Care Trigger: Bowel Care/ Management
Helps to review current practice vs. best practice vs. where it links to best practice
Developed by Jackie Dennis – Health/Continence Adviser
Updated: March 2011
Review By : March, 2013
Publication code: HCR-0311-022
Care Trigger – Key areas
Does the care service have policies and clear
procedures in place for:
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Promotion of continence that separates
bowel and bladder care management
Bowel management and care
Check list of evidence
National Care Standard/Best Practice
Guidance
The Staff working in the care service are
familiar with these policies/procedures and
demonstrate a good knowledge of their
implementation
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The policies guide staff to best practice and
inform the care for service users.
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NB: The focus should be on promoting
continence and not ‘incontinence’ therefore the
language used within any information must be
promotion and positive aiming for
maintaining/improving functional level.
The policy records the service’s local
continence advisory service details and
contingency arrangements for requesting
containment products for unplanned events
What is the prevalence of bowel incontinence
within the service? –
Review pre inspection information related to
continence management and promotion
What other factors are effecting the promotion of
bowel continence for service users
And; explore
 How accessible are the toilets?
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www.rcn.org.uk/members/downloads/digit
alrectalexamination
www.aca.co.uk
Royal College of Nursing, CPD,
continence focus – Bowel Dysfunction
The Royal College of Physicians, Bowel
Care In Older People, Research and
Practice
www.rcn.org.uk/members/downloads/digit
alrectalexamination
www.aca.co.uk
Royal College of Nursing, CPD,
 How do residents call for assistance (are
call systems available and accessible in
bedrooms/day rooms?)
 What is the signage within the service
highlighting bathrooms with toilets/toilet
Within the individual service users’ personal
areas?
plans, there should be an assessment which has
 What is the usage of aperients within the
identified bowel dysfunction and there needs to
service? You should cross reference to
be a separate bowel care, care plan.
personal plans re: assessment of need
for aperients vs. the appropriate diet and
fluid management to reduce likelihood of
constipation.
 Cross match the ‘pad’ order sheet sent to
their local continence resource service –
does it match with the individual service
user’s care plan or are other service
users accessing products not specifically
for them?
NB: The prevalence will differ depending on
service user need.
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continence focus – Bowel Dysfunction
The Royal College of Physicians, Bowel
Care In Older People, Research and
Practice
NMC Guidelines for records and record
keeping 2010
the service’s recent admissions and explore
what the service user’s continence functional
level was at admission and what is it at the
time of inspection, noting
improvement/deterioration over what period
of time and any mitigating circumstances for
deterioration?
Do the personal plans highlight an individual
assessment of bowel activity (where
appropriate) and, if an issue is identified, the
management of care need related to continence
issues?
Do the bowel care, care plans reflect the
potential for improvement, or are they simply a
prescription for containment?
As part of the assessment is there a detailed
history taken and continence assessment
charts used?
Are investigations undertaken to determine
any underlying issues? e.g. bowel infection,
commencement on any medication that may
have had an impact on the individual
bowel/gastric function.
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www.rcn.org.uk/members/downloads/digit
alrectalexamination
www.aca.co.uk
Royal College of Nursing, CPD,
continence focus – Bowel Dysfunction
The Royal College of Physicians, Bowel
Care In Older People, Research and
Practice
www.promocon.co.uk
Explore the personal plans and the specific
care planning related to:
 faecal incontinence and/or
constipation
 PMH
A care plan should be in place where a need
is identified.
What is the service’s ongoing assessment
process of individual service users, needs?
 Review personal plans and specifically
the Bowel care plans re: information
about individual toilet requirements,
alternatives to toilet use, not just pads
ongoing assessment.
 Do staff take cognisance of the individual
behaviours that may highlight the person
may be in need of using the toilet. e.g.
agitation?
 How do staff communicate with the
service user to convey support with
continence needs e.g. use of signs,
pictures?
 If aperients are prescribed it should be
clear when these should be administered
within the personal plan.
Cross reference individuals who are being
given aperients to their dietary care plan.
For example, if issues with constipation are
identified, the service should also be
ensuring appropriate dietary/fluid input to
help with specific issues.
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NMC Guidelines for records and record keeping
2010
Are the care staff familiar with current best
practice
Staff training – are care staff trained to care for
someone who presents with a continence care
need?
Is there commitment from the provider to the
ongoing CPD of all staff re: continence
promotion
Episodes of bowel incontinence should be
contained discreetly
 Review staff training records – explore
whether staff have received training
related to managing bowel dysfunction
issues relevant to their client group - eg
assessment, awareness of the need for
accurate assessment, care planning and
reviews/ reassessment.
 What links does the service have with
their local continence resource service?
 Are staff familiar with the service’s bowel
continence promotion policy
 Staff have undertaken learning relating to
bowel care and management
 On observation individual residents
should not have soiled patches on their
clothing or visible containment products.
 Pads should not be used to protect
furniture – if products leak containment
should be reviewed.
 Staff awareness of when the service user
may have the need to empty their bowels
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www.rcn.org.uk/members/downloads/digit
alrectalexamination
www.aca.co.uk
Royal College of Nursing, CPD,
continence focus – Bowel Dysfunction
The Royal College of Physicians, Bowel
Care In Older People, Research and
Practice
Association of Continence advice (ACA)
continence resource pack for care homes
Dignity and Privacy of service users
This Care Trigger Tool is designed to be of assistance to SCSWIS inspectors when reviewing practices and policies. The contents have
not been issued as SCSWIS policy, but to offer common sense guidance on relevant areas of practice.
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