DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC)

Transcription

1 DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) GUIDELINE FOR WOMEN WITH INCONTINENCE IN PRIMARY CARE (in north Derbyshire) This is an updated guideline It includes details on locations of continence clinics It includes both blank and example bladder and fluid intake forms The referral aspect of this guideline relates to Chesterfield Royal Hospital Foundation Trust AH JAPC - Guideline for women with incontinence in Primary Care Page 1 of

2 Guidelines on the Management of Women with Urinary Incontinence in Primary Care Within Primary Care Take a full urogynaecology history including sexual history where relevant Perform a pelvic examination including Simms speculum assessment, to assess any genital prolapse Perform urinalysis and if abnormal request MSU for culture and sensitivity see attached sheet Encourage weight loss if appropriate Provide a Voiding Diary and information sheet to be completed during the course of - days (enclosed) Refer patient to Locality Continence Clinics for pelvic floor physiotherapy and bladder drill therapy see list of clinics and venues (enclosed) Review patient after - months to assess progress, taking into account report from Continence Clinical Advisor Urgency/Urge Incontinence Drug Treatment all are equally effective and choice is based on cost-effectiveness First line - oxybutynin.-mg tds Second line modified release oxybutynin -mg daily (patch twice weekly if oral effective but not tolerated) Third line - solifenacin mg once daily Fourth line trospium 0mg twice daily or darifenacin.-1mg daily. Further management and referral depend upon outcome and any continuing distressing symptoms. Referral to Secondary Care If poor response or intolerance to medication then refer to urogynaecologist or female interest urologist with copy of recent voiding diary and report from Locality Continence Advisor (LCA) Stress Urinary Incontinence refer to urogynaecologist or female interest urologist with copy of recent voiding diary and report for locality Continence Advisor (LCA) Urge incontinence refer to urogynaecologist or female interest urologist Mixed Urinary Incontinence refer to urogynaecologist or female interest urologist with copy of recent voiding diary and report from Locality Continence Advisor (LCA) Persistent troublesome symptoms of genital prolapse only refer to general gynaecologist or uro-gynaecologist Women with urinary and faecal incontinence require a multidisciplinary approach between urogynaecologist, colorectal surgeon, specialist physiotherapist, diagnostic imaging and medical physics. Women who present with recurrent incontinence after stress surgery should be refer to urogynaecologist or female interest urologist Urogynaecologists at CRHFT - Mr P M Tromans and Mr Muthukumarapappan Urologists with an interest in female urology Mr D Shipstone Referrals to Stepping Hill should be made to Dr. Azziz Ibrahim AH JAPC - Guideline for women with incontinence in Primary Care Page of

3 UTI Dipstick Protocol for Excluding Clinically Suspected Infection in Uncomplicated Cases * If sample is a CSU please refer to notes below* Urine Specimen Visual Appearance Clear Cloudy or blood stained Test with Multistix SG Send to lab for MC & S If out of hours Fridge and send the next day If ALL the following are NEGATIVE Nitrate Leucocytes Protein (-VE or trace) Discard Report as No Evidence of Infection If ANY of the following are POSITIVE Nitrate Leucocytes Protein (+ or more) Send to lab for MC & S If out of hours Fridge and send the next day Notes: Dipstick testing from patients with LONG TERM INDWELLING catheters is not indicated Urine from long term catheters should be sent to Microbiology only from 1. Patients who are systemically ill and are thought to be bacteraemic/septicaemic secondary to urinary tract infection. Patients with severe local symptoms resulting from Urinary tract colonisation. Patients whose catheters are repeatedly blocking/bypassing as a result of bladder colonisation. Patients where a sample is part of MRSA screening Chesterfield and North Derbyshire Royal For more information contact Hospitals NHS Trust BLADDER Microbiology CHART Ext 0 Dr Czarniak Ext To be used in conjunction with the ASSESSMENT FORM FOR CONTINENCE AH JAPC - Guideline for women with incontinence in Primary Care Page of

