National Neonatal Surgical Benchmarking Group
Management of rectal washouts(2017)
Practitioner agreed patient focused outcome:Optimal care and management byundertaking rectal washout’s will be achieved
by utilising an evidence based, family centred, collaborative team approach.
Ref: Guideline for the management of bowel irrigation (rectal washout) for less than one year old infants and children (2011). Leeds Healthcare Pathways.
Great Ormond Street Hospital (2010). Clinical guideline rectal washout.
Tod et al (2007). Rectal irrigation in the management of functional bowel disorders: a review
Indicators / information that highlights concerns which may trigger the need for benchmarking activity:
Patient satisfaction surveys.
Complaints figures and analysis.
Critical incident analysis.
Documentation audit. / Research critique / trial.
FACTOR / BENCHMARK OF BEST PRACTICE.
1 / Preparation of the family. / All families will receive appropriate information from the multidisciplinary team to enable them to fully participate in the decision making process and give informed consent.
2 / Delivery of rectal washout’s / The assessment and planning of care is focused upon the relevant neonatal issues and is evidence based. Care is individualised, evaluated and documented.
3 / Education and training of health professionals / All nursing staff receive an evidence based, consistent and comprehensive education / training program covering all aspects of a rectal washout and attend ongoing update sessions to maintain competencies.
4 / Preparation for discharge / transfer. / All families /carers are competent and confident in meeting the infants’ needs within the community setting. They have access to a supportive multidisciplinary team at all times.
NAME OF UNIT: / NAME OF PERSON (S)
COMPLETING BENCHMARK
Factor One: Preparation of the family
PROHIBITIVE BARRIERS / BEST PRACTICEAll families will receive appropriate information from the multidisciplinary team to enable them to fully participate in undertaking the rectal washout.
Ref:The report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary. 1984-1995. Learning from Bristol. (2001) The Stationary Office. UK
BAPM (2004)Consent for common neonatal investigations, interventions and treatments
BAPM (2004) Consent in neonatal clinical care. Good practice framework
DoH, (2009) Reference guide to consent for examination or treatment (second edition). DoH: London
INDICATORS OF BEST PRACTICE / Yes
2 / Developing
1 / No
0
A parental teaching pack is available.
Parental competence to provide care is assessed and documented.
Parental understanding / acceptability of the information is assessed.
Information is evidence based.
Information is user friendly & understandable to the family.
It is in a format that the family can access (Fact sheets, leaflets,videos, translated materials).
Parents have the opportunity to discuss the information with the MDT.
There is a neonatal / paediatric specialistnurse available.
Score Factor 1
□ □ □ □ □
0-34-67-910-1314-16
E D C B A
Factor Two: Delivery of rectal washout
PROHIBITIVE BARRIERS / BEST PRACTICE. / The assessment and planning of care is focused upon the relevant neonatal issues and is evidence based. Care is individualised, evaluated and documented
Ref: Bradnock T and Walker G (2008). The current management of Hirschprungs Disease in the UK. A National Summary of Practice
INDICATORS OF BEST PRACTICE / Yes2 / Developing
1 / No
0
There is an individual rectal washout care plan.
There are sufficient equipment / products available for the delivery of rectal washouts.
There are evidenced based policies / procedures and guidelines in place.
Treatment is effective / interventions / targets are negotiated with the MDT.
Score Factor 2
□ □ □ □□
0-1 2-3 4-5 6-78
E D C BA
Factor three: Education and Training – Health Professionals
PROHIBITIVE BARRIERS / BEST PRACTICENursing and medical staff receive education /training to maintain competencies.
Ref: NMC. (2015) Code of Professional Conduct for Nurses, Midwives and Health visitors. London
Kings College London (2009). Nursing competence: What are we assessing and how should it be measured? Policy plus evidence, issues and opinions in healthcare. Issue No 18
INDICATORS OF BEST PRACTICE / Yes2 / Developing
1 / No
0
Staff that undertakea rectal washout, areassessed and evaluated as competent.
There is a database to record staff training & assessment.
Education and training resources for staff are evidence based and reviewed as per Trust policy.
Appropriate experts are available within the organisation to provide ongoing education & training.
The training program is influenced by the clinical governance process
Score Factor 3
□ □ □ □ □
0-12-34-5 6-8 9-10
E D C B A
PROHIBITIVE BARRIERS / BEST PRACTICE
All families /carers are competent and confident in meeting the infants’ needs within the community setting. They have access to a supportive multidisciplinary team at all times.
Factor four: Family preparation for discharge.
Ref: Johnson A, Sandford J, Tyndall J (2008). Written and verbal information versus verbal information only for parents being discharged from acute hospital settings to home.
The Cochrane Library
Healthcare provider’s attitude towards parent participation in the care of the hospitalization of children (2012). Journal of specialists in pediatric nursing.
INDICATORS OF BEST PRACTICE / Yes2 / Developing
1 / No
0
Parental / carer competency is assessed and documented.
Parents / carers participate in planning for discharge package.
The parents / carers have the opportunity to discuss the information with the MDT for discharge home.
The information is reviewed and updated regularly.
Do parental / carer’s views influence training program?
Parental satisfaction survey regarding family preparation is given to parents.
Score Factor 4
□ □ □ □ □
0-2 3-5 6-8 9-11 12
E D C B A
Action planned to move towards best practice statement
Compiled by / Unit: / Date:Aim:
Optimal care and management by rectal washout will be achieved by utilising an evidence based, family centred, collaborative team approach.
Action required: / By whom: / Date to be completed: / Reflection / comment
RECTAL WASHOUT
TEACHING CHECKLIST FOR PARENTS AND CARERS DELIVERING CARE
NAME / Date shown / Date practiced / Date practiced / Date practiced / Date practiced / Sign when competent
DISCUSSION
SAFETY & HYGIENE
PREPARING EQUIPMENT
POSITIONING
ASSESSING ABDOMEN PRE & POST WASHOUT
INSERTING TUBE
GRAVITY WASHOUT
POTENTIAL PROBLEMS
PROBLEM SOLVING
CLEANING EQUIPMENT
DISPOSAL OF FLUID
ORDERING SUPPLIES
CONTACT NUMBERS
National Neonatal Surgical Benchmarking Group April 2010
Post Operative Wound Assessment Scoring Scale
Characteristics of wound / Scoring Scale0 / 1 / 2
Suture line / Intact / Partial detachment, superficial thickness
0-20% / Gaping wound, full thickness
25-100%
Haemorrhage / Nil / Small / Moderate
Discharge
Haemoserous exudate / Nil / Small / Moderate
Inflammation
Erythema / Mild
One area / Moderate
Sporadic around sutures / Extensive around wound and spreading out
Bruising/haematoma / Nil / Small / Moderate
Evidence of infection/pus / Nil / Slight / Moderate
Observe post operative wound using the above assessment scale hourly or more frequently as clinically indicated and document on nursing intensive care chart.
Reduce frequency of observation as clinically stable to 4 – 6 hourly for the first five days following surgery.
If you score 6 or more commence a wound assessment chart and refer to medical staff, wound link nurse and/or tissue viability nurse.
References:
Bailey I.S. et al (1992) Community surveillance of complications after hernia surgery, British Medical Journal 304:469-71.
Wilson A.P. et al (1986) A scoring method (ASEPSIS) for postoperative wound infections for use in clinical trials of antibiotic prophylaxis, Lancet 1(8476):311-3.