continence assessment and management · web viewincludes assessment of the external and internal...

CHHS14/033

Canberra Hospital and Health ServicesClinical ProcedureContinence Assessment and Management

Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – General Principles of Care for the Management of Patients with Continence Issues........................................................................................................................................ 2

Section 2 – Continence Assessment..........................................................................................3

Section 3 – Bowel/Bladder Diary...............................................................................................3

Section 4 – Urinalysis Assessment............................................................................................4

Section 5 – Bladder Scan/Post-Void Residual of Urine..............................................................5

Section 6 – Uroflowmetry.........................................................................................................6

Section 7 – Prescription of Continence Aids..............................................................................7

Section 8 – Per Vaginal and Per Digital Rectal Examination......................................................8

Section 9 – Bedwetting Alarms...............................................................................................12

Implementation...................................................................................................................... 12

Evaluation............................................................................................................................... 12

Related Policies, Procedures, Guidelines and Legislation.......................................................13

References.............................................................................................................................. 13

Search Terms.......................................................................................................................... 14

Consultation............................................................................................................................17

Doc Number Version Issued Review Date Area Responsible PageCHHS14/033 1.0 November 2014 November

2018RACC CCP Continence Service

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS14/033

Purpose

The purpose of this Procedure is to provide clinicians with information for the safe and effective management of adults and children with continence issues.

Scope

Alerts

Scope

The Continence Assessment and Management Procedures describe practice which will be performed by registered nurses, physiotherapists or medical staff. New nursing, physiotherapy or medical staff, or students (within their defined scope of practice) will be required to perform these skills under the direct supervision of a competent practitioner.

Clinicians providing assessment, education and clinical procedures must have current theoretical and clinical knowledge in continence management.

Section 1 – General Principles of Care for the Management of Patients with Continence Issues

In accordance with the 4th International Consultation on Incontinence, most bladder and bowel control problems can be cured or improved.

It is each clinician’s responsibility to ensure an appropriate management plan is in place to treat/manage patients’ individual continence needs.

1. Prior to any continence interventions a detailed continence assessment is required in order to identify contributing factors, a urinalysis is performed as part of clinical assessment for patients presenting with continence or urological problems.

2. Continence consultations should to be held in a private room. Attendance at the consultation by another person must be with the patient’s permission. Often it is better if partners and children are not present as this may inhibit the conversation.

3. Where possible the information should be collected from the patient directly and permission sought before asking for clarification from carers or other people.

4. When this is not possible, such as in the case of patients suffering from dementia, the carer should be asked to comment only on what they have actually seen and not their interpretation of the events.

5. Continence management is multidimensional and requires a multidisciplinary approach. Referral to dietitian, occupational therapist, and specialist medical services (eg sleep lifestyle clinic) can provide additional advice and interventions to assist in promoting



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effective continence management. Consider referral to these specialists for patients who have conditions such as poor nutritional status, poor mobility and activity levels or sudden changes in their continence function.

6. Refer patients to the Community Care Continence Service on discharge from hospital as required (refer via Community Health Intake – ph 62079977).

Back to Table of Contents

Section 2 – Continence Assessment

Prior to intervention, a detailed continence assessment is required in order to identify the patient’s history and contributing factors to urinary and bowel dysfunction. Continence assessment tools can be found on the Clinical Records Forms Register. Physical examinations can include abdominal examination, perineal (including sensation) and/or rectal examination, examination of the external genitalia, vaginal examination and neurological testing.

Other investigations: Bladder/bowel diary Urinalysis assessment Bladder scan / post void residual of urine Uroflow

For assessment and management of post partum urinary retention, refer to Management of post partum urinary retention Maternity Practice Guideline.


Section 3 – Bowel/Bladder Diary

The bladder diary and bowel diary are objective tools to assess a patient’s voiding and elimination patterns. Bladder function is assessed by gaining information on the number of voids, distribution and volume of voids and fluid intake. Bowel function is assessed by elimination pattern, volume and consistency of faeces.

Diaries should be kept for a minimum of 48 hours for bladder assessment and 2-3 weeks for bowel assessment, longer diaries may have a reduced compliance. Patients should be instructed to keep the diary under circumstances approximate to normal everyday life and may be repeated post intervention.




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Section 4 – Urinalysis Assessment

The 4th International Consultation on Incontinence recommends that performing a urinalysis be considered a standard procedure for all patients with continence or urological problems.Urinalysis is used as a screening test to detect haematuria, glucosuria, pyuria and bacteruria. Urinalysis can be performed using reagent strips or using a diagnostic analysing machine.

