Participant Support Procedures > Complex Bowel Care Procedure
Authorised by Chief Executive Officer
Approved date: 19 September 2023
Statement
Kyeema is committed to ensure workers delivering complex bowel care meet the needs of each participant. Kyeema ensures the workers are aware of and understand the relevant health support plan. The support plan for complex bowel care has been developed and is overseen by a relevant health practitioner, and each participant is involved in the assessment and development of their health support plan (HSP). The support plan is up to date, reviewed annually, readily available, clear and concise and clearly identifies and describes the support needs and preferences of the participant.
This procedure supports Kyeema to apply the NDIS practice standards Module 1 – High Intensity Daily Personal Activities Module
Scope
This procedure applies to relevant managers, participants and the workers who support participants with high intensity daily personal activities.
Relevant legislation
NDIS Practice Standards
NDIS Practice Standards: High Intensity Support Skill Descriptors current version
Definitions
Complex bowel care is a type of bowel care that is provided to people who have chronic issues with their bowel health such as chronic constipation or faecal incontinence.
Stoma site is the location where a colonoscopy bag is inserted into the body.
What is an ostomy baseplate?
A baseplate adheres to the peristomal (around the stoma) skin, helping protect the skin from stoma output, and attaching the pouch to the body. In a two-piece system, the baseplate is separate from the pouch; in a one-piece system they are combined together.
Autonomic dysreflexia can occur in people with spinal cord injuries above the T6 level. Sudden and uncontrolled increase in heart rate and blood pressure which can lead to stroke, heart attack or death. Can be caused by a full bladder, bowel or skin irritation which the brain cannot control.
Ileostomy and colostomy bags are connected to the opening of the abdomen (ileostomy bag) or the bowel (colostomy bag). Both bags are used to collect waste and gas.
Procedure
Before supporting a participant with high intensity needs, the worker is required to:
•agree to and sign their own Individual Training Plan (ITP)
•attend all training requirements as per their ITP
•read and understand the participants Health Support Pan – Bowel Care CCF-81 or the relevant health practitioners care plan
•after reading the health support plan or care plan, sign and date the Staff Acknowledgement – Health Support Plans CCF-59, kept in the participants file
It is important to follow the specific instructions in the participants support plan and to consult with the supervisor/health practitioner for clarification. Before starting the bowel supports procedure, confirm that the support plan is the correct and current plan for the participant.
Gain the participants consent
Complex bowel care is an intensely personal support that requires understanding and protecting the participants dignity. Before proceeding with bowel care check for the participants consent, expectations, capacity, and preferences for being involved in the delivery of the support.
Common types of bowel care support (refer to individual plan for details):
•laxatives
•enemas – administered by a nurse
•suppositories
•abdominal massage to help bowel movement
•digital stimulation – manual rectal stimulation technique to facilitate rectal emptying
•caring for stoma site
•changing colonoscopy bag
Bowl related conditions:
•Constipation – bowel movements are infrequent, hard and difficult to pass.
•Diarrhea – bowel movements are loose and watery.
•Faecal incontinence -individual loses control of their bowel movements.
•Irritable bowel syndrome (IBS) – chronic condition that affects the large intestine. Can cause a variety of symptoms such as constipation, diarrhea, abdominal pain and bloating.
•Spinal cord injury – can damage the nerves that control the bowel. Can cause constipation, faecal incontinence, and diarrhea.
Hygiene and infection control
Follow hygiene and infection control
•wash hands with soap and water
•wear fresh gloves
•cleaning and disinfectant equipment
How to change a colonoscopy bag:
You will need these supplies:
•new colonoscopy bag
•adhesive remover wipes (optional)
•skin barrier wipes (optional)
•gloves
•washcloth
•mild soap
•warm water
•disposable bag for use supplies
1. Wash hands thoroughly with soap and water
2. Remove the old bag. Gently peel the old bag away from the skin (may need adhesive remover wipes)
3. Clean the skin around the stoma. Use a washcloth and mild soap. Rinse the area with warm water and pat dry
4. Apply a skin barrier if the skin is irritated. This can help the protect the skin from the adhesive on the new bag
5. Attach a new bag. Follow the instructions that came with the bag to attach to the stoma
6. Dispose of the old bag. Place the old bag in a disposable bag and seal tight
7. Wash hands again with soap and water to prevent the spread of infection
Additional tips for changing a colonoscopy bag:
•Change the bag as soon as it becomes full or leaks.
