· Web viewUnderstanding of the anatomy and physiology of the lower gastro-intestinal tract. Identification of possible causes of constipation. Knowledge and understanding of the

Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy

CATEGORY: Procedural DocumentCLASSIFICATION: ClinicalPURPOSE The purpose of these guidelines is to

provide practical guidance for the provision of bowel care for patients with a colostomy or ileostomy

Controlled Document Number:

TBC

Version Number: 1 draft 3

Controlled Document Sponsor:

Executive Chief Nurse

Controlled Document Lead:

Clinical Nurse Specialist Functional Bowel Service

Approved By: Executive Chief NurseExecutive Medical Director

On:Review Date:Distribution:

Essential Reading for:

Information for:

All Nursing, Medical and Allied Health Care Professional staff involved in direct patient care which involves stoma care

All clinical staff

To be read in conjunction with the following document: CD ref 345: Bowel Care Guidelines for Adult Patients aged 16 years and over

Page 1 of 22Document index no: TBCGuidelines for the Bowel Care of Patients with a Colostomy or Ileostomy

CO

NTR

OLL

ED D

OC

UM

ENT

Contents Page

1.0 Colostomy 2 Colostomy output 3

2.0 Ileostomy 3 Ileostomy output 3

3.0 Constipation 3Constipation patients with a colostomy 3 Colostomy irrigation 4 Enema administration via a Foley catheter 4 Who can perform colostomy irrigation and enema

administration via a Foley catheter5

No output in patients with an Ileostomy 54.0 Diarrhoea / high output 64.1 High output in patients with an ileostomy 6

Causes of high ileostomy output 6 Signs and symptoms of patients with a high ileostomy

output6

Patient assessment for high ileostomy output 6 Treatment of high ileostomy output 7 Stoma management during an episode of high ileostomy

output8

4.2 High output in Patients with a colostomy 8 Stoma management during an episode of high colostomy

output8

5.0 Monitoring of the Guidelines 8References 9AppendicesAppendix 1: Flowchart: Guidelines for the management of constipation for

patients with a colostomy11

Appendix 2: Procedure: The administration of colostomy irrigation 12

Appendix 3: Procedure: The administration of an enema via a Foley catheter.

15

Appendix 4: Colostomy Irrigation: Criteria for competence and evidence of supervised practice

17

Appendix 5 Administration of an enema via a Foley catheter : Criteria for competence and evidence of supervised practice

20

1.0 Colostomy A colostomy is an opening into the colon and is formed: When the distal part of the colon is removed (e.g. abdomino-perineal

excision of rectum). When there is trauma to the lower rectum and/or anus. To defunction an obstructed colon To rest an acutely inflamed bowel (e.g. Crohn’s disease)


To promote cleanliness and healing of distal bowel (e.g. rectovaginal or rectovesical fistulas).

(Breckman, 2005)

1.1 Colostomy Output

Colostomy Type Output

Right sided or transverse colostomy

Fluid or semi-solid faeces

Left sided colostomy Formed faeces

2.0 IleostomyAn ileostomy is an opening into the small intestine and is formed when the colon is either: removed (e.g. panproctocolectomy for Crohn's disease).Or effluent is diverted from it (e.g. anterior resection and loop ileostomy for

rectal cancer (Black 2005).

2.1 Ileostomy Output

If part of the small bowel has been resected, or if the stoma is positioned higher in the small bowel, a shorter absorbable length of bowel (short gut) is created. The shorter the absorbable length of bowel, the greater the ileostomy output will be.

A drainable pouch is the appliance of choice for all ileostomy patients and can remain in position for 3-4 days.

3.0 Constipation

3.1 Patients with a ColostomyThe majority of patients that have a colostomy will have a sigmoid colostomy. The output from this will normally be a formed motion and it will act once or twice a day.

Patients with a colostomy who present with constipation should be assessed and treated in accordance with the Guidelines for the Management of Constipation in Patients with a Colostomy (Appendix 1). An assessment of the patient’s normal bowel function must be undertaken and documented in the patient’s records. A record of bowel movements or lack of movements must be made on the Prescribing Information and Communication System (PICS) at least daily.


