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

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.