4 Name: Sex: M/F Title NHS No: Hospital No: D.O.B. Age: Occupation: Special Instructions Week Commencing:. 1. Please enter in the white column the volume (mls) each time you pass urine. Please tick in the shaded column each time you are wet. Day/Date and Time Midnight 1am Noon 1pm Totals FLUID CHART AH JAPC - Guideline for women with incontinence in Primary Care Page of

5 Please enter the amount you drink Day/Date and Time Midnight 1am Noon 1pm Totals AH JAPC - Guideline for women with incontinence in Primary Care Page of

6 NORTH DERBYSHIRE CONTINENCE CLINICS Chesterfield locality Surgery contacts Clinical Advisor Contact number Holywell House L Morgan-Jones 01 0 Whittington Moor Surgery A Crawford 01 0 Chatsworth Rd MC M Marsden 01 0 Newbold Surgery A Robinson 01 1 Open referral Clinical Advisor Contact number Saltergate Health L Morgan-Jones Scarsdale L Morgan-Jones 01 0 Brimington Clinic J Brown 01 C Hobson Chesterfield Royal Hospital Foundation Trust Physiotherapy Department 01 (Consultant and GP referral only) High Peak and Dales locality AH JAPC - Guideline for women with incontinence in Primary Care Page of

7 Open referral Clinical Advisor Contact number Stanton Day Unit C Pearson 01 1 Whitworth Hospital L Harrison Cavendish Hospital S Gee 01 1 J Brown Chapel HC P Lee 01 1 New Mills Clinic A Cameron 01 0 North Eastern Derbyshire locality Open referral Clinical Advisor Contact number Clay Cross Hospital J Bunday 01 1 Shirebrook HC K Carr 01 Tibshelf HC R Short 0 0 Bolsover Hospital R Short 01 1 Eckington HC R Short 01 Killamarsh Clinic R Short 01 Dronfield HC R Short 01 Whitwell HC S Brown 0 01 Langwith Surgery S Brown 0 01 Instructions for patients on completing the fluid and bladder charts AH JAPC - Guideline for women with incontinence in Primary Care Page of

8 Fluid chart Your Doctor /nurse requires a detailed record of the liquid you drink, both the amount of liquid i.e. number of cups /beakers and the type of fluid, e.g. tea, coffee, water, juice etc. Please write the day and date in the top column (dark grey), then during the day every time you have a drink write down the amount and type of fluid in the column below besides the time you drink it. A cup holds approximately mls and a beaker/glass approx 00mls Bladder chart Your Doctor /nurse requires a detailed record of the urine you pass, how often you go to the toilet to pass urine, how much you pass each time and if you are wet (leak urine) To help you with this you may need to purchase a plastic measuring jug, these can be bought for a few pence (0-0p) Again write the day and date in the top column (dark grey), then during the day every time you go to the toilet to pass urine pass the urine into the jug and write down the amount measured in the jug in the white column next to the time of day you passed it. If you are unable to measure the urine, simply tick the time of day you pass the urine in this column, (this will not give the Dr/Nurse as accurate information but is better than not completing the form). If you are wet tick the time of the day when you are wet in the second (grey) column. Completed examples follow BLADDER CHART - EXAMPLE AH JAPC - Guideline for women with incontinence in Primary Care Page of

9 To be used in conjunction with the ASSESSMENT FORM FOR CONTINENCE Name: Sex: M/F Title NHS No: Hospital No: D.O.B. Age: Occupation: Special Instructions Week Commencing:. 1. Please enter in the white column the volume (mls) each time you pass urine. Please tick in the shaded column each time you are wet. Day/Date and Time Midnight 1am Noon 1pm Totals AH JAPC - Guideline for women with incontinence in Primary Care Page of

10 Please enter the amount you drink FLUID CHART - EXAMPLE Day/Date and Time Midnight 1am Noon 1pm Totals tea 0 water 00 coffee tea 00 juice 00 cola 0 water tea 00 horlicks AH JAPC - Guideline for women with incontinence in Primary Care Page of