Ileostomy Output

all small bowel in circuit600 mls in 24 hrs -

porridgy consistency

Please refer to the Trust’s Bowel Care guidelines (current version) for additional information regarding use of laxatives.

If the patient remains constipated contact the Colorectal Clinical Nurse Specialist (CNS) Team for advice and management.

The following procedures may be considered. Colostomy Irrigation Enema Administration via a Foley Catheter

3.2 Colostomy Irrigation (see Appendix 2 for procedure)Colostomy irrigation is the installation of water into the colon via the stoma. The purpose of irrigation is not to wash out the entire colon but to induce a reflex which brings about a peristaltic wave and evacuates faeces from the distal colon (Karadağ et al 2005).

Indications for Colostomy IrrigationColostomy irrigation may be performed in the following situations: As a management procedure performed by some patients to control their

faecal output. As a method of preparing the colon for surgery or investigative

procedure. To relieve constipation in patients who have an established colostomy.

(Pringle, 2005)

Contraindications for Colostomy IrrigationRegistered nurses must not undertake colostomy irrigation when: The registered nurse has not demonstrated competence in colostomy

irrigation. The patient has capacity and does not give consent for the procedure. The patient has cardiac or renal disease, as fluid overload may occur. The stoma is stenosed, prolapsed or herniated. The patient’s bowel is obstructed. The patient is in the immediate post-operative period when lack of stomal

output may be due to paralytic ileus. The patient is under 16 years of age.

3.3 Enema Administration Via a Foley Catheter (see Appendix 3 for procedure)A Medical Devices Alert (MDA/2010/001) stipulated that devices should only be used for the purpose for which they were intended, i.e. a Foley catheter for urine drainage. However, as there is no other means of introducing enema fluid into the colon via a colostomy and a Trust risk assessment has been undertaken, it is acceptable that a Foley catheter is used for this purpose.

Indications for Administration of an Enema via a Foley Catheter Enema administration via a Foley catheter is usually undertaken for

constipation in the post-operative period.

Exclusions and Contraindications for Administration of an Enema via a Foley Catheter


Registered nurses must not undertake administration of an enema via the colostomy when: The registered nurse has not demonstrated competence in enema

administration via a colostomy. The patient has capacity and does not give consent for the procedure. The stoma is stenosed, prolapsed or herniated.

3.4 Who can Perform Colostomy Irrigation and Enema Administration via a Foley CatheterA registered nurse who has undertaken education and training and can provide evidence of competence can perform the following procedures: Colostomy irrigation (Appendix 4) Enema administration via a Foley catheter (Appendix 5)

The supervised practice and assessment of competence will be undertaken by a practitioner who is competent in the performance of colostomy irrigation and/or enema administration via a Foley catheter. The number of supervised practices required to achieve competence will be determined by the registered nurse and supervisor, taking into account the registered nurse’s own learning needs.

A registered nurse who can demonstrate competence in the procedures of colostomy irrigation and/ or enema administration via a Foley catheter, can delegate these procedures to carers or patients as appropriate, ensuring their competence is assessed and reviewed as necessary (NMC 2010).

The registered nurse is responsible for informing his/her manager if he/she does not feel competent in these procedures and for identifying any training needs.

3.5 Training Requirements for the Performance of Colostomy Irrigation and Enema Administration via a Foley Catheter.Before undertaking the procedures of colostomy irrigation and/ or enema administration via a Foley catheter, registered nurses must ensure they are competent in the following areas: Understanding of the anatomy and physiology of the lower gastro-

intestinal tract. Identification of possible causes of constipation. Knowledge and understanding of the various treatment options for

constipation. Planning nursing care to prevent and treat constipation. Knowledge and understanding of the indications and contra-indications

for colostomy irrigation and enema administration. Working knowledge of the Mental Capacity Act (2005) and the Trust’s

Consent to Examination or Treatment Policy and Procedure (current versions)

3.6 No output in patients with an IleostomyPatients with ileostomies CANNOT become constipated (Burch 2005).


An ileostomy is an opening into the small bowel and the faeces by its nature is of a liquid consistency. Therefore patients with an ileostomy must not be prescribed laxatives.

