What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Approximately 900,000 children in the UK experience continence difficulties. These difficulties are caused by a spectrum of overlapping bowel and bladder symptoms referred to as bowel and bladder dysfunction (BBD).

The negative impact on the health and wellbeing of children living with BBD is well documented. Early identification/management is essential to prevent chronic changes in the bladder and bowel which persist into adulthood.

There are causal links between these conditions and therefore they require an integrated approach for effective treatment. In Highland, children with BBD do not have access to an integrated children’s community continence service that provides individualised evidence-based care in line with national guidance. There are separate clinics for different aspects of continence care resulting in costly, inefficient use of clinical services, multiple long wait times and a lack of joined up approach to treatment. This project would involve setting up a one-stop nurse led clinic for paediatric BBD.

What does your project aim to achieve?

Currently there are separate clinics for constipation/soiling, nocturnal enuresis and daytime incontinence, plus there are a variety of healthcare professionals supporting children with delayed toilet training. Some are in primary care, some are in secondary care, and each have their own waiting lists, referral criteria, paperwork etc. A one stop clinic would aim to improve outcomes for children with BBD by…

·        Ensuring all aspects of BBD are identified, assessed and treated in one clinic

·        Ensuring evidence-based practice in line with national guidance

·        Creating clear and effective pathways from universal services to secondary care

·        Reducing  multiple waiting times for access to Gp, school nurse and paediatrician clinics

·        Ensuring comprehensive assessment by healthcare professionals with the necessary skills and expertise

·        Creating necessary documentation to ensure the smooth running of the service e.g. referral criteria and assessment documentation.

Overarching aim is to prevent BBD continuing into adulthood through quicker identification, assessment and management.

How will the project be delivered?

The idea is to run a pilot clinic, situated in Raigmore hospital, for children with BBD. This would be run by a band 7 nurse with band 4 and admin support.

The plan would be to use the audit cycle below

1.      Identify topic – improving outcomes for children with BBD

2.      Select standards – Paediatric Continence Forum: Children’s continence commissioning guide, 2019

3.      Data collection – current patient journey vs new patient journey. Would include numbers of children seen in the different clinics/ waiting lists and times/ number of appointments. Engagement with stakeholders – HVs, Gps, school nurses, paediatricians

4.      Data analysis – method of assessing outcomes, patient feedback

5.      Implement change – establishment of referral criteria and pathways, assessment documentation, management of red flags, location and admin support

6.      Allow time for changes to take place

7.      Re-audit – repeat data collection to see whether there is improvement in identified criteria i.e. reduced waiting times, shorter clearer journey, patient satisfaction

How is your project going to share learning?

This project will build on information and learning obtained from carrying out a scoping exercise of Children’s Continence Services in Highland, which identified the following shortfalls:

• No designated children’s continence service
• No paediatric continence nurse specialist
• Lack of clinical supervision and unchecked advice being given to children/families

The recommendations from the exercise focus on creating an integrated service. This project would trial putting that advice into practice. Only 1 in 14 Health Boards in Scotland have an integrated Paediatric Continence service which includes all 5 areas (toilet training, enuresis, daytime wetting, constipation/soiling and product provision). Therefore, this project has the potential to demonstrate good practice which could be employed in other areas to improve outcomes for children with BBD. The findings will be disseminated through the Q network and also through Paediatric Continence Scotland. Hopefully this project would also provide further evidence of the need for an integrated service in Highland.