Contents
1 Aim
The aim of this procedure is to provide staff with the information required when patients require products for containment.
2 Scope
This procedure applies to all staff, whether in a direct or indirect patient care role who deliver continence care to adult patients in Doncaster care group.
Adherence to the procedure is the responsibility of all trust staff, including agency, locum and bank staff.
3 Link to overarching policy
3.1 Links to associated documents
4 Procedure
4.1 Home delivery of continence products
Doncaster specialist continence service (SCS) offer a comprehensive service based on the principle of individual assessment. Following this assessment and if conservative treatments have failed, then an assessment of disposable or reusable continence products will be undertaken.
4.2 Eligibility to receive provision of body worn incontinence products
The specialist continence service has overall responsibility for the provision and supply of continence products, following an assessment by health care professionals and an annual reassessment
4.3 Provision criteria
- Incontinence can be managed by a comprehensive range of products and pads should only be supplied in accordance with the continence provision guide.
- Products are only provided after a comprehensive assessment and pad weighing, such as two-piece system, wraparound, and belted. This will objectively assess the degree of incontinence and therefore enable the health care professional to prescribe products that will meet the patient’s needs. Alternative collection devices must be considered for example, prescription urinals, urinary sheaths and body worn urinals, bags, and adaptive underwear (for example, specialist briefs with adapted collection systems).
- Annual reassessments of a patient’s symptoms.
- Absorbent products should not be supplied for treatable medical conditions (or for bodily fluids other than urine or faeces).
- The custom and practice of automatically providing products to adults (including those with an Acknowledged disability) is not appropriate and could be considered discriminatory.
- If an individual is assessed to have capacity and declines treatment, provision of products will not be offered as an alternative (an exception will be end of life).
4.4 Continence product provision
- Patient’s that have a pad weight of less than 400mls will not be eligible for products.
- Maximum of 4 disposable pads in 24 hours will be prescribed. However, if following a pad weigh individual results indicate a need for an increase in products this will be discussed with the specialist continence service clinical team lead on an individual basis.
- Patients receiving the shaped range of products will be supplied with 5 pairs of fixation pants every 6 months. Individual cases will be reviewed should the need arise for more frequent replacement be identified.
- “All in one” products will only be provided to patients with a severe physical or mental impairment or for patients with profuse diarrhoea. Existing patients will continue to receive their current allocation of supplies.
- Disposable pull up pants are available on prescription, a maximum of 2 pair, per day, dependent on clinical need and following a Multi-disciplinary team (MDT) within specialist continence service.
- Two washable absorbent bed sheets to be supplied every 12 months. For patients on an airwave mattress, they can be prescribed kylie sheets or pad and pants not both. Following guidance from the tissue viability specialist nurse kylie sheets can be used on air wave mattresses if they are not tucked in.
- Where appropriate a combination of reusable and disposable products for daytime and night-time may be provided at the discretion of the specialist continence service clinical team lead, maximum of 3 disposable pads and 2 washable bed sheets. Again, this is based on individual need
- Pad weigh has now become part of the continence assessment as incontinence is not easy to quantify. The Urodynamic Society (1997) have looked at recent research and evidence and now recommend the use of pad weighing as an objective assessment to record urine loss. Using this tool will clearly identify a patient’s level of incontinence and will ensure the most suitable product to be prescribed.
- Patients and their carers will be offered practical support, advice and a choice of appropriate products for coping with symptoms during the period of assessment and for as long as they experience episodes of faecal incontinence. Pads in quantities sufficient for the individual’s continence needs will be prescribed (NICE 2007, 2014).
- Once assessed and products prescribed, all patients will have an annual telephone reassessment.
4.5 Rapid response
Community nursing staff attending end of life (EOL) patients or patients in a crisis situation who requires an emergency supply of continence products will have access to a supply of continence products to meet patient needs. End of life packs are located at each community nurse base
The patient will be given 3 days’ supply of products. The community nurse will complete the fast-track prescription form, located on SystmOne under communications and letters, indicating that the patient is either EOL or in a crisis situation and that the patient has been given continence products (including the amount supplied from stock) to use prior to the 24-hour delivery.
Community nursing services must update the log sheet within the product store in order to evidence the management of stock levels and the appropriate use of products to meet the needs of EOL patients.
The ordering of all continence products will be carried out by specialist continence service administration colleagues through the information provided on the fast-track prescription form.
