Quality statement 4: Reviewing maintenance therapy

Quality statement

Children and young people with idiopathic constipation starting maintenance therapy have their first treatment review by a healthcare professional within 6 weeks.

Rationale

It is important to review maintenance therapy in children and young people with idiopathic constipation to prevent faecal impaction, and to assess for possible issues, such as problems with taking medicine and toileting.

Quality measures

Structure

Evidence of local arrangements to ensure that children and young people with idiopathic constipation starting maintenance therapy receive their first treatment review from a healthcare professional within 6 weeks.

Data source: Local data collection.

Process

Proportion of children and young people with idiopathic constipation starting maintenance therapy who receive a review of their treatment from a healthcare professional within 6 weeks.

Numerator – the number in the denominator who receive their first treatment review from a healthcare professional within 6 weeks.

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

Data source: Local data collection.

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 the first treatment review of maintenance therapy for children and young people with idiopathic constipation within 6 weeks of treatment starting.

Healthcare professionals perform the first treatment review for children and young people with idiopathic constipation who are starting maintenance therapy within 6 weeks.

Commissioners ensure that they commission services from providers that can demonstrate that they perform the first treatment review for children and young people with idiopathic constipation who are starting maintenance therapy within 6 weeks.

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

Children and young people starting laxatives for the ongoing treatment of constipation (either as their first treatment or after treatment to clear a blockage) receive a treatment review from a healthcare professional within 6 weeks.

Source guidance

  • Constipation in children and young people (NICE clinical guideline 99) recommendation 1.4.10.

Definitions of terms used in this quality statement

Idiopathic constipation

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

Maintenance therapy

Treatment with laxatives, either following disimpaction for the ongoing treatment of idiopathic constipation or for the initial treatment of idiopathic constipation if the child or young person does not have faecal impaction. [NICE clinical guideline 99]

Review during maintenance treatment

Review during maintenance treatment includes ensuring that the child or young person's faeces do not become impacted and assessing for possible issues in maintaining treatment, such as problems with taking medicine and toileting.

The timing of review during maintenance treatment will depend on the individual needs of the child or young person and their parents or carers. It could range from daily contact to every few weeks.

After the first review, ongoing review and reassessment should be tailored to treatment response. Maintenance therapy should continue until regular bowel habits are established, which may take several months. Some children and young people may need maintenance therapy for several years.

A pragmatic timeframe for review of maintenance treatment within 6 weeks of starting treatment is proposed for measuring the quality statement. [Adapted from NICE clinical guideline 99, recommendations 1.4.10 and 1.4.11, and expert opinion]

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 advisers and paediatricians. [Expert opinion]