Inverclyde Nurse-Led Enuresis Service Service Inverclyde Nurse-Led - - PowerPoint PPT Presentation

Inverclyde Nurse-Led Enuresis Service Inverclyde Nurse-Led Enuresis Service Inverclyde Nurse-Led Enuresis Service

School health department

History

• Originally led by cmo’s
• 2003, at suggestion of Dr. Bryan kelly Paediatrician, the

service became nurse-led

• The first clinic commenced in Port Glasgow
• Second 6 months later commenced in Greenock
• Two school nurses were trained to use “The three

systems approach”

• Further two nurses and two nursing assistants have

completed training this year

The Three Systems Approach

• Developed using evidence based studies by Dr. Richard

Butler, Clinical Psychologist and Dr Philip Holland Consultant Paediatrician both at Leeds Primary Care Trust

• Published in 2000
• It sought to provide a clinical tool whereby the problem of

enuresis could be better understood and treated

• It also sought to take pressure off the child by giving

physical explanations of which the child has no control

Founded on the notion that bedwetting results from:

• Inability to reduce nocturnal urine volume

(through lack of vasopressin release)

• Bladder instability
• Lack of arousal to full bladder signals

First Visit

• Full history taken
• Parents asked to measure bladder capacity for 1 day at

weekend

• Record wet/dry nights
• Advice is given re fluids. = Drink at least 6-7 drinks

during day

• No brown drinks
• No fizzy drinks
• No lifting
• No nappies
• Good bedtime routine

Second Visit

• Predicted bladder capacity estimated (age + 1 x 30mls.)
• Charts analysed
• Treatment started
• A few children have come back to the clinic, and after

the simple advice given, have become dry!!

The Three Systems Checklist

Lack of Vasopressin

• Wets soon after sleep
• Size of wet patch large
• Weak urine concentration in the morning

Bladder Instability

• Frequent daytime voiding
• Urgency / need to dash to toilet
• Pass small amounts
• Small bladder capacity
• Size of wet patch variable
• Wakes up after wetting

Arousability

• Will occasionally wake to void
• Will wake but avoid going to the toilet
• Will wake to external sounds
• Will wake when ill or excited

Treatment

Lack of vasopressin Desmopressin acetate (desmomelt 120mcg - 240mcg) Unstable bladder Ditropan (oxybutynin 2.5mg up to 10mg in divided doses) Difficulties with arousability Bedtime routine, fluids, reinforcement with charts Sometimes alarm added into treatment for lack of vasopressin and arousability

Follow up

• Seen within 2 weeks of starting treatment
• Approx. every 6 weeks after a treatment pathway has

become successful

• Telephone consultations
• Closer follow up if using alarm
• After 3 successful months on desmomelts treatment is

slowly decreased to ensure medication is not being taken unnecessarily

• If child F.T.A. X 2 a letter is sent to parents asking to

contact within 10 days or will be discharged

• G.P. Would be notified if no contact from

parent, and child still on medication

• Referrals are taken from G.P’s, School Nurses, Health

Visitors and direct referral from parents

• Referrals are taken for children with nocturnal enuresis and

daytime wetting

• Closely work with nurses on L north at I.R.H who run a

hospital based clinic and take referrals from clinics

• Enuresis is affected by constipation and referrals are made

by the clinic to the community childrens nurses on the ward

• There is a direct referral pathway from the clinics to Dr.

Kelly at the I.R.H

Referrals

Email Jean.Burton@renver-pct.scot.nhs.uk Tracey.Doyle@renver-pct.scot.nhs.uk Letter to: Jean Burton at P.G.H.C Tracy Doyle at G.H.C Telephone 01475 506026 (answer machine) Self referral by parent to school health dept via Greenock or Port Glasgow health centre

Further Information

E.R.I.C = education and resources for improving childhood continence www.eric.org.uk www.trusteric.org (for teens) www.ericshop.og.Uk (webshop) www.i-c-c-s.org (helpful handouts) www.urinecontrol.co.uk (ferring) www.promocon.co.uk (disabled living) www.emea.europa.eu