Digital Rectal Examination And Digital Removal Of Faeces .
Digital Rectal Examination andDigital Removal of FaecesForHealthcare Professionals as part ofAdult Bowel ManagementApproved By:Policy and Guideline CommitteeDate of OriginalApproval:12/05/2008Trust Reference:B16/2008Version:V4Supersedes:V3 – June 2021 Policy and Guideline CommitteeTrust Lead:Elinor Howcroft – Continence Nurse SpecialistRhonna Asuncion – Spinal Injuries Specialist NurseBoard Director Lead:Chief NurseDate of LatestApproval:17 September 2021 – Policy and GuidelineCommittee (minor amendments process)Next Review Date:July 2024Page 1 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
CONTENTSSectionPage1Introduction and Overview32Policy Scope – Who the policy applied to and any specific exemptions33Definitions and Abbreviations445Roles – Who does whatPolicy Implementation and Associated Documents – What to do and how todo it5.1 Patient Capacity, Consent and Choice5.2 Digital Rectal Examination5.3 Digital Removal of Faeces5.4 Associated Procedure566Education and Training Requirements6.1 Digital Rectal Examination6.2 Digital Removal of Faeces99107Process for Monitoring Compliance118Equality Impact Assessment119Supporting References, Evidence Base and Related Policies1110Process for Version Control, Document Archiving and Review12Appendices6789Page1Digital Rectal Examination132Digital Removal of Faeces163Faecal loading/Faecal Impaction- definition194Guideline for Treating Adult Faecal Loading/Faecal Impaction205Bristol Stool Scale216Adult Bowel Care Pathway227Digital Rectal Examination Sticker23REVIEW DATES AND DETAILS OF CHANGES MADE DURING THE REVIEW2021 review Appendix 6 added – Adult Bowel Care Pathway Appendix 1 – point 21 added Appendix 7 added 6.2 F added 4.7 f, 5.3.3 e and 6.2.2 d- the phrase “on an individual patient basis”removed 4.7 i and 5.3.3 f –the phrase “The competency of DRF will only last aslong as the patient is on the ward. Once the patient is discharged from thehospital, they will return to their normal care regime and the nurse’scompetency in DRF will cease.” removedKEY WORDSDigital Rectal Examination, DRE, Digital Removal of Faeces, DRF, Bowel ManagementPage 2 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
1INTRODUCTION AND OVERVIEW1.1This document sets out the University Hospitals of Leicester (UHL) NHS Trustpolicy and procedures for Digital Rectal Examination (DRE) and Digital Removal ofFaeces (DRF) for healthcare professionals, limited for adult patients, as part ofbowel management. The document outlines the professional and legal aspects ofDRE in relation to bowel management for patients and is based on standards fromthe Royal College of Nursing “Management of lower bowel dysfunction, includingDRE and DRF” (RCN 2019) and “The Royal Marsden Management of ClinicalNursing Procedures ninth edition”. Nurses must always practise with the bestavailable evidence, maintaining their knowledge and skills for safe and effectivepractice (Nursing and Midwifery Council 2015).1.2Practitioners are in a strong position to improve the management of bowel care,and by implementing simple steps, can provide patients with the appropriateadvice and information about their symptoms and treatment. DRE may be used aspart of an assessment to establish the presence of the stool in the rectum and toestablish the appropriate treatment programme; a care plan will outline the nursingintervention required for the patient. ***Contraindications to performing DRE andDRF are considered and guidance on how to perform the DRE & DRF procedureis provided. It is important that the underlying causes for any identified bowelmanagement dysfunction are investigated and plans made to prevent futureproblems or reoccurrence.1.3DRE and DRF are invasive procedures and should only be performed whennecessary and after individual assessment. With advances in oral, rectal andsurgical treatments in recent years, the need to use DRF has reduced but for asmall group of patients e.g. patients with; spinal injuries, spinal cord lesions,neurological conditions, faecal impaction and patients in Intensive Therapy Units,Brain Injury Units, these procedures may remain a part of their bowel managementor as part of acute intervention (RCN, 2019; Ness 2013).1.4The Patient Safety Alert – Resources to support safer bowel care for patients atrisk of Autonomic Dysreflexia (ref number: NHS/PSA/RE/2018/005) identified thatpatients with spinal cord injuries dependant on DRF are at risk of developingAutonomic Dysreflexia if delays occur during admission in their bowelmanagement