The Sentinel Stroke National Audit Programe (SSNAP) is an audit of England, Wales and Northern Ireland on the quality of care for patients with stroke up to 6 months after admission. Amongst various standards, it measures the “percentage of applicable patients who have a continence plan drawn up within 3 weeks of clock start“. Loss of bladder and bowel control is common after stroke and is estimated to be present in around 50% of patients with stroke. It is also an area of stroke nursing that is under-researched and has a huge impact on the quality of life. NHS England has also identified that patients with neurological conditions are a group at risk of bladder and bowel dysfunction and recommends case finding.
According to the recent SSNAP data, between January and March 2016, almost 90% of patients had a continence plan drawn up within 3 weeks of clock start, which means that not all patients with stroke and neurogenic bladder and/or bowel dysfunction have a continence care plan within 3 weeks of admission. However, having a continence plan doesn’t necessary mean that we are promoting continence. On the other hand, with the developement of Early Support Discharge Teams or Community Rehabilitation teams, the length of stay of patients with stroke has reduced and more patients are discharged from hospital within 4 or 5 days of hospital admission to continue their rehabilitation at home.
Hence, there are three questions that we must ask ourselves about our stroke services:
1. What is the percentage of applicable patients who have a continence plan that promotes continence?
2. Do all patients with stroke have a continence assessment on admission and a plan that promotes continence done by discharge?
3. Are we reviewing continence plans frequently during hospital admission or in the community?
© Ismalia de Sousa, 2016