5.1.1 Complex Bowel Care

Complex Bowel Care

5.1.1

Version 6.1 March 2024

5.1.1 Complex Bowel Care Contents Preamble ............................................................................................................................. 3 Complex Bowel Care ........................................................................................................... 3 Plan Development ............................................................................................................ 4 Policies and Procedures................................................................................................... 4 Support Worker Training .................................................................................................. 4 Procedure ............................................................................................................................ 5 Bowel care equipment ...................................................................................................... 5 Administration of enemas ................................................................................................. 5 Administration of suppositories ........................................................................................ 5 Bristol Stool Chart ............................................................................................................ 6 Summary ............................................................................................................................. 7 Supporting Documents ........................................................................................................ 8 Policies ............................................................................................................................. 8 Forms ............................................................................................................................... 8 Information Sheets ........................................................................................................... 8 NGO Training ................................................................................................................... 8 Legislation ........................................................................................................................ 8 NDIS Practice Standards and Quality Indicators ................................................................. 9 5.1 High Intensity Daily Personal Activities .......................................................................... 9 5.1.1 Complex Bowel Care............................................................................................... 9 Human Services Quality Standards ................................................................................... 10 3 Responding to Individual Need ................................................................................... 10 6 Human Resources....................................................................................................... 10 Delegation of Authority....................................................................................................... 10 Version Details ................................................................................................................... 11

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Preamble BigDog Support Services Pty Ltd (BigDog) ensures that each client requiring complex bowel care receives appropriate support relevant (proportionate) to their individual needs.

Workers with appropriate competency training and assessment provide bowel care to our clients. BigDog considers it imperative to involve our clients in all aspects of their service delivery and the direction of their services to their ability. The dignity of risk is an essential part of this choice and control.

Complex Bowel Care Bowel care is the care and management process of eliminating faecal matter from a client’s body. Bowel care can encompass personal hygiene, assistance with toileting, medications to promote bowel function and administration of the same.

The bowel consists of the small and large intestines, which both play an important role in keeping people healthy. They allow the body to absorb fluid and nutrients from food and process and expel the waste.

Signs of a healthy bowel can include: regular bowel movements of wellformed (types 3 and 4) stools being able to hold on for a short amount of time after first feeling the urge to pass a stool defecating within roughly a minute of sitting on the toilet passing a stool without any pain or need to strain completely emptying the bowel when having a movement Constipation and poor bowel emptying A condition of the digestive system characterised by hard faeces that is described as difficult or painful when passing faeces and passing faeces infrequently.

Diarrhoea Loose, watery faeces and is usually frequent.

Faecal incontinence Uncontrolled passing of faeces creating social or hygiene problems for the client.

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Plan Development Each client is involved in the assessment and development of the plan for their high intensity daily personal activity and management. With their consent, the client's health status is subject to regular and timely review by an appropriately qualified health practitioner.

Health practitioners may include; a Registered Nurse, Dietitian, Speech Pathologist, Pharmacist, Medical Specialist, General Practitioner and Stomal therapist deemed competent by training.

The plan identifies how risks, incidents and emergencies will be managed, including required actions and escalation to ensure client wellbeing.

Policies and Procedures Appropriate policies and procedures are in place, including a training plan for workers, that relate to the support provided to each client who has enteral feeding needs.

The requirements of this role will be clearly documented in a care management plan that has been developed and is overseen by an external health practitioner.

Both the training plan and the management support plan will include the identification of risks including actions and escalations.

Support Worker Training BigDog will ensure that the worker has the relevant knowledge and has received client specific training in order to safely support the client in the community.

Within this course, the worker will gain an understanding of their obligations when delivering Complex Bowel Care support. They will learn what Complex Bowel Care support involves and how to identify functional and dysfunctional digestive systems. The course will first discuss what a good bowel care plan looks like and review the NDIS requirements. Next, the course will cover bowel care interventions and worker responsibilities. And lastly, how to manage bowel care risks, incidents and emergencies.

After this lesson workers will be able to: 1. Explain what complex bowel care is and how to differentiate between functional and dysfunctional digestive systems 2. Explain what a good bowel care plan looks like, including the NDIS requirements for approving and providing Complex Bowel Care support 3. Have a deeper understanding of bowel care interventions and how to manage risks, incidents and emergencies 4. Explain worker role and responsibilities when delivering complex bowel care Course duration: 42 minutes Any other client specific training will be delivered by an appropriately qualified RTO.