Urinalysis using reagent strips – (insert section from urinary procedure when available)

Urinalysis using CLINITEK Status®+ analyser Urinalysis in the Community Care Continence Clinics is performed using the CLINITEK Status®+ analyser (used with Multistix 10SG reagent strips). CLINITEK Status® + analyser are diagnostic appliances and are used in the clinic setting to measure the physical characteristics of urine including acid base and urine concentration.

Equipment CLINITEK Status®+ analyser Multistix 10SG reagent strips

Multistix 10SG reagent strips are used with the CLINITEK Status® + analyser:- Check the expiry date on Multistix prior to use (discard 12 months after opening)- Do not use discoloured reagent strips- Replace cap immediately after removing reagent strip- Do not touch test end of reagent strip- Reagent strips must be kept in a cool dry place away from sunlight

ProcedureThe CLINITEK Status® +analyser calibrates automatically before each measurement. The analyser calibrates by reading the white calibration bar at the appropriate wave lengths to ensure accurate test results. The white calibration bar must be kept clean to ensure accurate results. Refer to manufacturer’s instruction manual for operation, quality control, care of the white calibration bar and general maintenance. Quality control testing is dependent on usage (monthly testing in the Community Care Program Continence Clinics).

If results are outside the expected range, use the manufacturer’s manual to check the various settings of the CLINITEK Status® + analyser. Make corrections as appropriate prior to retesting (contact the manufacturer on 1800 028 251 if the quality control remains outside expected range).

If the urinalysis is out of the normal recommended parameters, inform the patient’s General Practitioner (GP) and advise the patient to follow up with the GP. Document in the clinical record. Doc Number Version Issued Review Date Area Responsible PageCHHS14/033 1.0 November 2014 November


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Section 5 – Bladder Scan/Post-Void Residual of Urine

A bladder scan is an important component of continence assessment and bladder management. It is used by clinicians to assess the patient’s bladder volume and post-void residual (PVR) of urine.

PVR urine volume is the volume remaining in the bladder immediately after completion of voiding. Measurement of PVR urine volume provides quantitative feedback to assist in the assessment of bladder function in order to avoid potential complications of urinary retention. The bladder scan is a portable, battery-powered ultrasound device that has been developed specifically for the non-invasive measurement of total bladder volumes and/or PVR urine volumes. It consists of a hand-held ultrasound transducer (scan head) and a base unit with a display screen.

Equipment Bladder scan

Currently the Community Care Continence Service and TCH Urology ward use the Verathon BVI9400 machine, TCH Outpatient Department uses the Verathon BVI 3000 machine.

Procedure1. Before using the scanner conduct a risk assessment - take particular care when scanning

patients who are pregnant or have a pace maker2. Assess patient’s clinical history, symptoms and reason for bladder scan3. Explain the procedure, obtain verbal consent and document in clinical record4. Scan in the supine position5. Check battery, change the battery when it is low6. Follow instructions for scanner set-up 7. Place the scan head on the patients’ abdomen (suprapubic area) and aim toward the

bladder 8. the unit automatically calculates and displays the bladder volume9. document the results in the clinical record and notify the Medical Officer

Residual greater than 100mls will usually require monitoring and repeat bladder scan.

Essential steps to achieve more accurate results Use adequate ultra sound gel ( approximately the size of a twenty cent piece) Select male on the machine if female clients have had a hysterectomy Check the direction of the scanner head Position the scanner head on the suprapubic site Do not remove scanner head while scanning



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Assess the shape and size of the image. When part of the bladder image reaches the perimeter of the screen the result may not be accurate

Repeat the bladder scan as many times as required to obtain most accurate reading. If unsure get the patient to void and repeat scan. Subtract pre-void from post-void volume to give more accurate result

When discrepancy between the result and clinical symptoms occur, seek advice from staff with expertise in using the bladder scanner


Section 6 – Uroflowmetry

Uroflowmetry is used to calculate the flow rate of urine over time. Uroflowmetry is used by clinicians to assess patients with complex continence issues, it assists in excluding conditions that alter the voiding phase of urination.

Only clinicians who are competent in the procedure and interpretation of results should use Uroflowmetry as a diagnostic tool.

Uroflowmetry with the measurement of post-void residual urine is also recommended as a screening test for symptoms of voiding dysfunction.

