Resources to support safer bowel care for patients at risk of autonomic dysreflexia


A Patient Safety Alert has been issued signposting resources to support safer provision of bowel care for patients at risk of autonomic dysreflexia (AD).

A range of resources to assist providers are listed in the alert and below.

Resources from Nursing and Midwifery Council

The Nursing and Midwifery Council's 2018 Future nurse: Standards of proficiency for registered nurses specifies the knowledge and skills that registered nurses must demonstrate when caring for people of all ages and across all care settings. See: Nursing Procedures Part 2, page 35, point 6.5 ‘administer enemas and suppositories and undertake rectal examination and manual evacuation when appropriate’.

Resources from Royal College of Nursing

The Royal College of Nursing has developed an online resource for registered nurses, nursing students, healthcare assistants (HCAs) and assistant practitioners working in any healthcare setting or specialism designed to help support people who have incontinence or bowel and bladder problems.

Additionally and specifically, the 2012 guidance Management of lower bowel dysfunction, including digital rectal examination anddigital removal of faeces provides a review of lower bowel dysfunction in adults and procedural guidance for Digital Rectal Examination, Digital Removal of Faeces and Digital Rectal Stimulation.

Resources from Multidisciplinary Association of Spinal Cord Injury Professionals

The Multidisciplinary Association of Spinal Cord Injury Professionals' 2012 Guidelines for management of neurogenic bowel dysfunction in individuals with central neurological conditions bring together the research evidence and current best practice to provide support for healthcare practitioners involved in the care of individuals with a range of central neurological conditions. While most research evidence around neurogenic bowel management is related to individuals with spinal cord injury, the principles identified can be applied to individuals with other conditions with appropriate assessment and evaluation.

Resources from Spinal Injuries Association

The Spinal Injuries Association's patient and professional resources 2013 Living with Spinal Cord Injury Factsheet: Autonomic Dysreflexia gives practical advice and guidance for patients and carers. 

Resources from NHS England

NHS England's 2018 Excellence in continence care framework is intended to assist commissioning discussions for those developing high quality community continence services. See section ‘Commissioning for dignity and value’ page 13.

Resources for general practitioners

Guidance that may particularly be helpful for GPs are contained in the Multidisciplinary Association of Spinal Cord Injured Professionals 2012 Guidelines for management of neurogenicbowel dysfunction in individuals with central neurological conditions. Specifically see page 10, a quick guide to neurogenic bowel management; and page 17 section 6.9, clinical outcomes and complications of neurogenic bowel dysfunction.

Tracy's story patient video

Tracy shares her personal story of the fear she experienced when hospital staff didn’t listen to her advice regarding her symptoms of autonomic dysreflexia.

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