Introduction

This document outlines the information required, and the expectations of a Hireup Support Worker when providing bowel care support and of the Client when bowel care is required on shift.  

The method of bowel care can vary greatly from person to person. It can include oral medications, suppositories, enemas, bowel washouts, abdominal massage and manual removal. The elimination of the bowel can be from the anus or a stoma site.

The method that is most suited to the Client is to be determined by an appropriate, registered health professional, such as a doctor. This is to be documented in a bowel care plan, reviewed every 12 months or as otherwise stated by the treating health professional. 

This policy aims to ensure the standard of service delivery remains safe and high quality by implementing strategies to prevent adverse events for those who require bowel care.

Hireup Values 

Hireup’s values provide us with the direction in which we engage with our community and develop policy and process across the business. 

We recognise that bowel care is intensely personal in nature, and only a part of a person’s overall support needs. By upholding the value of ‘the person is the point’ we take an individualised approach to bowel care.  

Hireup acknowledges Clients and their families are experts in their individual bowel care support. Central to this understanding is the principle of ‘championing choice’ and control for Clients to make informed decisions about their bowel care support. Whilst Hireup is not responsible for the assessment or development of a Client’s bowel care plan, we support Clients to engage with suitable health professionals and to be involved in the planning and management of their bowel care, as well as any individual training arrangements. 

Definitions

Support Worker: a person that provides support to the Client, typically in a paid capacity. 

Suppository: a solid medication designed to be inserted into the rectum to be dissolved.

Enema: a liquid medication injected into the rectum to expel its contents.

Bowel washout: used in people with constipation or bowel conditions to help empty the bowel and manage their condition.

Manual removal: the manual removal of stool from the rectum.

Stoma: an opening to the inside of the body, created surgically or occurring naturally (for example, the mouth, nose or anus).

Stoma care: use of equipment and consumables such as stoma bags, skin sealants, barriers or powders to maintain a healthy stoma.

Bowel Care Plan: a document that outlines for service users:

• Communication preferences
• Type/s of bowel care required (for example, medication or procedure used)
• Timing of bowel care (for example, once per week, morning, PRN)
• Level of assistance required
• Equipment needed (such as medications, PPE, stoma bags)
• Normal stool appearance
• Risks to look for and action required to respond to risks (including autonomic dysreflexia management)
• Troubleshooting and emergency management (including signs, symptoms and actions for common problems such as reflux, stomach pain or changes in bowel habits, or in case of autonomic dysreflexia)

Guidelines

Service Provider

As the service provider, Hireup will:

• Work with the Client (or their Account Manager where applicable) to determine the support they require from Hireup, and determine what documentation is required.
• Determine areas of bowel care that are within the scope of practice for a Support Worker to provide.
• Regularly review the bowel care plan to ensure the information provided is the most up to date and appropriate.
• Provide Support Workers with written procedures for the Provision of Bowel Care, in conjunction with the Client (or their Account Manager where applicable) and their treating Health Professional.
• Ensure Support Workers have access to support plans and ensure these plans are only updated by a registered and relevant health professional.
• Identify areas of education and training for Support Workers.
• Provide Support Workers with appropriate training and assessment to ensure the safe provision of bowel care, including regular supervision.
• Provide Support Workers with access to personal hygiene guidelines. 

Support Worker 

A Support Worker MAY: 

• Perform any task that is listed on the plan, apart from those that must be completed by a health professional. If concerned or unsure, talk to the Client (or their Account Manager where applicable), and contact the Hireup support office for support.
• Access supervision outside of scheduled supervision timeframes by contacting Hireup directly.

A Support Worker MUST: 

• Complete online training modules provided by Hireup within the allocated time frame unless otherwise specified by Hireup.
• Follow the support plan as provided and raise any concerns with the Client (or their Account Manager where applicable) immediately, as well as notify Hireup.
• NOT change any part of the plan or deviate from the plan provided.
• Report any issues or concerns arising from the delivery of bowel care (such as bowels not open, bleeding, constipation, diarrhoea, stoma blockages) to the Client, (or their Account Manager where applicable) and/or their health professional immediately, followed by an incident report to Hireup once safe to do so.
• Identify any gaps in knowledge and report these to Hireup for further advice.

Client

A Client MUST: 

• Provide Hireup with an honest and accurate account of their support needs.
• Advise Hireup if they are at risk of autonomic dysreflexia and provide a support plan outlining the management of associated signs and symptoms.
• Provide a support plan to Hireup that outlines their specific bowel care support requirements, completed by an appropriate, registered health professional.
• Have the plan reviewed by an appropriate, registered health professional when changes occur. At a minimum, the plan should be reviewed every 12 months unless otherwise indicated on the plan.
• Advise Hireup of any changes to support needs, requirements or the bowel care plan.
• Report any concerns regarding Support Worker’s capability in providing bowel care support to Hireup for further advice.