EquipmentThe Community Care Continence Service uses the Urocap 111 machine. This is a Transputer-controlled instrument designed to measure and record the change in volume of fluid within a collection vessel during micturition. When a volume change is sensed, the unit begins to print the flow curve and compute voiding parameters. At the end of micturition, the instrument prints a table of results with an annotated space to record the patient’s details. For operating instructions see the manufacturer’s manual.

When recording results, ensure the following information is documented: Maximum flow rate Volume voided Voiding time (always), flow time (if intermittent) Average flow rate, total voided volume, total voiding time Patient’s opinion of normality of voiding Residual urine (ultrasound)

Where abnormal results occur, the patient’s GP/Urologist should be notified in writing (see Normal and Abnormal Uroflow Graphs in Attachment 1).

Calibration should be carried out every 6 months as per manufacturer’s instructions.

Alert: there is a possible explosion hazard if the Uroflow is used in the presence of flammable anaesthetics.Back to Table of Contents



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Section 7 – Prescription of Continence Aids

Continence aids are not intended as a cure, they may be prescribed as part of a treatment plan to control leaks and manage social incontinence. A continence assessment assists clinicians in identifying patients who are eligible for assistance through the Continence Aids Payment Scheme (CAPS) or the ACT Health Equipment Scheme. Applicants seeking assistance from the ACT Equipment Scheme (ACTES) Continence Service will have expended their allocation from Continence Aids Payment Scheme (CAPS) first.

Prescribing continence aids: Complete continence assessment Determine management plan Assess needs for continence aids, consider the patient’s:

o Level of incontinenceo Mobility, vision and dexterityo Cognitive functiono Degree of impact of the incontinence on patient’s activities of daily living and social

lifeo Motivation of the patient to use the products

Prescribe appropriate continence aids, considero Urinals/bed pans, commodes, catheters, sheaths, pads/pull pants, bed and chair

protection, non slip mats, skin care products and anal bowel management systems. Assess patient’s suitability for continence aids assistance. It is each clinician’s

responsibility to ensure the patient’s diagnoses meets the criteria of individual continence assistance schemes.

Provide patient with details on purchasing continence products Re- assess patient’s continence needs as required

Continence Aids Payment Scheme:The Continence Aids Payment Scheme (CAPS) is an Australian Government Scheme that provides a payment to assist eligible people who have permanent and severe incontinence to meet some of the cost of their continence products. Funding Schemes summary of eligibility - for guidelines and detailed information on eligibility and necessary paperwork: www.bladderbowel.gov.au

ACT Equipment Scheme (ACTES) Continence Aids: All patients seeking assistance from the ACT Equipment Scheme must meet eligibility criteria Refer to ACT Equipment Scheme policy Document Number CHHS13/564.


Section 8 – Per Vaginal and Per Digital Rectal Examination



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http://www.bladderbowel.gov.au/

CHHS14/033

This section applies to the clinicians who perform vaginal (PV) and/or rectal (DRE) examinations as part of a continence assessment.

There must always be a documented clinical justification for the performing a PV and/or DRE examination and a reasonable prospect that the patient will benefit from this examination.

The examination must be undertaken with due regard to clinical urgency, hygiene and infection control as well as to the patient’s privacy, dignity and comfort.

The nature and reason for the examination must be explained to the patient, informed consent must be obtained and documented.

Patients should be given the option of having another person present during a PV and/or DRE examination. The offer of a chaperone should be documented in the clinical record as well as the outcome of this offer.

Any clinician with limited experience in performing PV and/or DRE examinations must be supervised by an appropriately qualified health professional.

PrecautionsThe following must be considered, but do not preclude PV and/or DRE examinations: Children, under 18 year olds and young people who are not yet sexually active. A parent

or guardian must be present for those under 16 Cultural and religious beliefs History of pelvic pain or sexual dysfunction Menstruation – proceed if patient and clinician both consent to the procedure, an

alternative examination date should be offered before proceeding Pregnant women with history of pregnancy complications Women up to 6 weeks post-partum Patients within 6 week post-operative period for pelvic or lower abdominal surgery Patients having undertaken radiotherapy to the pelvis within 6 weeks

Contraindications: Patients who does not understand the procedure or refuse to give informed consent.

Procedure1. General

Consent for physical examinations must be documented A water based lubricant such as KY-Gel is usually used for internal examinations.

Where a patient is sensitive to the lubricant, alternatives such as vegetable oil or water may be used and documented in the clinical record.