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Procedure Bowel care equipment Equipment required to provide appropriate bowel care may include, but is not limited to: disposable gloves (powder free) personal protective equipment (gloves, face shields and masks) disposable aprons lubricant (water-based) gauze swabs incontinence pads or Kylie a medical waste receptacle or bag paraffin wax medications.

Administration of enemas When administering an enema, the worker will: Explain to the client the steps that will be taken to administer the enema obtain the client’s verbal consent check the records to confirm the date and time the enema is due to be administered gather all the equipment needed to administer the enema wash and dry hands and put on disposable gloves place a protective disposable mat or waterproof cover under the client request the client lies on their left side with their gently knees drawn up, if possible warm the enema by placing it in a bowl of hot water lubricate the end of the enema tube using water or a smear of paraffin wax insert the tip of the enema nozzle into the rectum (this may cause the client some discomfort but should not cause pain) gently squeeze the enema into the rectum stop if there is pain and immediately call the coordinator or oncall dispose of all PPE and disposable mat immediately as per the Management of Waste Policy be ready to assist the client in going to the toilet, as they may need to go shortly after the enema is administered.

Administration of suppositories When administering a suppository, the worker will: Explain to the client the steps required to administer the suppository.

Get the client’s verbal consent.

Check the records to confirm the date and time that the suppository is due to be inserted.

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Have the client lie on their left side with the knees drawn up, if possible.

Insert the suppository into the rectum.

Suppositories may take some time to have a result.

Assist the client in going to the toilet when they ask or 30 minutes after administering the suppository.

Dispose of all PPE and disposable mat immediately following waste and infection management procedures.

Workers will assess the bowel movement using the Bristol Stool Chart (which provides a visual guide to the type of stool passed) and record in CareMaster the client’s Progress File Notes when the enema or suppository was given.

Bristol Stool Chart

Type 1 has the appearance of separate hard lumps, while type 2 is sausage-shaped but lumpy. Both types could indicate constipation, as these stools are hard, dry, and difficult to pass. They may also be darker in colour. This occurs when food passes too slowly through the digestive system and the colon absorbs too much water.

Type 3 has a shape similar to a sausage but with cracks on the surface, while type 4 has a comparable appearance to type 3 but with a smooth and soft surface. Experts generally consider these types to be the most healthy and typical stool forms.

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Type 5 stools are soft blobs with clear-cut edges that a person can pass easily. Some may also consider this type to be typical in those without bowel issues, while others may suggest it is too loose and may imply diarrhea.

Type 6 is a mushy stool that appears to consist of fluffy pieces with ragged edges, while type 7 is entirely liquid with no solid pieces. These types of stools may suggest a person is experiencing diarrhea, as the stools are loose. They may also be lighter in colour. This is due to passing the stool through the digestive system too quickly and the bowel is unable to absorb water.

Summary

In addition to having a healthy diet, drinking plenty of fluids, and getting regular exercise, people can try other strategies to improve their bowel health and function.

These may include: Bowel training: Clients can attempt to train themselves to have a bowel movement at consistent times each day. For example, they can try to pass a stool shortly after eating breakfast. It is also advisable for a client to allow plenty of time and use the bathroom as soon as they feel the need to go.

Positioning: Maintaining appropriate toilet posture may make it easier for clients to have a bowel movement and avoid straining. This typically involves relaxing, placing the feet on a footstool to ensure the knees are higher than the hips, leaning forward, bulging out the abdomen, and straightening the spine.

Changing medications: If a person suspects that a medication or supplement may be affecting their bowel movements, they should discuss this with their healthcare professional.

They may be able to change the dose or suggest a different medication.

Dietary changes: As well as eating more fibre, it may be beneficial for the client to consider avoiding foods and drinks that may irritate their stomachs. This may include alcohol, caffeine, and fatty foods. However, before making any drastic dietary changes, it is advisable to speak with a medical professional.

Any high intensity daily personal activity and management forms part of the formal training program and must be signed off by a Registered Training Organisation (RTO).

