continence summer 2007 - Invest for CONTINENCE

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continence summer 2007 - Invest for CONTINENCE


RCN Continence Care Forum

Summer 2007

Further information

    Contributions for the next issue should reach the editor by 2 October 2007

Sue Thomas


Letter from the Chair

A frightfully exciting conference

Katherine Wilkinson is inspired by the latest plans for this year‟s forum conference.

    I am writing this letter on my journey home from London following an RCN Continence Care Forum Committee meeting. It was a most enjoyable meeting; as a committee, we worked well together in finalising the plans for our forum conference, titled: „Continence care in action: demonstrating quality‟, to be held 31 October and 1 November, 2007 at

    York Racecourse.

    The conference programme is packed with a variety of excellent speakers and masterclasses, offering nurses at all levels of practice the opportunity to gain new knowledge and skills and, in the large exhibition, to learn about the products available for clients.

    Last year‟s conference was a huge success, and was well attended by delegates and companies. Because of this, we have been able to reduce the cost of registration this year to an extremely competitive price of just ?159 for RCN members who register before 18 September.

    I am aware of the pressures on many specialist nurses at present, and the difficulties that many of you are experiencing in taking study leave and receiving funding for attendance

    at conferences. I hope that you can manage to persuade your employer that the RCN Continence Care Forum Conference offers an excellent programme and exceptional value for money. I look forward to seeing you there!





    Do you think the RCN should proceed to a formal ballot on industrial action over this year‟s pay award? This is the question we will be asking members employed by the NHS who, this year, are looking at a pay award of just 1.9 per cent.

    The Government in Westminster chose to ignore the recommendation of the independent pay review body that NHS nurses should receive an increase of 2.5 per cent and wants to stage the award instead, reducing its real-terms value to 1.9 per cent and saving ?60m in the process even though the NHS in England ended the last financial year with a surplus of ?500m.

    The Scottish Executive has agreed to raise NHS nurses‟ pay by 2.5 per cent in full from the start of April and RCN Scotland has chosen to accept the award on that basis. But in England, Northern Ireland and Wales, ordinary, hard-working nurses stand to lose hundreds of pounds, at a time when the cost of living is high.

    Consequently, the RCN is balloting all its members employed by the NHS in England, Wales and Northern Ireland.

    This ballot is also an opportunity to check we have correct information about your employer and workplace this is vital in order to comply with legal requirements should we go ahead with a second ballot on industrial action. You can check your details on your ballot form, or, alternatively, update them online at , or telephone RCN Direct on: 0845 772 6100.

    Your ballot paper will be sent out to you in mid-July and forms must be returned by noon on Monday, 6 August 2007 make sure you vote!

For further information, visit

RCN Congress fringe event

Developing best practice in the management of children with constipation and soiling

    June Rogers MBE provides an overview.

    Constipation and soiling in childhood is a common condition that is often under diagnosed and under treated. This fringe session gave a summary of constipation and soiling, the causes, prevalence and impact on the child and family as well as an overview of the nurses‟ role in supporting such children and their families, in what is often a

    distressing condition.

Initial review results

    A review of paediatric continence promotion services carried out in 2003 in conjunction with the NHS Modernisation Agency found that, overall, the standard of service provision for children with continence problems was poor, with little evidence of a child-centred approach or integrated working (DH, 2003). This was then followed by the recommendation within the Children‟s National Service Framework for primary care trusts to develop integrated paediatric continence promotion services.

    The development of care pathways and locally agreed guidelines to help facilitate an evidence-based integrated approach to paediatric continence promotion, which is standardised across all disciplines, was recommended. The fringe session gave an opportunity to discuss evidence-based treatment options that can be initiated in primary care and the role of care pathways such as the IMPACT bowel care pathway.

Putting it into practice

    Evidence-based practice is seen as an important force in health care today and the use of developed practice guidelines and protocols is fast replacing the phrase „That‟s the way I‟ve always done it‟ (Munro 2004). Evidence-based practice integrates clinical

    experience and patient values with the best available research information (Craig et al., 2001). Developed clinical practice guidelines and protocols have been shown to improve the quality of care by reducing inappropriate variations, producing optimal outcomes,

    minimising harm and promoting cost-effective practices (American Academy of Pediatrics, 2004).

    Nurses also need to play an advocate role for the child and if they are aware of acknowledged or evidence-based treatment options that reduce the risk of adverse events, then that should be considered as the first treatment of choice. For example, traditional practice for a child with constipation who required dissimpaction was to use enemas or suppositories. This method is very distressing for the child and is also costly in terms of nursing time.

    There is now considerable emerging evidence, for example, regarding the use of oral therapy for dissimpaction that is effective, safe to use and not at all distressing for the child. It was stressed that nurses must take responsibility of keeping up to date and incorporating any new evidence, as it becomes available, into the pathways and developed guidelines.


    The fringe session was very interactive and provided the opportunity for nurses from different areas to discuss their local practice. Due to clashes with other paediatric events, the numbers who attended were small, but the feedback was very positive, with the majority reporting they were going back to see how they could now improve practice locally.

Changes ahead for home deliveries?

    Forum members respond to consultation document regarding proposed arrangements for the remuneration of services relating to appliances within Part IX of the Drug Tariff Arrangements for the reimbursement pricing of stoma and incontinence appliances under Part IX of the Drug Tariff.

    The RCN responded to this consultation document earlier this year, undertaking a survey of its Continence Care Forum members as part of the consultation process. Over 300 continence nurse specialists made individual comments. One of the main issues raised was that of home delivery services and appliance services.

    Having to obtain continence products over the counter at a chemist can be embarrassing as well as an inconvenience for transportation. For these reasons, many service users may

    prefer the discretion that a home delivery service offers. Access to a wide range of incontinence products, including some of the more unusual bespoke products, can make a huge difference to quality of life. The specialist nursing services provided by some companies are essential to ensure that the fitting of incontinence appliances is correctly undertaken and the forum indicated it would not wish this to be eroded.

One of the aims of this consultation is to “maintain and, where applicable, improve the

    current quality of care to patients and provide a consistent level of care”. The RCN stated it was unable to visualise how the current proposals will improve the service for patients, or even maintain the level of service currently available. The RCN hopes that the Department of Health will reconsider the proposed arrangements.


    American Academy of Pediatrics Steering Committee on Quality Improvement and Management (2004) Classifying recommendations for clinical practice guidelines, Pediatrics, Vol.114 (3), pp.874877.

    Craig J C, Irwig L M, Stockler M R (2001) Evidence-based medicine: useful tools for decision making, Medical Journal of Australia, Vol.174 (5), pp.2145.

    Munro N (2004) Evidence-based assessment: no more pride or prejudice, A A Clinical Nursing, Vol.15 (4), pp.5015.

NHS Modernisation Agency (2003) Good practice in paediatric continence services

    benchmarking in action, London: Department of Health.