regime. Please see Autonomic Dysreflexia Treatment Guideline ForAdult Spinal Patients with Spinal Cord Injuries (Trust reference B1/2019)1.5Chronic Spinal Injury patients can be admitted to acute general wards, with othermedical/surgical conditions, requiring continuity of their long-standing bowelmanagement interventions such as DRF to reduce the risk of AutonomicDysreflexia. Many of these patients will be experts in their own care andmaintenance of their normal bowel regime must be facilitated and assistanceprovided as appropriate. For some patients, the cause of their admission mayresult in their normal bowel management regime needing to be amended.2POLICY SCOPE – WHO THE POLICY APPLIES TO AND ANY SPECIFIC EXCLUSIONS2.1This policy applies to all adult patients (aged 18 years and older) who require aDRE.2.2This policy applies to those adult patients who require intervention to maintainregular bowel emptying and who have DRF agreed as part of their acute caremanagement on the Spinal Injuries wards/unitsPage 3 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
2.3This policy applies to adult patients (aged 18 years and older) who require DRFas part of acute intervention in faecal impaction.2.4This policy applies to patients admitted to acute adult wards requiring DRE andDRF for continuity of their long-standing bowel management.2.5This policy does not cover DRE and DRF in children.2.6This policy excludes midwives and pregnant women and digital rectalexamination for perineal repair, please refer to UHL Perineal or Genital TraumaFollowing Childbirth UHL Obstetric Guideline (INsite Document numberC99/2008)2.7The purpose of the policy is to inform staff of the expected standards of care tomaintain the safety of and promote high quality care to patients requiring DRE forbowel management, which may include DRF.2.8This policy applies to medical and registered nurses and registered nursingassociates who are competent and able to undertake this role, and who areemployed by the University Hospitals of Leicester NHS Trust.2.9UHL is a teaching hospital and provides placement or work based learningfor Pre- registration students such as Medicine, Nursing, Midwifery,Paramedic, Radiography, Physiotherapy,OccupationalTherapyandPharmacy and Trainees in the workplace such as Assistant Practitionersand Nursing Associates. This policy applies to these learners in the followingcircumstances:a. If DRE/DRF is a specific competency requirement of their placement orprogramme then the pre-registration student / trainee is able to perform theskill under direct supervision of their mentor / supervisor once they havereceived the relevant underpinning theory and passed a simulated practiceb. If the pre-registration student / trainee has passed an LCAT competencyassessment in practice they may be able to perform the skill withindirect supervision at the discretion of their mentor / supervisor and theRegistered Professional delegating the task.c. If DRE/DRF is not a specific competency requirement of their placement orprogramme then the pre-registration student / trainee must only participate inthe process as an observer.d. Please also see section 6 for education and training requirements3DEFINITIONS AND ABBREVIATIONSa. Anal tone - is the continuous and passive partial contraction of the anal sphinctermuscles, or the muscle's resistance to passive stretch during resting stateb. Bowel management – the medical intervention to manage constipation or faecalincontinencec. DRE - Digital Rectal Examination – the examination of the rectum with a fingerd. DRF - Digital Removal of Faeces – the removal of faeces from the rectum with afingere. LCAT – Leicester Clinical procedure Assessment Toolf.UHL - University Hospitals of Leicester NHS TrustPage 4 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
4.ROLES – WHO DOES WHAT4.1Executive leadThe Chief Nurse is the Board Director with lead responsibility for this policy4.2Clinical Directors, General Managers and Heads of Nursing are the leads fordisseminating the policy to staff within their Clinical Management Groups4.3The Spinal Injury Nurses will provide training and day to day advice andsupport where concerns are raised about the ongoing management of patientsrequiring DRF4.4The Continence Nurse Specialists will provide training and day to day adviceand Support where concerns are raised about the ongoing management ofpatients requiring DRE4.5Line Managers are responsible for:a. Completing a training needs analysis to identify where DRE and DRF training is arequirementb. Ensuring all their staff trained