Note and record if a patient is allergic to latex. Non latex groves are available. Patients have the right to decline a PV and/or DRE examination by a particular

clinician and have an alternative health professional perform the examination. Patients have the right to decline the examination or withdraw consent during the

procedure, the potential consequences must be explained to the patient without coercion and the patient should continue to be treated by the clinical team. Appropriate documentation should occur outlining the reasons for decline/withdrawal and a revised plan of care should be documented.



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Where possible, advance notice should be given that an examination may take place at the next visit. Examinations should not take place if the clinician feels that there is hesitation or discomfort from the patient about the physical assessment.

The examination should occur with the patient on a height adjustable bed, with a sheet and bluey beneath and a drape over.

Gloves must be worn, with double gloving useful if the vagina and anus are to be examined. After an anal examination, gloves must be changed if further examination occurs.

2. Abdominal examination: skin condition is evaluated; presence of surgical incisions, hernias or abnormal masses should be noted, and bladder and bowel distension should be assessed.

3. Neurological examination includes an assessment of the anal sphincter tone, evaluation of voluntary anal contraction and an evaluation for intact perineal sensation. If abnormalities are noted, or if neurologic dysfunction is suspected an extended neurological examination should be performed and documented.

4. Female Examination (see Per Vaginal Examination) includes assessment of the external and internal genitalia, pelvic floor strength and function, and presence and degree of prolapse. The woman should be lying on her back with the knees bent supported against the side rests of the bed.

External perineal examination, observe for: Perineal scarring Vaginal discharge Skin excoriation Part labia to observe for signs of oestrogen deficiency (e.g. observe skin colour in

the vagina for dryness, redness and atrophic vaginitis) Degree of prolapsed Ask woman to cough and observe for urine leakage associated with cough Observe for perineal descent or bulging associated with a pelvic floor contraction

Palpation, assess for: Sensation and pain in the surrounding skin and labia Sensation and pain in the introitus and lumen Muscles at rest Muscle function, strength and endurance Presence and degree of urogenital prolapsed



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5. Male Physical Examination (see Digital Rectal Examination) includes assessment of the external genitalia and pelvic floor strength and function. The man should be lying on his back with the knees bent up, feet on the plinth for the examination.

External perineal examination, observe for: Skin condition Urine loss when patient coughs Pelvic Floor contraction, anal wink and scrotal lift

Palpation, assess for: Sensation and pain in the surrounding skin Pain and scar tissue Integrity and tone of external anal sphincter (1-2 cm from the meatus) Integrity and tone of puborectalis (3-4 cm from the meatus) Muscle function, strength and endurance

Per Vaginal Examination1. Explain procedure to patient and obtain consent (document on care plan)2. Ensure privacy and offer chaperone3. Ask patient to remove underclothes and lie on couch with knees flexed and feet

apart, cover abdomen with sheet4. Wash and dry hands thoroughly and put on examination gloves5. Observe skin in genital region, identify scar tissue, lesions, excoriation or soreness6. Part labia and observe vaginal mucosa, identify any discharge or unpleasant odour7. Ask patient to cough/strain, observe for descending prolapse and/or urine loss 8. Ask patient to contract pelvic floor , observe for anus retracting, posterior vaginal lift

and urethral orifice ‘wink’9. Place non-dominant hand on patient’s abdomen and ask them to contract pelvic

floor again, feel for involvement of transverses abdominus muscles10. Inform patient that you will place a finger inside their vagina11. Apply lubricant to index finger and insert 3-5cm into vagina12. Palpate anterior vaginal wall, identify a cystocele or detect any tenderness (possible

urethritis) or bladder neck descent. Coughing will increase this13. Sweep finger from anterior to posterior wall on each side of the vagina, identify

muscle wasting, scar tissue, spasm or any other irregularities14. With finger at 4 o’clock then at 8 o’clock positions, ask patient to contract pelvic floor

muscles, identify deep and superficial muscle tone/involvement15. Remove finger from vagina, inform patient, then place finger on perineum and ask

patient to contract pelvic floor muscles again, feel for muscle involvement16. Remove and dispose of gloves, wash hands17. Record finding and score patient as per modified Oxford Pelvic Muscle grading score

