Abstract
Managing neurogenic bowel care after a spinal cord injury (SCI) involves multiple interventions and considerable time. Access to appropriate and safe neurogenic bowel care in Ireland varies significantly with lack of capacity/experience and/ or training often cited by healthcare professionals (HCP’s) for their refusal to perform bowel-care.
Difficulty in accessing neurogenic bowel care outside of specialist centres has resulted in costly delayed transfers of care from the National Rehabilitation Hospital (NRH).
A snapshot of 4 patients who had delayed transfers of care (2019 – Present) as a direct result of inaccessible neurogenic bowel care led to 936 additional days spent in-patient in the NRH, i.e. 2.56 years. In turn, causing delayed access to rehabilitation for new SCI patients.
Case Study: 25-year-old sustained a C3 SCI. Admitted to NRH 02/22 for 12-week rehabilitation. Delayed transfer of care, secondary to housing / accessing neurogenic bowel care. Housing needs were met yet by 12/23 he remains an inpatient, secondary to inability to access bowel care.
Patient's thoughts:
My life is spun upside down and so is my relationship, having lost control of my bladder and bowel and lost all sexual function.
Friendships have been lost.
My discharge back to my community has been delayed because of housing and access to bowel care. My house has been ready for months yet I remain in the NRH as a direct result of no nurses available to complete bowel care. A basic right I believe.
Approach: The following educational and information tools have been developed to ensure safe and consistent messaging and information for all levels of care:
A range of patient materials explaining the practical management of their neurogenic bowel care.
Development and delivery of a tailored course for community carers and HCA’s.
Delivery of an annual lecture to undergraduate nursing student, introducing neurogenic bowel care.
Monthly nationally accredited online courses in Neurogenic Bowel Management to train registered nurses. To date nearly 1,000 registered nurses have been certified.
Since 2021, 30 healthcare settings have been attended the Train the Trainer Course in Management of Neurogenic Bowel facilitating organisations to roll out appropriate training to their own staff.
Development of a comprehensive neurogenic bowel policy for the NRH which is currently being progressed as a framework for National Guidelines.
Conclusion: By sharing the wealth of knowledge gained from practical day to day care to provide guidance and confidence to professionals in the community caring for SCI; introducing the topic as an integral part of third level healthcare education and developing a range of education tools and materials giving a shared language and communication of skills to patients, carers, families and loved ones to talk openly about a difficult part of their lives, continues to support the post-injury community reintegration.
However, there is an urgent need to provide a competency structure for HCP in acute and primary care in order to allow the appropriate allocation of resources so delayed transfer of care for neurogenic bowel management can be minimised and, in the future, avoided altogether.