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Supporting Documents Policies 1.1 Person-Centred Supports 1.3 Privacy and Dignity 2.3 Quality Management 3.4 Responsive Support 5.0 High Intensity Daily Personal Activities

Forms NGO Course Report NGO User Report Training Attendance Sheet

Information Sheets Prior to Performing Digital Stimulation Stool Chart

NGO Training Complex Bowel Care Comprehensive Health Assessments (PA03) Transitions of Care (PA02)

Legislation Disability Discrimination Act 1992 (Cwth) Disability Services and Inclusion Act 2023 (Cwth) Disability Services Act 2006 (QLD) Health Act 1937 (QLD) Health Regulation Act 1996 (QLD) National Disability Insurance Scheme Act 2013 NDIS (Provider Registration and Practice Standards) Amendment Rules 2021 Queensland Guardianship and Administration Act 2000 (QLD) Queensland Human Rights Act 2019 (QLD) Queensland Mental Health Act 2016 (QLD)

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NDIS Practice Standards and Quality Indicators BigDog Support Services Pty Ltd (BigDog) is a registered NDIS provider and is required to apply the scheme’s practice standard and quality indicators.

The standards have been developed to create an important benchmark to assess provider performance and ensure that high quality and safe supports and services are provided to NDIS participants.

The four core modules are: 1.0 Rights and Responsibilities; 2.0 Governance and Operational Management; 3.0 The Provision of Supports; and 4.0 The Support Provision Environment.

The supplementary modules cover: 5.0 Specialist Support.

5.1 High intensity daily personal activities.

5.2 Implementing behaviour support plans.

5.1 High Intensity Daily Personal Activities These NDIS Practice Standards set out the responsibilities of BigDog when providing supports and services to clients that require the following.

5.1.1 Complex Bowel Care 5.1.2 PEG Feeding and Management 5.1.3 Severe Dysphagia Management 5.1.4 Tracheostomy Management 5.1.5 Urinary Catheter Management 5.1.6 Ventilator Management 5.1.7 Subcutaneous Injections 5.1.8 Complex Wound Management

5.1.1 Complex Bowel Care Each Participant requiring complex bowel care receives appropriate support relevant (proportionate) to their individual needs.

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Human Services Quality Standards The Standards set a benchmark for the quality of service provision. Each Standard is supported by a set of performance indicators which outline what BigDog is required to demonstrate to meet that standard.

3 Responding to Individual Need The assessed needs of the individual are being appropriately addressed and responded to within resource capacity.

3.3 BigDog ensures that services to the individual/s are delivered, monitored, reviewed and reassessed in a timely manner.

6 Human Resources Effective human resource management systems, including recruitment, induction and supervisory processes, result in quality service provision.

6.3 BigDog provides people working in BigDog with induction, training and development opportunities relevant to their roles.

Delegation of Authority Name

Position

Details

Steven Paull

Director

Authorise review and implementation

Courtney Carroll

Director

Authorise review and implementation

David Burrett

Operations Manager

Ensure information dissemination

Monique Paull

HR Manager Lawyer

Ensure compliance by employees

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Version Details This policy will be reviewed every twelve (12) months unless circumstances deem it necessary to review earlier. The review process will involve an analysis of the usefulness of the policy and to note any changes which are required to improve the policy.

If minor changes are made in wording or to clarify the intent, the version number will indicate this by adding a ‘point’ i.e. Version 1.0 indicates the original version and 1.1 with the first round of minor changes made. A significant change or intent of the policy will be indicated by a whole new number i.e. Version 2.0.

The following rules also apply in interpreting this policy: • Headings are for convenience only and do not affect interpretation.

• A singular word includes the plural and vice versa.

• A word that suggests one gender includes the other genders.

Date

V

June 2020

5.0 New Policy

January 2021

5.1 Updated Responsible Officers details

January 2022

5.2 Updated Responsible Offices details and NDIS (Provider Registration and Practice Standards) Amendment Rules 2021

June 2022

5.3 Practice Alert 23rd June 2022

January 2023

6.0 Included Human Services Quality Framework (HSQF) and Child Protection Act and the term “Participant” is returned to “Client” to allow for policies to cover NDIS and HSQF.

March 2024

6.1 Disability Services Act 1986 replaced with Disability Services and Inclusion Act 2023 and policy review process included.

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