Quality statement 1: Identification in high-risk groups

Quality statement

Adults in high-risk groups for faecal incontinence are asked in a sensitive way, at the time the risk factor is identified and then at times according to local care pathways, whether they have bowel control problems.

Rationale

Faecal incontinence is distressing and can have a big effect on everyday life. Many people are embarrassed to talk about faecal incontinence with doctors and nurses, and their family and friends. Others may report symptoms of diarrhoea to avoid talking about the condition directly. Faecal incontinence can have many different causes. However, once identified there are treatments that can help manage or sometimes cure it. There are also strategies to help people discuss the condition openly and to cope with it. To ensure that everyone with faecal incontinence has access to this management, including people who find it difficult to talk about, it is important that enquiry about symptoms is pro-active and sensitive. How often questions should be asked will vary for each person and will depend on the level of risk and individual circumstances. This might happen at annual review for example, but as a minimum, questions should be asked at the time a risk factor is identified.

Quality measures

Structure

a) Evidence of identification of locally relevant groups at high risk of faecal incontinence from those listed in NICE clinical guideline 49 recommendation 1.1.2.

Data source: Local data collection.

b) Evidence of local initiatives for raising awareness of faecal incontinence among staff working with groups at high risk, including training in talking openly and sensitively about the condition.

Data source: Local data collection.

c) Evidence of local arrangements to ensure that when the risk factor for faecal incontinence is identified, staff ask adults in high-risk groups whether they have bowel control problems.

Data source: Local data collection. The National Audit of Continence Care (NACC) collects data on whether organisations ask a screening question(s) relating to bladder and bowel problems as part of initial assessment.

d) Evidence that local care pathways relevant to the groups at high risk of faecal incontinence include prompts to ask about bowel control problems (for example, at annual review).

Data source: Local data collection.

Process

Proportion of adults in locally relevant groups at high risk of faecal incontinence (from those listed in NICE clinical guideline 49 recommendation 1.1.2) who have been asked whether they have bowel control problems.

Numerator – the number of people in the denominator who have been asked whether they have bowel control problems.

Denominator – the number of adults in identified locally relevant groups at high risk of faecal incontinence (from those listed in NICE clinical guideline 49 recommendation 1.1.2).

Data source: Local data collection. The National Audit of Continence Care (NACC) collects data on how faecal incontinence was identified for each person in the audit.

Outcome

a) Feedback from adults who have been asked about whether they have bowel control problems, on whether this was done in a sensitive way.

Data source: Local data collection.

b) Incidence of faecal incontinence.

Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers ensure that systems are in place for the identification of locally relevant groups at high risk of faecal incontinence from those listed in NICE clinical guideline 49 recommendation 1.1.2 and that local pathways for care of adults in these groups include prompts to ask about bowel control problems (for example, at annual review). Providers should also raise awareness of faecal incontinence among staff working with groups at high risk, and provide training on talking openly and sensitively about the condition.

Health and social care practitioners ensure that they ask adults in identified locally relevant groups at high risk of faecal incontinence, in a sensitive way, at the time the risk factor is identified and then at times according to local care pathways, whether they have bowel control problems.

Commissioners ensure that they commission services that identify key people who are responsible for raising awareness of faecal incontinence and promoting continence and commission from providers that can demonstrate they have systems in place for the identification of locally relevant groups at high risk of faecal incontinence from those listed in NICE clinical guideline 49 recommendation 1.1.2 and that local pathways for care of adults in these groups include prompts to ask about bowel control problems (for example, at annual review). Providers should also raise awareness of faecal incontinence among staff working with groups at high risk, and provide training on talking openly and sensitively about the condition.

What the quality statement means for patients, service users and carers

Adults who are at risk of faecal incontinence (certain groups of people are more likely to have this than others) are asked in a sensitive way by health or social care staff whether they have problems controlling their bowels.

Source guidance

  • Faecal incontinence (NICE clinical guideline 49), recommendation 1.1.2 (key priority for implementation).

Definitions of terms used in this quality statement

Faecal incontinence

This is any involuntary loss of faeces that is a social or hygiene problem [NICE clinical guideline 49, scope].

High-risk groups for faecal incontinence

These include:

  • frail older people

  • people with loose stools or diarrhoea from any cause (for example, inflammatory bowel disease)

  • women following childbirth (especially after obstetric anal sphincter injury)

  • people with neurological or spinal disease or injury (for example, spina bifida, stroke, multiple sclerosis, spinal cord injury)

  • people with severe cognitive impairment

  • people with urinary incontinence

  • people with pelvic organ prolapse and/or rectal prolapse

  • people who have had colonic resection or anal surgery

  • people who have undergone pelvic radiotherapy

  • people with perianal soreness, itching or pain

  • people with learning disabilities.

[Adapted from NICE clinical guideline 49, recommendation 1.1.2 (key priority for implementation)]

Sensitive

Sensitive enquiry about faecal incontinence includes not asking more often than is appropriate for the person's level of risk. [Expert opinion]

Equality and diversity considerations

Risk of faecal incontinence relates closely to many of the protected characteristics that are covered by the Equality Act 2010, including age, disability, sex, and pregnancy and maternity. The consequences may also impact on others, including religion and belief. If people at risk are not asked about faecal incontinence, and if the condition is not effectively managed and treated, some people covered by the Act could be adversely affected. These people may have more than one protected characteristic or be affected by socioeconomic factors. Faecal incontinence may itself be counted as a disability if it occurs over the long term and has a substantial adverse effect on day-to-day activities. Sensitively asking people at risk about faecal incontinence promotes dignity and respect and is an important first step in removing any unequal access to care. Any enquiry about faecal incontinence should take into account the person's religion and belief and be culturally appropriate. People with faecal incontinence may also be unable to work. Providing assessment, effective management and treatment is likely to allow increased participation in society and public life, promoting equality of opportunity. If the person at risk of faecal incontinence lacks capacity, input from carers should be sought.