If an ileostomy stops working and the patient has symptoms of abdominal pain, nausea and vomiting it could signify small bowel obstruction due to recurrent disease, mechanical obstruction or a food bolus (Lawson 2003) and should be fully investigated. Refer to the patient’s consultant and the Colorectal Clinical Nurse Specialist (CNS) for advice.

4.0 Diarrhoea/ High OutputFor guidance regarding stool sampling refer to the Trust’s Infection Prevention and Control Policy and associated Procedures (current versions) http://uhbpolicies/assets/ClostridiumDifficileProcedure.pdf

4.1 High Output in Patients with an IleostomyHigh output in patients with an ilesostomy can be caused by: A short gut (this will require long term fluid and electrolyte replacement) Diet (e.g. oranges, figs, prunes, chocolate and beer) – many people can

tolerate these if taken in small quantities. Medication – including antibiotics and drugs which increase gut motility Disease and/or obstruction (e.g. Crohn’s disease, cancer) and their effect

such as sub-acute obstruction. Food poisoning Abdominal infections and abscess Viral infections Malabsorption Anxiety Chemotherapy/ radiotherapy.

(Black, 2000; Breckman, 2005; Lawson, 2003)

4.1.1 Signs and Symptoms of Patients with a High Ileostomy Output Listlessness Irritability Weight loss Dry mouth Crampy abdominal pain Decreased urinary output Nausea and vomiting may occur.

Dehydration and electrolyte imbalance can occur rapidly, requiring urgent treatment (Breckman 2005).

4.1.2 Patient Assessment during an episode of High Ileostomy OutputThis must be documented in the patient’s records, and an accurate volume of output recorded on the fluid balance section on PICS History of onset Consistency and colour and amount of faeces Symptoms associated with diarrhoea Recent lifestyle changes, emotional disturbances or travel abroad Dietary history Normal medication (recent antibiotics)


http://uhbpolicies/assets/ClostridiumDifficileProcedure.pdf

Significant past medical history Hydration status Peristomal skin integrity

(Taylor 1997, Hogan 1998)

4.1.3 Treatment of High Ileostomy Output The first step is to prevent or correct dehydration by:

Fluid replacement The hospital pharmacy will make up and supply a rehydration solution in accordance with the World Health Organisation (WHO) formulation (BNF 2011).If the rehydration solution is not available, a simple rehydration solution is St Mark's Electrolyte Mix. This can also be made up at home by the patient:

Six level 5ml spoonfuls Glucose (20g)

One heaped 2.5ml spoonful of Sodium Bicarbonate (2.5g) (Bicarbonate of Soda).

One level 5ml spoonful Sodium Chloride (3.5g) (table salt)

Dissolved in one litre of tap water.

The quantity of rehydration solution required in a 24 hour period will be determined by the volume of loss from the ileostomy. The solution must be made up freshly each day (UKMi 2014).

Dioralyte® or other ‘over the counter’ rehydration solutions do not contain the equivalent balance of electrolytes as contained in the WHO or St Mark’s Solution. Therefore they are not appropriate for use in patients with a high ileostomy output.

The patient can be encouraged to consume food or drink to help replace lost salt and potassium. For example; Oxo and tomato juice both replace salt and fruit juice replaces potassium. A list of foods containing potassium and sodium can be obtained from the hospital dietitian.

Intravenous fluids and electrolytes may be indicated if symptoms persist (Black 2000).

