1. Caring for you...closer to home Adult Bladder & Bowel Care Service Lee O’Hara Clinical Service Lead Hertfordshire Community NHS Trust

2. Caring for you...closer to home 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

3. Caring for you...closer to home 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)

4. Caring for you...closer to home 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.

5. Caring for you...closer to home 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)

6. Caring for you...closer to home 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

7. Caring for you...closer to home Care Pathways Genuine Stress Incontinence – females/males Overactive bladder Neurogenic bladder Obstructive bladder symptoms Bowel care – constipation/faecal incontinence Mixed symptoms

8. Caring for you...closer to home Patient Care Clinics – 15 sites across Hertfordshire Home visits – own homes, residential care

9. Caring for you...closer to home Assessment (i) Incontinence is a symptom, not a diagnosis Assessment of the individual’s incontinence is crucial so that effective management can take place

10. Caring for you...closer to home Assessment (ii) Holistic assessment to include: Mobility Dexterity Dietary and fluid intake Family/carer support Sexual relationships Cultural issues

11. Caring for you...closer to home Assessment (iii) Cognitive ability Medical/Surgical/Obstetric history Quality of life As well as bladder and/or bowel symptoms

12. Caring for you...closer to home Assessment (iii) Bladder/Bowel diaries Pre and post void bladder scan Flowmetry Vaginal/pelvic floor muscle assessment Urinalysis

13. Caring for you...closer to home 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)

14. Caring for you...closer to home 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

15. Caring for you...closer to home 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

16. Caring for you...closer to home Clinical Policies Assessment of Bladder & Bowel Dysfunction – Adults Urinary Catheter Management Autonomic Dysreflexia Supply of Continence Products

17. Caring for you...closer to home 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

18. Caring for you...closer to home 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

19. Caring for you...closer to home Thank you for your attention. Any questions?