in DRE and DRF are aware of their responsibilitiesregarding these proceduresc. Identifying and supporting staff to attend the necessary training and complete theassessment of competence in practiced. Maintaining HELM records for staff who are competent in DRE and DRF,ensuring that numbers of staff trained meet service neede. Ensuring that staff competent in DRE and DRF provide evidence of maintainingtheir knowledge and skills in the procedure as part of the appraisal process4.6Staff who perform DREa. Must be supported by their line manager and carry out this activity as an integralpart of their key responsibilities within their role as identified at their appraisalb. Have undertaken appropriate education and training in DREc. Be assessed as competent in performing the procedure within their clinical areaby an LCAT assessord. Adhere to the clinical care requirements set out in this policye. Must update themselves on any changes in the policy and proceduresf.4.7Must update themselves on the policy and procedures if they last performed DREmore than 36 months ago – if further support is required, to contact theireducation teamStaff who perform DRFa. Must be supported by their line manager and carry out this activity as an integralpart of their key responsibilities within their role as identified at their appraisalb. Have undertaken appropriate education and training in DRFc. Be assessed as competent in performing the procedure within their clinical areaby an LCAT assessord. Adhere to the clinical care requirements set out in this policye. Must update themselves on the policy and procedures if they last performed DRFmore than 36 months ago – if further support is required, to contact theireducation teamPage 5 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
Staff outside of adult trauma orthopaedic units may only come into infrequentcontact with chronic spinal cord injury patients requiring DRF. These patientsneed to be assessed by the Spinal Cord Injury Nurse and DRF performed as perpatient care plan Staff can then perform DRF as part of a patient’s regular bowelmanagement, if they are already competent in DRE and following training from aLCAT assessor competent in DRFf.g. Patients with chronic spinal cord injury who are admitted to wards/units outside ofSpinal Injury wards/units and require DRF as part of their long-standing bowelmanagement regime must be referred to the Spinal Injury Team.h. Due to the irregularity of this cohort of patients being on the general wards,nurses on the ward who have completed DRE training & competencies will betaught and assessed for DRF as per appendix 3.5POLICY IMPLEMENTATION AND ASSOCIATED DOCUMENTS – WHAT TO DO AND HOW TO5.1Patient Capacity, Consent and ChoiceDO ITa.Valid consent must be obtained prior to performing the procedure. Patientsmust be informed, and involved, with the decisions regarding their care. Referto trust Information about the procedure must be given to the patient in a waythey will understand. Consent to Examination or Treatment UHL Policy(Includes consent for Photography) (A16/2002)b.The dignity and respect of the patient must be considered at all timesincluding religious and cultural beliefs. DRE is an invasive procedure andshould only be performed when necessary, after individual assessment and itis vital to check for allergies prior to undertaking this procedurec.Patients should be informed that they have the right to request a chaperonewhen undergoing this procedure. If a chaperone cannot be provided, thepatient must be informed and asked if they wish to continue with theprocedure. Chaperone Policy (Trust Reference B39/2008)d.When a patient’s capacity to consent to DRE / DRF is in doubt, the healthcareprofessional must undertake a formal mental capacity assessment, inaccordance with the Trust Mental Capacity Act Policy (B23/2007). If thepatient is deemed to lack capacity to consent to DRE/DRF then theappropriate healthcare professional must decide if it is in the patient’s ownbest interests to undergo DRE/DRF The best interest decision must be madeand recorded in accordance with trust policy and reflected within thepatient’s individual plan of caree.If it is deemed to be in the person’s best interests to undergo DRE/DRF thenthe Mental Capacity Act permits the use of proportionate restraint, providedPage 6 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
