Background Neurogenic Bowel (NB) is defined as dysfunction of the colon or rectum due to loss of normal sensory or motor control.¹ Symptoms such as constipation, diarrhoea or incontinence can severely impair an individual’s physical, psychological, social, recreational and sexual wellbeing.² Guidelines dictate the standard for NB management in acute, neurorehabilitation and community settings.³ We felt knowledge, skills and guidance were comparatively lacking at St Joseph’s Hospice (STJH), where management was often reactive, rather than proactive, despite the high prevalence of neurological conditions.

Objectives To raise awareness of NB at STJH and improve the quality of life for patients through coordinated, multidisciplinary care.

Methods Employing Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team (MDT) was assembled to plan how to improve NB management at the hospice. Initially, meetings were held with stakeholders, including the Practice Development Nurse and the Quality and Patient Experience Lead. Subsequently, a retrospective notes review of hospice inpatients at risk of neurogenic bowel was conducted over six months, gathering data on diagnosis, Palliative Care Outcome Scale (IPOS) scores, bowel charts, and prescribing practices. The first intervention comprised small-group teaching sessions at the hospice, accompanied by pre- and post-intervention questionnaires to assess staff knowledge and confidence. Collaborating with specialists at the National Spinal Injuries Centre, UK, a hospice-wide NB guideline was developed and implemented. Additionally, a patient information leaflet was created, and the Neurogenic Bowel Dysfunction Score (NBD) was integrated into the hospice’s electronic records system. Ongoing assessments will include repeating an inpatient note review and charting of weekly NBD scores. Future plans include a simulation session to improve practical skills and collaboration with the hospice.

Results Baseline mean IPOS constipation score was 2.5 (SD=1.4, n=10). Pre- and post-teaching surveys showed only 10 of 25 staff had any knowledge of NB at baseline, with staff confidence in NB management increasing from 2.2 (SD=1.56, n=15) to 6.0 (SD=3.0, n=15) on a 10-point scale.

Discussion This innovative project exemplifies the theme of constructing, challenging and transforming, as we learnt from neurorehabilitation to address the unique needs of hospice patients with NB. Rehabilitation and palliative care share common principles; rehabilitative palliative care aims to enable people to live as independently and fully as possible within the limitations of advancing illness.⁴ This guideline represents the first dedicated to NB specifically in a hospice setting, to the authors’ knowledge. While staff awareness and confidence have improved, further research is needed to assess patient symptom improvement. The IPOS subscale ‘constipation’ may not fully capture NB symptoms, suggesting the need for validation of the NBD score in a hospice setting.

References

1. Emmanuel A. Neurogenic bowel dysfunction. F1000Research. 2019;8:1800.

2. DeLisa JA, Kirshblum S. A review: frustrations and needs in clinical care of spinal cord injury patients. J Spinal Cord Med. 1997 Oct;20(4):384–90.

3. Multidisciplinary association of spinal cord injured professionals. Guidelines for management of neurogenic bowel dysfunction in individuals with central neurological conditions. 2012.

4. Tiberini R, Richardson H. Rehabilitative Palliative Care. Hospice UK; 2015.