Quality statement 1: Assessment

Quality statement

Children and young people who are bedwetting have a comprehensive initial assessment.

Rationale

A number of factors can cause or contribute to bedwetting in children and young people that may affect their treatment and support needs. A comprehensive initial assessment will ensure the plan for managing bedwetting meets the child's or young person's needs and helps parents or carers to cope with bedwetting.

Quality measures

Structure

Evidence of local arrangements to ensure that children and young people who are bedwetting have a comprehensive initial assessment.

Data source: Local data collection.

Process

Proportion of children and young people who are bedwetting who have a comprehensive initial assessment.

Numerator – the number in the denominator who have a comprehensive initial assessment.

Denominator – the number of children and young people presenting with a new episode of bedwetting.

Data source: Local data collection. Data on the recording of the assessment can be collected using the NICE nocturnal enuresis audit support (criteria 1 and 2).

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

Service providers (such as GPs and NHS trusts) ensure that they have clear policies to train and support healthcare professionals to carry out comprehensive initial assessments for children and young people who are bedwetting.

Healthcare professionals (such as GPs, school nurses and community nurses) undertake a comprehensive initial assessment of children and young people who are bedwetting.

Commissioners (such as clinical commissioning groups, local authorities and NHS England area teams) ensure that the services they commission have sufficient healthcare professionals competent in carrying out comprehensive initial assessments for bedwetting.

What the quality statement means for children, young people, parents and carers

Children and young people who are bedwetting have an assessment in which they (and their parents or carers if appropriate) are asked questions to help work out what is happening, what might be causing it, and to find out more about any other relevant problems they might have.

Source guidance

Definitions of terms used in this quality statement

Comprehensive initial assessment

A comprehensive initial assessment of bedwetting includes the pattern of bedwetting and related factors such as fluid intake, toileting pattern and daytime symptoms, together with possible medical, emotional or physical triggers and individual needs that may have an impact on treatment and support. Physical factors such as constipation, urinary tract infection and diabetes should be identified and treated, and the impact of current medication considered. Other wider social, family, emotional and developmental issues should also be explored to ensure the plan for managing bedwetting meets individual needs and enables the family to cope with bedwetting. Healthcare professionals should consider possible maltreatment if parents or carers are thought to regard the bedwetting as deliberate, there is evidence of punitive treatment or if bedwetting does not resolve in a child or young person who was previously dry, unless a physical or emotional trigger can be identified. [Adapted from NICE clinical guideline 111, recommendations 1.3.1 to 1.3.19]

Equality and diversity considerations

Healthcare professionals should take into consideration the cultural and communication needs of children and young people (and their parents or carers if appropriate) when assessing children and young people with bedwetting.

Healthcare professionals should fully assess bedwetting in children and young people with developmental or learning difficulties or physical disabilities because symptoms can be improved with the correct support and treatment.

The quality statement does not cover children younger than 5 years. The decision about whether to formally manage bedwetting in children younger than 5 years would be a clinical judgement; it would not be appropriate in all cases.