An alert has been issued to the NHS in England after concerns were raised about patients with spinal injuries facing delays in receiving specialist care to clear their bowels, which can result in a brain haemorrhage, high blood pressure, extreme discomfort and ultimately death.
NHS Improvement received 61 reports to its National Reporting and Learning System (NRLS) over the past four and a half years of patients in hospital – including those with spinal injuries and neurological conditions – not being provided with specialist bowel treatment quickly enough to ensure their regular bowel routine continues as normal.
The NRLS reports included three incidents of autonomic dysreflexia – a life-threatening condition that can happen to people who have injured their spinal cord or upper back. The condition leads to dangerous spikes in blood pressure which can lead to cardiac arrest, stroke, brain haemorrhage and even death.
One patient said: “Despite explaining my situation, I had to wait eight days for an enema. I’d had shoulder surgery so couldn’t do it myself. I had the beginnings of Autonomic Dysreflexia.”
Most patients requiring specialist bowel care have lost their ability to clear their bowels on their own following spinal injuries, caused either by trauma or because of a long-term neurological illness, such as a stroke, multiple sclerosis, or cerebral palsy.
The Spinal Injuries Association, the spinal cord injury charity, surveyed its 10,000 members and found that 49% of them had not been given bowel care while in hospital.
NHS Improvement found that more training and experience among NHS staff is needed outside of specialist injuries units for how to provide bowel care. The UK Spinal Injuries Association found that 41% of all trusts did not run courses to train their staff in manual bowel care removal techniques.
NHS Improvement also found that across the NHS, excluding specialist spinal injury and community heath teams there was:
- unclear local policies stating who could undertake digital removal of faeces (DRF), including the patient’s own carers or health professionals from another provider
- lack of knowledge of relevant clinical guidance
- uncertainty over requirement and provision of training
- uncertainty over using alternative methods of bowel management
- a mistaken belief that this type of care constituted assault.
Now NHS Improvement is calling on providers of NHS funded care to take action to ensure that these patients are given the potentially life-saving care they need.
The NHS in England has been asked to review their bowel care guidance and develop an action plan within the next six months outlining how they will ensure spinal injury patients receive the bowel care they need in a timely manner.
To support this, NHS England has published new guidance to help address any confusion across the NHS on when patients should receive this treatment, who is required to provide it and how this should be given. These resources mean that when a patient with a spinal injury or neurological condition is in hospital their normal bowel routine is not disrupted.
NHS Improvement’s Executive Medical Director and Chief Operating Officer, Dr Kathy McLean, said:
“We know patients with spinal injuries who need care from teams unfamiliar with their needs are waiting too long to receive the vital bowel care they need. The failure to provide this care can cause a dangerous reaction, including rapid rising blood pressure, which can put patients’ lives at risk.
“We are urging the NHS to take immediate action to ensure staff are aware of the importance of maintaining patients’ normal bowel routine and know how to get support from colleagues with specialist skills whenever they need it. This not only keeps patients safe but ensures that they are treated with the care and dignity they deserve.”
Dr Rupert Earl, Chair of Spinal Injuries Association said:
“We welcome the publication today of the NHS Improvement Patient Safety Alert. This represents a significant step forward in driving standards of care for spinal care injuries people across the NHS.
“Our members frequently tell us of their bad experiences of the bowel care they receive in non-specialist settings– and the life-threatening implications of poor care. We look forward to working further with NHS Improvement to ensure that appropriately trained staff, as well as the appropriate policies, guidelines and oversight process are all in place to ensure that every spinal care injuries person gets the care they need and deserve.”