Employing Integrated Care for the Spinal Cord Injured Population ensuring access to their fundamental right to Neurogenic Bowel Care 

It is widely recognised that lack of capacity, experience and/or training in primary and acute care can lead to healthcare professionals' refusal to perform neurogenic bowel care on spinal cord injured (SCI) individuals. Although the number of spinal cord injuries in Ireland is relatively small in comparison to other acquired chronic injuries, the impact of having a neurogenic bowel on this patient group is considerable. Mismanagement of bowel care leads to costly extended hospital stays and, to a number of complications: autonomic dysreflexia, pressure injuries, dermatitis, mucosal damage, sepsis, incontinence/ constipation, in addition to the anguish of the loss of privacy and dignity. However, spinal cord injured patients and their healthcare professionals (HCP) continue to face barriers accessing appropriate neurogenic bowel care in Ireland. A study carried out by Pryor et al (2020) on SCI individuals admitted to acute hospitals, found that neurogenic bowel policy varied widely between healthcare settings, with some having no bowel policy at all and the lack of appropriate equipment created additional difficulties. Aim: The Specialist Advanced Nurse Practitioner (ANP) in Spinal Cord Injury / Dysfunction at the National Rehabilitation Hospital (NRH) has developed A comprehensive neurogenic bowel policy based on the lived experience of all parties involved in neurogenic bowel care. This policy has been put in place to ensure safe and consistent messaging and information for all levels of care from patient, through to carers, to primary care onto acute care. Methodology: Systematic Review required. Dedicated education at undergraduate level for all nursing students, introducing neurogenic bowel care as standard practice. Mandatory standardised training for all new nursing staff. Regulation of revision courses / updating skills. Standardisation of competency assessment. Conclusion: There is an urgent need for National Neurogenic Bowel Guidelines endorsed by the Irish Health Service Executive, (HSE) that will drive competency and awareness. The guidelines should increase awareness of the complications that occur with poor neurogenic bowel management. They need to provide a competency structure for HCP in acute and primary care in order to allow the appropriate allocation of resources so delayed transfer of care for neurogenic bowel management can be minimised and, in the future, avoided altogether. They need to ensure that the barrier of lack of safe neurogenic bowel care is removed.