The Role of The Specialist Nurse In Bladder and Bowel Dysfunction

1. The Role of The Specialist NurseIn Bladder and Bowel Dysfunction Angela Patterson Lead Clinical Nurse Specialist Bladder and Bowel Dysfunction South Eastern Trust

2. Background • Affects more than 6 million in the UK • Affects all age groups • Can have devastating consequences • Costs to the NHS 353.6million (1998) • More cost effective to treat than contain • 80% can be cured - RCOP • Conservative treatments should be first line option (NICE and SIGN guidelines) • All clinics are Nurse Led

3. Episodes of Care Aims of service are to alleviate bladder and bowel dysfunction and incontinence through treatment • Almost 1800 new referrals = over 3,500 FTF contacts • Majority of clients below 65 – 73.5% • Ages range from 13 years – no upper limit • Referral criteria • Referrals received from wide spectrum of sources • 73.6% of all clients seen did not require containment products – significant savings for Trust. • Community based service with in reach to acute hospitals

4. Quality of Life • Incontinence can lead to social isolation and depression. • Withdrawal from sexual activity. • Feelings of shame, frustration, stigmatised. • For older adults, can be deciding factor in long term care placement • Direct correlation between falls, fractures and hospital admission -females over 65: 19 – 42% have falls of these 4 – 9% will sustain fractures. Cost to NHS 1.4 million per day • Loss of skin integrity – pressure ulcers caused by poor continence care 1.4 – 2.1 Billion per year. • Treatment restores self esteem, confidence, self belief, independence, return to normal activities • Reduces safety concerns • Efficient use of resources

5. Improved Patient Experience • Satisfaction survey conducted twice yearly • Results show 100% satisfaction with • Staff Attitude • Communication Skills • Privacy and Dignity • Treatment and Care • Patient experience • Service User Group: Flowline

6. Improved Patient Safety • Successful treatment will result in improved safety outcomes. • Treatment will prevent incontinence dermatitis and loss of skin integrity • Involved in pass it on collaboration with tissue viability colleagues • Involved in creation of SRC guidelines and catheter care bundles in conjunction with infection control colleagues - PFA

7. Access to Services • All Clinics are nurse led - held in variety of community settings (6 locations) • Clinic appointment times are flexible to suit client needs • Domiciliary visits can be arranged as required • On discharge patients given contact number for on-going support with option of self referral if required in the future

8. Achievement of Service Objectives • To change culture from containment to treatment – passive to proactive - MDT • To ensure team is safe and effective in what we do – outcome measures / USS • To ensure team is providing good value for money – UDS / onward referral rate less than 10% - efficient use of Consultant time. • To achieve efficiency savings through improved data collection and monitoring

9. Thank You For Listening Any Questions? angela.patterson@setrust.hscni.net