Medications Medication can be used to reduce a high ileostomy output in the following ways: To reduce gut motility (e.g. loperamide, codeine phosphate). Infective

causes of a high output must be excluded before these drugs are commenced

As bulking agents (e.g. ispaghula husk; Fybogel® /Isogel®)(Breckman 2005)

Foods that Help to Thicken Ileostomy OutputPage 7 of 22

Document index no: TBCGuidelines for the Bowel Care of Patients with a Colostomy or Ileostomy

Porridge Shredded wheat White rice Smooth peanut butter Stewed apple Marshmallows Jelly babies Root vegetables , especially potatoes Under ripe bananas Brown bread Cream crackers

(Black 2000)

4.1.4 Stoma Management during an Episode of High Ileostomy Output The application of a urostomy pouch attached to a continuous drainage

bag will avoid frequent emptying of a conventional ileostomy pouch. High output pouches, which also attach to continuous drainage bags, are

available on request from the colorectal CNS team or ward 728. If the skin is excoriated, calamine lotion should be applied and allowed to

dry before applying the stoma pouch. Avoid the use of barrier creams and films as this may reduce adherence of the pouch.

For further advice please contact the colorectal CNS.

4.2 High Output in Patients with a Colostomy Causes, presenting factors, assessment and treatment of diarrhoea in patients with a colostomy are the same as that for an ileostomy patient.

Foods That Help To Thicken Colostomy Output Ripe bananas Boiled rice Tapioca Peanut butter Instant mashed potatoes

(Fittleworth, undated)

4.2.1 Stoma Management during an Episode of High Colostomy Output If the patient normally uses a closed pouch then a drainable one may be

more appropriate enabling regular emptying. If the skin is excoriated, calamine lotion should be applied and allowed to

dry before applying the stoma pouch. Avoid the use of barrier creams as this may reduce adherence of the pouch.

For further advice please contact the Colorectal CNS.

5.0 Monitoring of the GuidelinesThe controlled document lead will lead the audit of the guideline with support from the Practice Development Team. The audit will be undertaken in accordance with the review date and will include: Any untoward incidents related to stoma care Skin integrity around the stoma Number of staff trained and as assessed as competent in administration of

an enema via a Foley, and the number of staff trained and assessed as


competent in colostomy irrigation.

All audits must be logged with the Risk and Compliance Unit.

References

Black P K (2000) Holistic Stoma Care Balliere Tindall and RCN. Edinburgh

Breckman B (2005) Problems in Stoma Management. In Breckman B (ed) Stoma Care and Rehabilitation. Elsevier Churchill Livingstone London.

Burch J (2005) Caring for the older person with a stoma. Nursing and Residential Care. Vol. 7, no.4,pp. 162-166

Dougherty, L. Lister, S (Eds) (2011) The Royal Marsden Hospital Manual of Clinical Procedures (8th Edition). Blackwell Publishing, Oxford.http://uhbhome/Policies/R/RoyalMarsden.html [accessed 15.07.14]

Fittleworth, (undated) Dietary advice for colostomists. Patient advice leaflet.

Karadağ A, Bülent Menteş B, Ayaz S (2005) Colostomy irrigation: results of 25 cases with particular reference to quality of life. Journal of Clinical Nursing Volume 14, Issue 4, p 479–485

Lawson A (2002) Complications of stomas in Stomas: Elcoat C, (ed) (2003) Stoma Care Nursing. London

Medicines and Healthcare Products Regulatory Agency (2010) Medical Device Alert: Medical devices in general and non-medical products (MDA/2010/001), MHRA, London. http://www.mhra.gov.uk/home/groups/dts-bs/documents/medicaldevicealert/con068160.pdf [accessed 10.09.14]

Mental Capacity Act 2005, http://www.legislation.gov.uk/ukpga/2005/9/contents [accessed 15.07.14]

Pringle W (2005) Irrigation In Breckman B (ed) Stoma Care and Rehabilitation. Elsevier Churchill Livingstone London.

