by the general population, with an estimated UK prevalence of 52 per cent. Despite this, constipation is often both misdiagnosed and under-treated both in children and adults. This paper will look at the issues and suggest specific management strategies for addressing constipation in both the general adult population and these apparently vulnerable groups.
June Rogers MBE, RN, RSCN, BA(Hons), MSc, ENB 216, ENB N01, ENB 978. PromoCon Team Director, Disabled Living Manchester.
Article accepted for publication: January 2013
Irritable bowel syndrome (IBS) is associated with a significant impairment of quality of life. Due to the nature of its symptoms, the role of the nurse is central to the care of patients who may have IBS. The often embarrassing symptom profile means that patients may rely on nurses to provide psychological and physical support in helping them to improve their symptoms. In this article, the author discusses the management of patients with irritable IBS, including the optimal delivery of care for patients and the role of community nurses in dealing with this chronic condition.
Isobel Mason, Nurse Consultant, Gastroenterology, Royal Free London NHS Foundation Trust, London
Why does incontinence continue to lag behind many other key healthcare conditions, despite being a massive public health issue? There is a vast literature base that informs us that incontinence can affect men, women and children at any age, and that even slight incontinence can have a severe impact on quality of life for individuals and carers.
Sharon Eustice is a Nurse Consultant at the Bladder and Bowel Specialist Service, Truro, Cornwall
Urinary incontinence affects quality of life in a large number of people of varying ages. For a significant number of patients the problem has to be addressed by catheterisation, a treatment method that can give rise to a host of potentially avoidable complications. Catheter stabilisation is an essential practice in avoiding unnecessary damage to the urethra and accompanying pain. While a number of products are available, there seems to be no preferred device for securing catheters. This article looks at CliniFix® (CliniMed, Buckinghamshire), a universal tube-securing device, which approaches tube fixation in a different way to strap-style-devices.
Julian Spinks, Kent-based GP with a special interest in continence
Community nurses’ caseloads may include a large number of catheterised patients and catheter-related infection is a significant problem, with up to 90–100% of those who are catheterised long-term going on to develop a catheter-associated urinary tract infection (CAUTI). For community nurses, ensuring that their skin and that of the patient has been cleansed before any catheter-related intervention is paramount. This article looks at the use of a new antimicrobial cleansing solution (octenilin®; Schülke) and whether its properties reduced the infection risk associated with catheterisation in the community.
Tim Sandle, Head of Microbiology, Bio Products Laboratory Limited, Watford
