Quality statement 3: Reviewing disimpaction therapy

Quality statement

Children and young people with idiopathic constipation starting disimpaction therapy have their treatment reviewed by a healthcare professional within 1 week.

Rationale

Review of treatment within 1 week of starting disimpaction therapy should establish whether the treatment has worked and help prevent relapse. Children and young people with faecal impaction are at high risk of relapse and should be closely monitored. Faecal impaction should be resolved before maintenance therapy is started.

Quality measures

Structure

Evidence of local arrangements to ensure that children and young people with idiopathic constipation starting faecal disimpaction therapy have their treatment reviewed by a healthcare professional within 1 week.

Data source: Local data collection.

Process

Proportion of children and young people with idiopathic constipation starting disimpaction therapy who receive a review of their treatment from a healthcare professional within 1 week.

Numerator – the number in the denominator who receive a review of their treatment from a healthcare professional within 1 week.

Denominator – the number of children and young people with idiopathic constipation starting disimpaction therapy.

Data source: Local data collection. NICE Constipation in children and young people: audit support tool, criterion 14.

Outcome

a) Rates of reimpaction.

Data source: Local data collection.

b) Production of regular soft stools.

Data source: Local data collection.

c) Rates of unplanned hospital attendance for constipation.

Data source: Hospital episode statistics from The Health and Social Care Information Centre. Child health indicator profiles including data on hospital admissions for constipation in those aged 0‑24 years are also available from Public Health England's Child and maternal health intelligence network.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that staff perform a review of laxative treatment for disimpaction in children and young people with idiopathic constipation within 1 week.

Healthcare professionals review treatment within 1 week for children and young people with idiopathic constipation who are starting laxative treatment for disimpaction.

Commissioners ensure that they commission services from providers that can demonstrate that they provide treatment reviews within 1 week for children and young people with idiopathic constipation who are starting laxative treatment for disimpaction.

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

Children and young people starting laxative treatment for a blockage in the bowel caused by constipation (called faecal impaction) should have their treatment reviewed by a healthcare professional within a week.

Source guidance

  • Constipation in children and young people (NICE clinical guideline 99) recommendation 1.4.8.

Definitions of terms used in this quality statement

Disimpaction therapy

Treatment with laxative stimulants for the evacuation of impacted faeces. [NICE clinical guideline 99]

Idiopathic constipation

Constipation that cannot (currently) be explained by any anatomical, physiological, radiological or histological abnormalities. [NICE clinical guideline 99, Introduction]

Healthcare professional

The review of laxative treatment can be undertaken by a number of healthcare professionals such as GPs, school nurses, health visitors, practice nurses, continence advisors and paediatricians. [Expert opinion]