(see table below)18. Discuss findings with patient and plan care as appropriate



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Digital Rectal Examination1. Explain procedure to patient and obtain consent (document on care plan)2. Ensure privacy and offer chaperone3. Ask patient to remove underclothes and lie on couch with knees flexed and feet

apart, cover abdomen with sheet4. Wash and dry hands thoroughly and put on examination gloves5. Observe skin in genital region, identify scar tissue, lesions, excoriation or soreness6. If necessary part buttocks and observe anal opening, identify any infection or skin

irritation7. Ask patient to cough/strain, observe for descending perineum and/or bowel

prolapsed8. Ask patient to contract pelvic floor, observe for anus retracting, and♀: posterior vaginal lift and urethral orifice ‘wink’♂: penile retraction and scrotal lift

9. Place non-dominant hand on patient’s abdomen and ask them to contract pelvic floor again, feel for involvement of transverses abdominus muscles

10. Inform patient that you will place a finger inside their anus11. Apply lubricant to index finger and insert 3-5cm into anal meatus12. Palpate anterior rectal wall, identify a rectocele or detect any tenderness (possible

urethritis) or bladder neck descent. Coughing will increase this13. Sweep finger from anterior to posterior wall on each side of the anus, identify muscle

wasting, scar tissue, spasm or any other irregularities14. With finger at 4 o’clock then at 8 o’clock positions, ask patient to contract pelvic floor

muscles, identify deep and superficial muscle tone/involvement15. Remove finger from anus, inform patient, then place finger on perineum and ask

patient to contract pelvic floor muscles again, feel for muscle involvement16. Remove and dispose of gloves, wash hands17. Record finding and score patient as per modified Oxford Pelvic Muscle grading score

(see table below)18. Discuss findings with patient and plan care as appropriate

Modified Oxford Pelvic Muscle grading for pelvic floor contractility. Haslam, J (1995)Grade 0 No muscle contractionGrade 1 A flicker of contractionGrade 2 A weak contractionGrade3 A moderate contraction with externally

visible ‘lift’Grade 4 A good/firm contractionGrade 5 A strong contraction that can oppose

pressure from the examiner’s finger




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Section 9 – Bedwetting Alarms

Bedwetting alarms can be used in the management of nocturnal enuresis.

Children with bedwetting issues can be referred to the Community Care Continence Service for assessment and advice. When the use of a bedwetting alarm is recommended, the physiotherapist in the Community Care Continence Service will discuss how to use of the equipment and what follow up care is required with the child/parents. Bedwetting alarms are available in the Community Care Program for loan to patients.


Implementation

This procedure will be communicated to relevant staff via existing education and training programs - nurses and physiotherapists who are new to the Community Care Program receive education on Continence Management as part of their orientation/induction, the Community Care Program Continence CNC provides regular updates to nursing teams through the Community Care Practice Development Program.


Evaluation

Outcome Measures Adults and children with continence issues are assessed and managed safely and

effectively Clinicians adhere to the general principles of care and management of patients with

continence issues, and to the procedures outlined in this document.

Method Care plans and management plans are documented in the patients’ clinical records

and are reviewed at each continence clinic visit. Clinical care and adherence to procedures is monitored by managers through the

annual clinical record documentation audits, managers provide feedback to individual staff members and to teams annually.

Riskman clinical incident reports are monitored and any issues relating to continence management are assessed by the relevant nursing and allied health managers of the Community Care Continence Service. The incidents are discussed with relevant clinicians. Riskman reports are tabled at the monthly Community Care Program Clinical Governance Committee meetings and are discussed by the managers at monthly staff meetings.

The Consumer Engagement Team forward patients’ feedback to the relevant managers, managers discuss patient feedback at staff meetings.



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Related Policies, Procedures, Guidelines and Legislation

Policies and ProceduresACT Infection Prevention and Control Policy, Document Number CED06-008Nursing and Midwifery Continuing Competence Policy and Standard Operating Procedure, Document Number DGD12-050Consent and treatment SOP, Document Number DGD12-044

StandardsHome and Community Care (HACC) National Standards Instruments and Guidelines Australian Nurses for Continence Competency Standards Australian Physiotherapy Association StandardsDept of Health and Ageing, Continence Aids Payment Scheme GuidelinesDepartment of Veterans’ Affairs, Rehabilitation Appliances Program Guidelines


References

Abrams, P., Cardozo, L. Khoury, S. & Wein, A. (eds) (2009) INCONTINENCE, 4 th International Consultation on Incontinence 4 th Ed ., Plymbridge Distributors, UK

Abrams P, Andersson K, Birder L, Members of Committees, Fourth International Consultation on Incontinence Neurourol Urodyn. 2010; 29(1):213http://www.rcpamanual.edu.au/sections/pathologytest.asp?s=33&i=794