•Report any concerns to the supervisor and the health practitioner.
•There are different types of colonoscopy bags so always follow the manufacturer’s instructions.
How to clean and protect the skin around the stoma site:
1. Wash hands thoroughly with soap and water
2. Remove the ostomy pouch and baseplate.
3. Gently clean the skin around the stoma with warm water and mild soap
4. Rinse the skin thoroughly with water and pat dry with a soft towel
5. Inspect the skin for any signs of irritation, such as redness, rash or sores
6. Report and irritation to the supervisor and health practitioner
7. If advised, apply a thin layer of skin barrier cream around the stoma. This will help protect the skin from the stoma output and the adhesive on the ostomy baseplate
8. Apply the ostomy baseplate and pouch
How to administer a suppository:
1. Wash hands thoroughly before insertion
2. Use gloves
3. Position the participant according to their health support plan e.g., lie down on the side with the top leg slightly bent and the bottom leg straight.
4. Remove suppository from the wrapper and wet or use lubricating jelly
5. Insert the suppository gently into the rectum, narrow end first
6. Push the suppository gently but firmly past the sphincter
7. For adults push the suppository in about 6.5cm / 3 inches
8. Dispose of rubbish
9. Wash hands thoroughly with warm soapy water
10. Record suppository insertion on Bowel Activity Record Chart CCF-94
How to perform digital stimulation:
1. Wash hands thoroughly with soap and water and use gloves
2. Gently inserting a gloved lubricated finger to the middle joint of the finger through the anus into the rectum and slowly rotating the finger in a circular motion
3. Continue rotation until flatus or stool passes or the internal sphincter relaxes. Continue rotation for approximately 15-20 seconds (longer than one minute is not usually required).
4. Repeat steps approximately every 5-10 minutes until evacuation of stool is complete and there is no more stool in the rectum, or it is evident that the reflex has tired, and is not prompting evacuation of stool. Three to six repeats per episode of bowel management is common, but this varies for individuals.
5. Wash hands thoroughly with soap and water
Toilet routines:
•The health practitioner will assess and recommend specific toilet routines for support workers to follow. The specific routine will be documented on their health support plan.
Autonomic dysreflexia signs, symptoms and action.
Symptoms:
•Severe headache
•Sweating above the level of the spinal cord injury
•Flushing of the face
•Pounding in the ears
•Blurred vision
•Nasal congestion
•Slow or rapid pulse
•High blood pressure
•Anxiety
•Headache
Action:
•call 000
•call supervisor
How to respond to poor bowel function or related problems:
•faecal incontinence may require the participant to wear absorbent pads or underwear.
•laxatives (oral or suppositories) may be recommended by the health practitioner for constipation.
•always report to your supervisor and follow the health practitioner’s bowel care plan.
Bowel care emergencies can be sudden and unexpected, they can be very uncomfortable and even painful. Symptoms may include severe pain, bleeding, fever, nausea or vomiting, diarrhoea that is not stopping, constipation that is not responding to treatment.
•Stay calm and collected
•Assess the situation and seek medical attention immediately
•Call 000, your supervisor and the health practitioner
•Record all observations and actions in the shift notes
•Supervisors may require an incident report form to be completed
Reduce the risk of bowel care emergencies by:
•managing their bowel and bladder health
•avoid skin irritations.
•staying hydrated
•taking prescribed medications
•be aware of signs and symptoms.
Additional tips for bowel care:
•Be patient and understanding. Bowel care can be sensitive and embarrassing topic for some people.
•Communicate effectively with the participant. Explain what you are going to do and why.
•Use gentle touch and avoid causing pain.
•Be aware of the participants individual needs and preferences.
•Document your observations and interventions carefully.
Recording observations
Observe and record bowel change habits and the stool form using the Bristol Stool Form Scale. Record whether or not suppositories were administered, identify any changes that require action. Use the following forms or form provided by the health practitioner.