that the healthcare professional reasonably believes that restraining theperson without capacity is necessary in order to prevent them coming toharm. Any restraint must be reasonable and in proportion to the potentialharm that may be caused to the incapacitated person if restraint is not used.This must be discussed with the Consultant in charge of the person’s carebefore performing DRE/DRF. Specific guidance about using appropriaterestraint can be found in the Trust’s restraint guidance which is located withinthe Trust’s Violence and Aggression Policy. Advice can also be sought 3oradultsafeguarding@uhl-tr.nhs.uk.5.2Digital Rectal Examination5.2.1 Indications for performing DRE for bowel managementDRE can be used as part of a clinical assessment as part of a bowel careassessment. Patient history and stool charts should form part of a bowelassessment. DRE should not be used as a first line investigation into theassessment and treatment of constipation.DRE can be used to establish the following:a. The presence of faecal matter in the rectum, the amount and consistencyb. Faecal loading/impactionc. Presence of anal tone and the ability to initiate a voluntary contraction and towhat degreed. The need for and type of rectal medication in certain circumstancese. The efficacy of enemas, rectal irrigation/washouts in certain circumstancesf.The outcome of rectal/colonic washout/irrigation if appropriate5.2.2 Contraindications for performing DREDRE should not be undertaken if:a. The medical staff have given specific instructions that this procedure is not totake placeb. Patient consent has not been gained – where the patient is able to give ownconsent to undergo DRE, the procedure should be explained in full, the needfor the procedure and that consent has been gained, should form part of thecare plan and be documented on EVERY occasion. If the patient is unable toconsent, staff should refer to the Mental Capacity Act Policy (B23/2007)c. Febrile/septic neutropenic patients5.2.3 Circumstances when caution needs to be applied – consult with patient’sdoctor before proceeding DREa. Active inflammation of the bowel, including Crohn’s disease, ulcerative colitisand diverticulitisb. Recent radiotherapy to the pelvic areac. Rectal or anal painPage 7 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
d. Rectal surgery or trauma to the anal or rectal area (in the last 6 weeks)e. Tissue fragility due to age, radiation, or malnourishmentf.Obvious rectal bleeding – consider possible causes for thisg. A known history of abuseh. Spinal Cord Injury patients with an injury at or above the sixth thoracicvertebra due to the risk of autonomic dysreflexia (see appendices 1 & 2)i.Stable neutropenic or thrombocytopenic patientsj.If the patient is unable to consent, and it is felt to be in the patient’s bestinterest, staff should refer to the UHL Consent Policy and discuss with themulti-disciplinary teamk. If patient has known history of allergies such as latex5.3Digital Removal of Faeces5.3.1 Indications for performing DRFa. When other methods of bowel emptying fail or are inappropriateb. Faecal impaction or loading when all methods of bowel emptying have failedor are inappropriatec. Incomplete defecationd. Inability to defecatee. Neurogenic bowel dysfunctionf. In many patients with spinal cord injury, DRF is an integral part of theirroutine:1. In the early acute phase after spinal cord injury to remove stool from theareflexic rectum to prevent over-distension with consequent damage tolater reflex rectal function2. A necessary intervention for a majority of chronic spinal cord injuredindividuals, as part of a well-structured bowel management programme3. As a method of choice for long-term bowel evacuation in individuals withareflex bowel dysfunction4. Maybe used for removal of stool prior to placing suppositories/enemas inindividuals with reflex bowel or to complete evacuation where reflexactivity alone is insufficient to empty the bowel5.3.2 Contra-indications for performing DRFSee contraindications for performing DRE see section 5.2.25.3.3 Circumstances when caution needs to be applied – consult with patient’sdoctor before proceeding DRFa. Tetraplegia and higher paraplegia patients will not feel any pain when DRF isperformed and will be at risk of acute autonomic dysreflexia refer to theAutonomic Dysreflexia Treatment Guideline For Adult Spinal Patients withSpinal Cord Injuries (Trust reference B1/2019)b. Chronic spinal cord injury/neurogenic bowel dysfunction patients may requireDRF as part of their normal bowel management regime. Many individuals withneurogenic bowel dysfunction are experts in their own care and maintenanceof an existing effective bowel management programmePage 8 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