Bayer The Clinitek 50 Instruction Manual. Bayer Corporation. Elkhart, USA 2005

Bayer The Check- Stix Log Book. Bayer Corporation. Elkhart, USA 2005

Bayer The Check-Stix Quality Control Strips Packet Insert. Bayer Corporation. Elkhart, USA 2005

Brazier A, Palmer M. Collecting Clean Caught Urine in the Nursing Home, Geriatric Nursing. Vol 16, No 5, pp 217-224, Mosby-Year Book, 2005

SimmervilleJA, Mated WC, Pahira JJ. Urinalysis: A Comprehensive Review. Journal of American Family Physician. March 15, 2005

Clinical guidelines for the physiotherapy management of females aged 16 – 65 years with stress urinary incontinence. The Chartered Society of Physiotherapists



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CHHS14/033

Dynamic Testing (2005) Griffiths, D. et al. in INCONTINENCE: 3rd International Consultation on Incontinence; Abrams, Cardozo, Khoury and Wein (Eds)

Refer to link for information for client eligibility www.bladderbowel.gov.au

Getliffe, K. and Dolman, M. (eds.) (2007) Promoting Continence. A Clinical and Research Resource (3 rd . Edition) , Bailliere & Tindall, Toronto

Haslam, J. (1995) The physical assessment of the pelvic floor. Journal of the Association of Chartered Physiotherapists in Women’s Health. No 77, August 1995.


Search Terms

ContinenceIncontinenceUrinary BladderBowelUrinalysisVaginal examination

Digital rectal examinationBladderscanUroflowContinence aidsBed wetting




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http://www.bladderbowel.gov.au/

CHHS14/033

Attachment 1NORMAL UROFLOW

ABNORMAL UROFLOWS

DETRUSTOR OVERACTIVITY - Supranormal flow is established very rapidly; cessation is equally rapid as the bladder neck closes suddenly.

OUTFLOW TRACT OBSTRUCTION - Trace has a "flat top" appearance, with abnormally low flow rate. Maximum flow occurs soon after onset of voiding.

INTERMITTENT FLOW - Intermittent flow due to fluctuating detrusor contraction. The flow rate changes relatively slowly.



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IRREGULAR FLOW – Irregular flow due to intermittent uncontrolled sphincter contraction during attempted micturition. The flow rate changes rapidly.

When the abnormal Uroflow is due to intermittent flow, both VOIDING TIME and FLOW TIME need to be documented. Voiding time is defined as the total time from beginning to end of micturition. Flow time is defined as the total time when urine is actually flowing.

Normal Urodynamic Measurements

Total voiding time:Normal time to void 100 ml: less than 10 secondsNormal time to void 400 ml: less than 23 seconds

Time to peak flow: less than one third of total voiding time

Peak flow rate: Below mean flow rate per bladder volumeAt least 15 ml/s for a volume of at least 150 ml.



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Consultation

NAME/POSITION/LOCATION (of person/s; groups consulted)

FEEDBACK RECEIVED

ACTION COMMENTS

Continence Physiotherapist Community Care Program

Yes Yes, clarified in the document and a link to the Continence Care Plan to be inserted

Continence CNC Community Care Program

Yes Title changed, added to scope of the document

Link to Continence Care Plan to be inserted

A link to be inserted to the Urinalysis section of Urinary Procedure

Prostate Cancer Specialist Nurse Yes

Physio Manager Community Care Program

Yes Sentence removed

Wording changed as suggested

Continence nurse, Community Care Program

Yes Wording changed as suggested

Nursing Services Manager Community Care Program

Yes Added: Refer patients to the Community Care Continence Service on discharge from hospital as required.

Nurse Managers Community Care Program

Yes IncludedHave changed ‘sign’ to ‘document’



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Urology Nurse, Outpatients TCH YesAccepted in document

Physiotherapist, Division of Women, Youth and Children Community Health Programs

Yes The procedure states that it is offered as an option for the patient but it does not state that it is mandatory for a 2nd person to be present. That way health professionals who work on their own can provide services without a 2nd person present.

Team leader Physiotherapy Paediatrics, Women’s Health and Acute Neuroscience

Yes Took out the list of formsWill need to be defined

CHHS Policy Committee Yes Removed, added necessary info under each stepThe same section will be used – will be added once finalised in the ‘urinary document’Removed the reference to ‘competent’ on p 2

Both sections reworked

Alert box inserted.

I have not changed the wording, clinicians would use ‘scope of practice’ to determine whether they can perform the procedures

Disclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.



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