4.6 Self-care
A despatch note will be attached inside the delivery box. The despatch note contains the call back number and the date the next delivery will be available.
Self-care is designed for re-activating deliveries only and cannot be used to bring a delivery forward or to change the type or number of products prescribed. If patients try to do this, housebound patients will be advised to contact the specialist continence service as a reassessment may be needed.
Continence products will be supplied every 12 weeks to community patients. All community patients must call Essity to activate their next order.
4.7 Transition from children’s continence service
Once a child reaches the age of 19, they will be transferred from the children’s continence service into the specialist continence service. To ensure that the transition is a smooth and seamless process, the patient and their parents or carers will be made aware of what to expect during the transition period by the children’s continence service. Once the patient has received their last prescription order by the children’s continence service, arrangements will be made for the patient to be assessed by an adult specialist continence nurse. The Children’s continence team will refer over to the adult service when the patient is 17 years and 11 months of age to allow time for the adult service to allocate the initial assessment within their service.
Following the assessment, a pad weigh will be performed, and the most appropriate products prescribed to meet the young person’s needs. The specialist continence service will aim to ensure that a delivery of products will be delivered in line with their 12 weekly delivery cycle so that there are no gaps in service.
4.8 Nursing, residential and learning disabilities care homes
Care home deliveries are every 12 weeks. Care home deliveries are activated once the care home delivery order form has been sent to the specialist continence service from the relevant home. This form includes a list of patient’s names that need their next delivery, any reasons for suspension for example, patient death, catheterised or improved needs to be documented. This form will only be accepted if the signature of the care home staff placing the order is eligible.
It is the homes responsibility to ensure that all patients who are on the home delivery service are added to the delivery form. Once the order has been activated and processed no changes can be made to the order. However, if there has been a problem with the delivery, they must contact specialist continence service within 48 hours. After this time Essity will not be able to deal with any discrepancies.
Patients who take up temporary residency in another area within England and Scotland or another country should be placed on a temporary stop. If patients do not activate their order for a year, then they will automatically be removed from the home delivery service. After this time the patient will need to be referred back into specialist continence service to have a full continence assessment and pad weigh.
4.9 Inpatient services
Pad use is based on individual holistic assessment and selection of the right product, if required. To maintain continuity of care, each ward will stock a core range.
Should continence symptoms become apparent during an inpatient stay, then a full continence assessment should be undertaken in order to ensure the most appropriate product is used.
On discharge, a referral should be made to the specialist continence service for a continence assessment, if required a supply of 7 day supply of body worn products should also be provided.
4.10 Annual reassessments
On an annual basis, all the house-bound patients will be reassessed by the community nursing teams, while non-house bound patients will continue to be reassessed by the specialist continence service. Patients will be sent a reassessment letter advising them to contact the specialist continence service within 14 days so that a review of their needs and associated products can be completed. Any patient that do not contact the specialist continence service within 14 days of receipt of the letter, will be sent another reminder informing them that if they fail to contact the service within the next 14 days then their products will be suspended until a reassessment is performed. Once products have been suspended a re-referral to specialist continence service will be required.
If a patient refuses to have a yearly reassessment then their products will be suspended until a reassessment is carried out.
Following reassessment patients who have been identified as having deterioration in symptoms must undergo a further pad weigh, to objectively assess the degree of incontinence so that the correct product can be prescribed to meet their clinical need. The pad weigh will be carried out at the patient’s home by a member of the specialist continence service or community nursing service.
5 Appendices
Please see continence manual webpage for appendices attached to this procedure.
6 References
- Association for Continence Advice (2017) Guidance for the provision of absorbent pads for adult incontinence. A consensus document.
- NICE (2014) Faecal incontinence in adults Quality Standard 54. The National Institute for Health and Care Excellence.
- The Urodynamics Society (1997) Standards of efficacy for evaluation of treatment outcomes in urinary incontinence. Recommendations of the Urodynamic Society. Urodynamic 1997; 16: 145 to 147.
Document control
- Version: 2.
- Unique reference number: 591.
- Date ratified: 5 March 2024.
- Ratified by: Clinical policies review and approval group.
- Name of originator: Senior continence specialist sister.
- Name of responsible individual: Executive director of nursing and allied health professionals.
- Date issued: 2 April 2024.
- Review date: 30 April 2027.
- Target audience: All clinical staff within Doncaster care group.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025