UK Medicines Information ( UKMi) (2014) Q&A 88.4 What is St Mark’s Electrolyte Mix (solution)? London Medicines Information Servicehttp://www.evidence.nhs.uk/search?q=%22What+is+St+Mark%27s+Electrolyte+mix%22 [Accessed 05.09.14]

University Hospitals Birmingham NHS Foundation Trust (current version) Bowel Care Guidelines for Patients, aged 16 years and over (CD ref: 345). University Hospitals Birmingham NHS Foundation Trust

University Hospitals Birmingham NHS Foundation Trust (current version) Policy for consent to examination or treatment, University Hospitals Birmingham


http://www.evidence.nhs.uk/search?q=%22What+is+St+Mark's+Electrolyte+mix%22

http://www.evidence.nhs.uk/search?q=%22What+is+St+Mark's+Electrolyte+mix%22

http://www.legislation.gov.uk/ukpga/2005/9/contents%20

http://www.mhra.gov.uk/home/groups/dts-bs/documents/medicaldevicealert/con068160.pdf


http://uhbhome/Policies/R/RoyalMarsden.html

NHS Foundation Trust http://uhbpolicies/Microsites/Policies_Procedures/consent-to-examination-or-treatment.htm [accessed 15.07.14]

University Hospitals Birmingham NHS Foundation Trust (current version) Procedure for consent to examination or treatment, University Hospitals Birmingham NHS Foundation Trust http://uhbpolicies/Microsites/Policies_Procedures/consent-to-examination-or-treatment.htm [accessed 15.07.14]


http://uhbpolicies/Microsites/Policies_Procedures/consent-to-examination-or-treatment.htm




Appendix 1

Guidelines for the Management of Constipation in Patients with a Colostomy


When did the patient last have bowels open?

Is this ‘normal’ for the patient

Yes

No

Monitor daily document in nursing records

When all has been done to rectify the potential causes; consider treatment with laxatives*:* see Trust ‘laxative treatment guidelines’(Appendix 2)

Bowel movement No bowel movement

Consider Digital examination of colostomy. Abdominal X-ray

Refer to Colorectal CNS for advice. An enema administered via a Foley catheter or stoma washout may be indicated.

IDENTIFY POSSIBLE CAUSES:General Inadequate fluid and fibre intake Immobility Pregnancy Drugs Antacids (containing aluminium and calcium) Anticholinergics (as used for treating Parkinson's

Disease) Antidepressants Antihistamines Calcium antagonists Cough suppressants (e.g. codeine and pholcodine) Iron preparations L-dopa Monoamine-oxidase inhibitors (MAOIs) Opioid analgesics (e.g. codeine, dihydrocodeine,

morphine dextropropoxyphene)Colorectal Painful rectal disease (e.g. haemorrhoids, fissures) Irritable bowel disease Neurological Any illness causing immobility Neuropathies Metabolic Hypercalcaemia HypothyroidismCognitive impairment Learning disability Confusion Dementia

EDUCATE THE PATIENT Increase dietary fibre (contact dietitian for

advice). Increase mobility where possible. Ensure adequate fluid intake (2L a day if not on

fluid restriction), especially if on bulk-forming laxatives or high fibre diet.

Increase fluid intake in hot weather

Appendix 2Procedure for the Administration of Colostomy Irrigation

Equipment Irrigation set, containing a graduated

water bag, plastic tubing with regulating clamp, cone tip, irrigation sleeve.

Paper tissues. Bowl of warm water. Rubbish bag

Stoma pouch/cap. Non-sterile jug. 1 litre of tepid water (36 – 38ºc) Deodorant aerosol. Disposable gloves and apron Peg

No Action Rationale1. Explain the procedure to the

patientTo obtain consent and co-operation

2. Prepare the bathroom/toilet where irrigation is to take place.

To ensure a comfortable acceptable environment

3. Ensure privacy To avoid unnecessary embarrassment to patient.

4. Wash and dry hands, prepare equipment for the procedure and put on gloves and apron

Although this is not a sterile procedure, care should be taken to avoid unnecessary contamination.