•Bowel Activity Record Chart CCF-94
•Bristol Stool Form Scale CCF-95
Reporting incidents
•Write up the shift notes during the shift, not at home in your personal time
•Report incidents to your team leader/supervisor/supports manager and document in the shift notes
•Your supervisor may request an incident report form to be filled out
Awareness & Training
The support worker is trained in the following skills:
•Infection control procedures
•How to replace and dispose of colonoscopy bags
•How to maintain charts and records
•How to monitor colonoscopy bag position
•How to monitor skin condition around the colonoscopy bag
•How to recognise and respond/report signs of deteriorating health and infection
In addition to the general training listed above, workers will be trained in the specific needs of each participant they support. Training should be delivered by an appropriately qualified health practitioner or a person who meets the expectations of this skills descriptor.
Kyeema should ensure that workers understand the support needs outlined in the support plan and what risks to look for and actions required to respond to risks, incidents, and emergencies.
Workers are required to complete a skills review (generally annually) and participate in participant specific training with a health practitioner. The training officer and/or supports manager will let workers know when this will occur.
Where a worker has not delivered this support for a period of more than three months, or if a participant’s support needs have changed and/or they have an updated support plan in place, it is recommended the worker be reassessed before supporting the participant and undertake refresher training if required.
Training provided:
Individual training plan (ITP)
•K:\Admin\Training\High Intensity Supports ITP\Individual Training Plan
Participant specific training with a healthcare professional and the worker/s
•Participant Specific Training Attendance Sheet HRF- 46
•K:\Admin\Training – Participant Specific Training HISW
Sentrient online training:
•Complex Care – Bowel Care
•Complex Care – Bowel Care Refresher (annual refresher)
•Infection Prevention & Control
Form used for workers to reflect and identify gaps in skills and knowledge:
•High Intensity Supports Skills review – Bowel & Catheter CCF-37
Responsibilities
The training officer will organise training for the workers.
The training officer will email a monthly reminder to team leaders to communicate any staffing and health plan changes.
The training officer and supports manager are responsible for ensuring workers have current skills and knowledge, and that the training of workers is documented and regularly audited.
•High Intensity Supports Skills review – Bowel & Catheter CCF-37
The team leader is responsible for updating the health support plan annually. If the plan is unchanged, the team leader will add the revised date to the plan stating that the plan is unchanged.
•Health Support Pan – Bowel Care CCF-81 or the health practitioners care plan
The team leader is responsible for filing CCF-94 on a monthly basis in the participant’s file.
•Bowel Activity Record Chart CCF-94 or the health practitioner’s bowel activity record chart
The team leader is responsible for communicating any staffing and health plan changes to the training officer.
The support worker is responsible for attending all allocated training sessions.
The support worker is responsible for reporting any changes to the participants bowel activity, participants health and wellbeing to their supervisor.
The support worker is responsible for filling in the bowel chart.
•Bowel Activity Record Chart CCF-94
Support workers are responsible for reading, understanding, and signing the participants HSP:
•Staff Acknowledgement – Health Support Plans CCF-59
Support plans are to be reviewed annually by the health practitioner. If the plan is unchanged, the team leader will add the revised date to the plan stating that the plan is unchanged. The worker supports the participant to provide feedback and request changes to their support plan as required.
Record Keeping
Hard copies are filed in workers and participant files.
Electronic records are kept in participants file, Sentrient and the k/d spreadsheet.
•Individual Training Plan K:\Admin\Training\High Intensity Supports ITP\Individual Training Plan
•High Intensity participant specific training (working document) K:\Admin\Training – Participant Specific Training HISW
Related Documents
NDIS Practice Standards: High Intensity Support Skill Descriptors current version
Participant Specific Training Attendance Sheet HRF- 46
Health Support Pan – Bowel Care CCF-81
Bowel Activity Record Chart CCF-94
Bristol Stool Form Scale CCF-95
High Intensity Supports Skills review – Bowel & Catheter CCF-37
Staff Acknowledgement – Health Support Plans CCF-59
High Intensity Supports Procedure