c. Should be facilitated. The regime may need to be amended due to a changein the medical or physical condition of the patient which will require expertadvice/assessmentd. Patients with chronic spinal cord injury who are admitted to wards/unitsoutside of Spinal Injury wards/units and require DRF as part of their longstanding bowel management regime must be referred to the Spinal InjuryTeam.e. Due to the irregularity of this cohort of patients being on the general wards,nurses on the ward who have completed DRE training & competencies will betaught and assessed for DRF as per appendix 3.5.4Procedures that support this policy are attached as the following appendices andmust be used by all staff within the scope of this policyProcedure / Process / StandardAppendixDigital Rectal Examination1Digital Removal of Faeces for Spinal Injury Patients2Faecal loading/Faecal Impaction- definition3Faecal loading/Faecal Impaction- guidelines for treatment4Bristol Stool Chart5Adult Bowel Care Pathway6DRE completion sticker76EDUCATION AND TRAINING REQUIREMENTS6.1Digital Rectal Examination (DRE) for bowel management6.1.1Medical Staff receive training on how to perform a digital rectal examination preregistration. This training also incorporates the use of DRE for otherassessment and diagnostic purposes. Medical staff are not required toundertake further training unless they have not had this in their pre-registrationcourse6.1.2Registered Nurses and Registered Nursing Associatesa. Complete the Trust competency based training and assessment programme,including the learning workbook. Training is provided at local level following atraining needs analysis, please see section 4.5a.b. Have completed a period of supervised practice, the time span of which willbe agreed by the assessor but to be completed within 6 months.c. Have evidence of assessment and competency signed by an appropriate /LCAT assessor.d. Accept responsibility for updating knowledge and skills and provide evidenceof this as agreed with line manager as part of the appraisal process.e. Those staff already performing DRE should ensure that they are up-to-dateon current evidence based practice and undergo a one off assessment by anLCAT assessor experienced & competent in DRE.f.6.2Management of the Bowel can be found in appendix 6.Removal of FaecesPage 9 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
6.2.1 All Medical and Registered Nurses and Registered Nursing Associates whoundertakes DRF must:a. Complete the Trust competency based training and assessment programmeincluding the learning workbook. Training is provided at local level followinga training needs analysis, please see section 4.5a.b. Have completed a period of supervised practice, the time span of which willbe agreed by the assessor but to be completed within 6 months.c. Have evidence of assessment and competency signed by an appropriate /LCAT assessor.d. Accept responsibility for updating knowledge and skills and provide evidenceof this as agreed with line manager as part of the appraisal process.e. Those staff already undertaking and performing DRF should ensure that theyare up-to-date on current evidence based practice and undergo assessmentby an LCAT assessor experienced & competent in DRF6.2.2 Staff who perform DRF as part of the spinal injury patient’s long-standing chronicbowel management must refer to the Autonomic Dysreflexia TreatmentGuideline for Adult Patients with Spinal Cord Injuries (Trust Ref: B1/2019)a. Ensure the patient is known to Spinal Injury Team to agree treatment regimeand plan of careb. Seek advice from Spinal Injury Team if agreed treatment regime is ineffectiveor patient’s condition changesc. Already be competent in DREd. Undertake competency based training and assessment on DRFe. Have completed a period of supervised practice with a LCAT assessorcompetent in DRFf.Have evidence of assessment and competency for that patient’s bowelmanagement signed by an appropriate / LCAT assessor6.2.3 Staff who perform DRF as part of the treatment for faecal impaction must:a. Ensure the patient has been reviewed by medical staff to agree DRFtreatment and plan of careb. Already be competent in DREc. Already have completed a period of supervised practice and have evidence ofassessment and competency of DRF signed by an appropriate LCATassessord. Accept responsibility for updating knowledge and skills and provide evidenceof this as agreed with line manager as part of the appraisal process6.3Staff new to the Trust and/or who have been trained elsewhere must:a. Provide evidence of the training and assessment programme they havesuccessfully completedb. Read the relevant Trust policies and undertake additional training relating toDRE and DRF and documentation as requiredc. Undertake a practical assessment by an appropriate/LCAT assessor withinown directorate/ward/unit. DRE training and LCAT competencies areavailable within University Hospitals of Leicester NHS Trust. Staff who havetrained in DRE/DRF outside of UHL or feel that their practice is out of datePage 10 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