5. Fill a non-sterile jug with 500 ml of tepid (36 – 38ºc) tap water

As the bowel is not sterile there is no need to use sterile water. If the solution is too warm mucosal damage may occur; if it is too cold unnecessary cramps may occur

6. Pour the tepid water into the water container and release the regulating clamp to prime the plastic tubing

To allow the tubing to be primed and filled with water thus preventing entry of air into the colon

7. Hang the water container on a hook behind the toilet pan. The base of the bag should be at shoulder height when the patient is sat on the toilet

To allow the water to gravitate into the colostomy. If the bag is positioned any higher, abdominal cramps may occur

8. Prepare equipment for a change of stoma pouch/cap. Warm water,paper tissues, rubbish bag, stoma pouch/cap

9. Instruct the patient to sit on the toilet pan, removing relevant clothing. Cover the legs with a blanket

To allow free access to the colostomy. To ensure dignity

10. Remove the stoma pouch and wipe excess faeces from stoma and peristomal skin

So that the stoma and skin are clean and clearly visible

11. Wash the stoma and skin with warm water and tissues and dry thoroughly

To promote cleanliness and prevent skin excoriation


No Action Rationale

12. Fit the irrigation sleeve over the stoma. The bottom end of sleeve is placed between the patient’s legs into the toilet pan

To ensure a water tight seal around stomal area

13. At the time of the first irrigation, wearing a disposable glove, perform a gentle digital examination of the stoma (it is not necessary to do this on every occasion)

To determine the direction of the lumen of the colon and relax the stoma

14. Through the top opening of the irrigation sleeve, insert the irrigation cone gently into the stoma so that a dam is made between the stoma and cone.

To ensure that the water, when instilled, is retained in the colon

15. Open the regulating on/off clamp and allow the water to flow into the colon – this will take 4-5 minutes

To allow water to run into the colon

16. When all the water has been instilled, remove the cone from the stoma, fold the top of the irrigation sleeve over and secure with a peg

To ensure that there is no leakage from the tip of the irrigation sleeve

17. Wait for a period of 20 minutes.Water and faeces will be evacuated from the stoma at varying intervals

To allow peristalsis to take place causing evacuation of faeces and water

18. Clean the lower end of the irrigation sleeve; fold up and clip the top end of the sleeve

To allow the patient to leave the toilet and pursue other toilet activities

19. After a further 10 minutes, when there is no further action and abdominal cramps have stopped, remove the irrigation sleeve and leave it hanging over the side of the toilet pan

20. Clean the stoma and peristomal skin with tissues and warm water and dry

To promote cleanliness and prevent skin excoriation. The appliance will adhere more securely to dry skin

21. Apply a clean stoma pouch/cap

22. Clean the irrigation sleeve (if using a reusable one) by holding it over the toilet pan and pouring warm water from a jug into it. A shower head attachment fixed to an adjoining washbasin could also be used

To clean any faeces and mucus from the irrigation sleeve


No Action Rationale

23. Hang the sleeve (if using a reusable one, water container and tubing to initially drip dry then dry thoroughly and store in a cool, dry place

To prolong the life of the plastic

24. Dispose of soiled tissues. Thecontents of the stoma pouch should be flushed down the toilet and the bag wrapped in a plastic or paper bag and placed in a plastic rubbish bag

Faeces should be disposed of down the toilet as it is a potential source of infection

25. Wash hands thoroughly To reduce cross-infection

26. Spray toilet area with deodorising aerosol

To eliminate any odour

Pringle 2005


Appendix 3Procedure for the Administration of an Enema via a Foley Catheter

into a Colostomy*.Equipment Size 14 Foley catheter* Phosphate Enema Water soluble lubricating gel 5ml syringe Water for injection

Spigot or blue clamps Tissues Bowel of water Stoma bag Disposable gloves and apron

No Action Rationale

1. Explain the procedure to the patient To obtain consent and co-operation

2. Prepare the bed space To ensure a comfortable acceptable environment

3. Warm the enema to the required temperature by immersing in a jug of hot water, testing with a bath thermometer. A temperature of 40.5–43.3°C is recommended for adults. (Royal Marsden Manual)

Heat is an effective stimulant of the nerve plexi in the intestinal mucosa. An enema temperature of body temperature or just above will not damage the intestinal mucosa

4. Ensure privacy To avoid embarrassment to the patient

5. Wash and dry hands, prepare equipment for the procedure and put on gloves and apron

To prevent cross infection

6. Lubricate the Foley catheter with water soluble lubricating gel

For ease of administration

7. Draw up 5mls of water for injection into syringe

8. Remove stoma bag and clean stoma and peristomal skin

So that the stoma and skin are clean and clearly visible

8. Position the patient comfortably on their right side

To enable the enema to flow into the right side of the colon

9. Perform a gentle examination of the stoma

To detect the presence of faeces in the distal colon

10. Insert the Foley catheter through the lumen of the stoma approximately 16-20 cms

To enable the enema to flow into the colon.

