References

Faaborg PM, Christensen P, Krassioukov A Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury. Spinal Cord. 2014; 52:494-498 https://doi.org/10.1038/sc.2014.45

Inskip JA, Lucci VEM, McGrath MS, Willms R, Claydon VE A community perspective on bowel management and quality of life after spinal cord injury: the influence of autonomic dysreflexia. J Neurotrauma. 2018; 35:1091-1105 https://doi.org/10.1089/neu.2017.5343

NHS Improvement. Patient safety alert. Resources to support safer bowel care for patients at risk of autonomic dysreflexia. 2018. https://tinyurl.com/ydyqq4qx (accessed 17 June 2020)

Nursing and Midwifery Council. Delegation and accountability. Supplementary information to the NMC code. 2015. https://tinyurl.com/y7uc6chc (accessed 17 June 2020)

Patient Safety Wales. Patient safety notice PSN046. Resources to support safer bowel care for patients at risk of autonomic dysreflexia. 2018. https://tinyurl.com/ycdfj29q (accessed 17 June 2020)

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Implementing the Welsh patient safety notice on bowel care for patients at risk of autonomic dysreflexia

25 June 2020
4 min read
Volume 29 · Issue 12

Bowel management is a key concern for individuals with spinal cord injury (SCI) and can commonly be associated with symptoms of autonomic dysreflexia (AD) (Inskip et al, 2018). Improving bowel function has been identified by patients with SCI as a key factor in enhancing quality of life (Inskip et al, 2018). Poor bowel care can not only trigger AD in those prone, but also faecal urgency, faecal leakage, constipation, haemorrhoids and abdominal distention (Inskip et al, 2018).

The NHS Improvement (NHSI) patient safety alert (NHSI, 2018) for England triggered a similar patient safety notice in Wales (Patient Safety Wales, 2018). Both documents highlighted widespread patient safety concerns with regards to bowel care and AD, which is a potentially life-threatening condition associated with spinal cord injury at T6 and above. It is characterised by a sudden, and potentially lethal, rise in blood pressure, risking cerebral haemorrhage and death (Spinal Injuries Association, 2013). Faaborg et al (2014) also state that other signs and symptoms of AD include headache, feelings of anxiety, bradycardia, cardiac arrhythmias, profuse sweating above level of injury, pale colour below level of injury, blurred vision and nasal congestion.

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