need to arrange for their competencies to be checked prior to performingDRE/DRFPROCESS FOR MONITORING COMPLIANCE7Element to ho or whatcommittee willthe completedreport go toNumber of staff trainedand competent in DREContinenceNurseSpecialistHELMreport ociated ntsDatixincidentreportingsystemReported to linemanager forinformation andaction asrequiredComplete Datixreportingsystem. Reportconcerns topatient safetyteam bycompleting aseriousuntowardincidentchecklist8EQUALITY IMPACT ASSESSMENT8.1The Trust recognises the diversity of the local community it serves. Our aimtherefore is to provide a safe environment free from discrimination and treat allindividuals fairly with dignity and appropriately according to their needs.8.2As part of its development, this policy and its impact on equality have beenreviewed and no detriment was identified.9SUPPORTING REFERENCES, EVIDENCE BASE AND RELATED POLICIESa. Dougherty, L. Lister, S & West-Oram, A (2015) Chapter 5 Elimination: Digital RectalExamination in: Royal Marsden Hospital Manual of Clinical Nursing Procedures,Ninth Edition. Accessed on Trust Internet. Accessed on trust 0165#c05-sec-0165 02/10/18b. Dougherty, L. Lister, S & West-Oram, A (2015) Chapter 5 Elimination: Digital RectalExamination: Procedure Guideline 5.20 : in: Royal Marsden Hospital Manual ofClinical Nursing Procedures, Ninth Edition. Accessed on Trust 174?resultNumber 0&totalResults 16&start 0&q digital removal of faeces&resultsPageSize 10&rows 10 02/10/18c. Kyle, G. (2011) Digital rectal examination. Nursing Times, 107(12), 18–19.d. Ness, W. (2013) Management of lower bowel dysfunction. Primary Health Care23(5), 27-30e. RCN (2019) Management of Lower Bowel Dysfunction, including DRE and DRF:Page 11 ofPolicy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel ManagementNext Review: July 2024V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents23
RCN Guidance for Nurses. London: Royal College of Nursing.Available at: publications/pub007522f. Guidelines for Management of Neurogenic Bowel Dysfunction in Individuals withCentral Neurological Conditions (2012) Initiated by Multidisciplinary Association ofSpinal Cord Injury Professionals. Available at /CV653N-Neurogenic-Guidelines-Sept-2012.pdfg. NHS England (2018) Excellence in Continence Care: Practical guidance forcommissioners, and leaders in health and social care. Available 18/07/excellence-in-continencecare.pdfh. Nursi
Policy for Digital Rectal Examination and Digital Removal of Faeces for UHL Non-medical Healthcare Professionals as part of Adult Bowel Management V4 Approved by Policy and Guideline Committee on 17 September 2019 (minor amendment) Trust Ref: B16/2008 . NB: Paper copies of this document may not be most recent version.
Keywords: Rectal cancer, Elderly, Frailty, Multidisciplinary management, Consensus Introduction According to the World Health Organization, colorectal cancer is the third most commonly diagnosed cancer in males and the second in females. Although rectal cancer, with a mean age at the time of diagnosis of 68 years for
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the liver and do not undergo first pass metabolism. The rectal mucus is more capable of tolerating various drug related irritations than the gastric mucosa 12. Therefore, the drugs delivered through suppositories to the lower and middle hemorrhoid veins are absorbed rapidly and effectively. Absorption Barriers a) Mucus layer
2500 North State Street, Jackson MS 39216 COLON AND RECTAL SURGERY CLINICAL PRIVILEGES Name: Page 4 OR PATH 2: As for specialty, plus, evidence of a minimum of five (5) computer-assisted procedure
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VICo surveillance stool specimen collection and testing. Clinic staff collected a stool specimen from enrolled individ-uals (whole stool or rectal swab if the former was not possible). The details of specimen collection and testing have been previ-ously described.17-19 Stool samples were stored at 4 C (rectal
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