11. Attach the nozzle of the enema container to the Foley catheter and gently squeeze the enema fluid into the colon

12. . Inflate the balloon on the Foley catheter with 5mls water

To prevent the Foley catheter becoming dislodged and to prevent backflow of enema fluid

13. Remove the enema container and spigot the end of the Foley catheter

To prevent backflow of enema fluid.


No Action Rationale

14. Leave the patient lying on their right side for 10 minutes

To allow the enema fluid to draw water into the colon and soften the faeces

15. Turn the patient onto their left side and leave for 10 minutes

To enable the enema fluid to pass into the left side of the colon and draw water into the bowel to soften the faeces

16. Withdraw the water from the balloon of the Foley catheter and remove the catheter

To enable easy removal of the catheter

17. Clean and dry peristomal skin and apply clear drainable bag

To observe output from the colostomy.

18. Dispose of waste into suitable receptacle in accordance with Trust policy and procedures for waste management

19. Wash hands thoroughly To reduce cross-infection

20. Document procedure and outcome in the patient’s notes and on their fluid chart

To ensure communication between the multidisciplinary team and a record of care given

*NBA Medical Devices Alert (MDA/2010/001) stipulated that devices should only be used for the purpose for which they were intended. i.e. a Foley catheter for urine drainage.However, as there is no other means of introducing enema fluid into the colon via a colostomy and a risk assessment has been undertaken, it is acceptable that a Foley catheter is used for this purpose.

Medicines and Healthcare Products Regulatory Agency (2010) Medical Device Alert: Medical devices in general and non-medical products (MDA/2010/001), MHRA, London. http://www.mhra.gov.uk/home/groups/dts-bs/documents/medicaldevicealert/con068160.pdf




Appendix 4(page 1 of 3)

UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUSTCRITERIA FOR COMPETENCE

END COMPETENCE: Colostomy Irrigation Date(s) of Education and supervised practice: ………………………………………………..

Name of Registered Nurse (print): ………………………………………………..

Name of Supervisor (print): ……………………………………………….. Designation:……………………………………………

Element of Competence To Be Achieved Date Achieved

Registered Nurse Sign

Supervisor Sign

Discuss and identify indications contraindicationsfor colostomy irrigationDemonstrate knowledge of relevant anatomyDemonstrate knowledge and understanding of why it is essential to follow the manufacturer’s instructions for the specific irrigation deviceDemonstrate a working knowledge of the Trust’s policy for consent to examination or treatmentDemonstrate a working knowledge of the Mental Capacity ActDemonstrate accurate provision of information pre and post the procedure in a way that the patient understandsDemonstrate maintenance of the patient’s privacy and dignity throughout the procedureDemonstrate the correct procedure of colostomy irrigation to include: Preparing the equipment Maintaining skin hygiene around stoma Performing a digital examination of the stoma Fitting the irrigation sleeve





Supervisor Sign

Inserting the irrigation cone Performing the irrigation Observing and maintaining skin integrity Recording faecal output Cleaning of reusable irrigation sleeve (if used) Disposal of waste in accordance with Trust Waste Policy and

associated procedural documents (current versions)Demonstrate safe infection control practices throughout the procedure. To include: Standard precautions Isolation proceduresDemonstrate knowledge and understanding of when to refer the patient to an appropriate medical practitionerDemonstrate accurate record keepingDiscuss any health and safety issues in relation to this procedureDemonstrate an understanding of the incident reporting processDemonstrate a working knowledge of the NMC Code: Standards of conduct, performance and ethics for nurses and midwives (2008)

I declare that I have expanded my knowledge and skills and undertake to practice with accountability for my decisions and actions.I have read and understood the guidelines for Colostomy IrrigationSignature of Registered Nurse: ……………………………………………………Date: …………………………………………………….I declare that I have supervised this registered nurse and found her/him to be competent as judged by the above criteria.

