Authors (including presenting author) :
Lam CP (1), Ng YHG (1), Liu LW (1), Lam YY (2), Futaba K (3), Ng CK (2), Ho PYB (4), Chui ST (1), Lau WY (2)
Affiliation :
(1) Department of Surgery, Prince of Wales Hospital, (2) Department of Surgery, North District Hospital, (3) Colorectal Surgery, The CUHK University, (4) Central Nursing Division, Prince of Wales Hospital
Introduction :
Bowel care which is a fundamental area of patient care being frequently overlooked. A big quality gap in bowel function service was identified in New Territories East Cluster (NTEC). There is around 70% of new referral cases in Colorectal SOPC are suffered from bowel function problems. And there is an average of 180 colorectal cancer patients with rectal surgery done per year in NTEC, over 60% developed one or more symptoms of Low Anterior Resection Syndrome (LARS). Large number of patients need bowel continence care, however, the service provided in hospitals was very limited. To cope with the great service demand, bowel function nurse clinics were established.
Objectives :
1.To provide comprehensive anorectal physiology testing and pelvic floor assessment to patients with bowel dysfunction or pelvic floor disorder 2.To provide tailor-made nursing interventions with patient outcomes improvement
Methodology :
The bowel function nurse clinics which included Prince of Wales Hospital and North District Hospital in NTEC were established under the Integrated Model of Specialist Outpatient Service through Nurse Clinic. Recruited patients mainly with three types of bowel problems, they were, faecal incontinence (FI), chronic constipation and LARS. In the clinical pathway, all patients were screened by Colorectal Specialist for excluding any malignancy disease before transferring to the nurse clinic for bowel management. The colorectal specialty nurses would perform anorectal physiology testing, pelvic floor assessment and provided nursing interventions which included dietary advice, behavioural modification, pelvic floor exercise, transanal irrigation and biofeedback for individualized treatment plan.
Result & Outcome :
Total 323 new cases were recruited in the clinics from October 2021 to September 2022 in NTEC. The outcome measures were adopted with different international scoring system and symptoms improvement. In the group with FI, the symptoms improvement was 76% that included decreasing episodes of FI and reducing incontinent products usage. For patients with constipation, increasing frequency of bowel movement and better stool consistency was found in 65%. For patients with LARS, the mode of LARS score before treatment was 41 (classified as major LARS) and reduced to 11 (no LARS) after nursing intervention provided. Patient satisfaction survey was collected and overall satisfaction with “strongly agree” was 90%. To conclude, the new bowel function nurse clinics are well placed to meet the service demands and effective improving patient health outcomes.