Signature of Supervisor: ……………………………………………………Date: ………………………………………………….

A copy of this record must be placed in the registered nurse’s personal file, a copy must be stored in the clinical area by the line manager and a copy can be retained by the individual for their Professional Portfolio.



UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUSTEVIDENCE OF SUPERVISED PRACTICE

To become a competent practitioner, it is the responsibility of each registered nurse to undertake supervised practice in order to perform Colostomy Irrigation in a safe and skilled manner.

Name of Registered Nurse ………………………………………………….DATE DETAILS OF PROCEDURE SATISFACTORY

STANDARD METCOMMENTS PRINT NAME,

SIGNATURE & DESIGNATION

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No



UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUSTCRITERIA FOR COMPETENCE

END COMPETENCE: Administration of an Enema via a Foley Catheter into a Colostomy

Date(s) of Education and supervised practice: ………………………………………………..

Name of Registered Nurse (print): ………………………………………………..

Name of Supervisor (print): ……………………………………………….. Designation:……………………………………………Element of Competence To Be Achieved Date

AchievedRegistered Nurse

SignSupervisor Sign

Discuss and identify indications contraindicationsfor administration of an enema via a Foley catheter into a colostomyDemonstrate knowledge of relevant anatomyDemonstrate knowledge and understanding of why a risk it was necessary to perform a risk assessment for the use of a Foley catheter for this purposeDemonstrate a working knowledge of the Trust’s policy for consent to examination or treatmentDemonstrate a working knowledge of the Mental Capacity ActDemonstrate accurate provision of information pre and post the procedure in a way that the patient understandsDemonstrate maintenance of the patient’s privacy and dignity throughout the procedureDemonstrate the correct procedure of enema administration via a Foley catheter to include: Preparing the equipment Warming the enema to the correct temperature Positioning of the patient Maintaining skin hygiene around stoma





Supervisor Sign

Performing a digital examination of the stoma Inserting the Foley catheter to the correct depth Instilling the enema Inflating the Foley catheter balloon Removing the Foley catheter Disposal of waste in accordance with Trust Waste Policy and

associated procedural documents (current versions)Demonstrate safe infection control practices throughout the procedure. To include: Standard precautions Isolation proceduresDemonstrate knowledge and understanding of when to refer the patient to an appropriate medical practitionerDemonstrate accurate record keepingDiscuss any health and safety issues in relation to this procedureDemonstrate an understanding of the incident reporting processDemonstrate a working knowledge of the NMC Code: Standards of conduct, performance and ethics for nurses and midwives (2008)

I declare that I have expanded my knowledge and skills and undertake to practice with accountability for my decisions and actions.I have read and understood the guidelines for the Administration of an Enema via a Foley Catheter into a ColostomySignature of Registered Nurse: ……………………………………………………Date: …………………………………………………….I declare that I have supervised this registered nurse and found her/him to be competent as judged by the above criteria.Signature of Supervisor: ……………………………………………………Date: …………………………………………………….

A copy of this record must be placed in the registered nurse’s personal file, a copy must be stored in the clinical area by the line manager and a copy can be retained by the individual for their Professional Portfolio.



UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUSTEVIDENCE OF SUPERVISED PRACTICE

To become a competent practitioner, it is the responsibility of each registered nurse to undertake supervised practice in order to perform enema administration via a Foley catheter in a safe and skilled manner.

Name of Registered Nurse ………………………………………………….DATE DETAILS OF PROCEDURE SATISFACTORY

STANDARD METCOMMENTS PRINT NAME,

SIGNATURE & DESIGNATION

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No


Documents

· Web viewUnderstanding of the anatomy and physiology of the lower gastro-intestinal tract. Identification of possible causes of constipation. Knowledge and understanding of the