The FINCH Service -nurse led services for patients with pelvic floor dysfunction

Service Outline

The FINCH service (faecal incontinence and constipation healthcare) is a pelvic floor service that offers assessment, diagnosis and treatments for patients with faecal incontinence, constipation, rectal evacuatory dysfunction, obstructive defecatory syndrome and anterior resection syndrome.

The service was established by the collaborative working of Miss Kathryn Gill (colorectal consultant) and Kelly Stackhouse (Lead clinical Nurse Specialist) in 2009. Prior to this there was no specialist service within the west midlands area for patients with bowel function disorders.

The service has been developed to such an extent that there are very few centers within England that now offer the scope and range of management strategies that the Finch Service offers.

Quality of Service

All patients that are seen within the service are offered thorough pelvic floor assessment, investigated as appropriate and commenced on a treatment pathway.

All patients referred into the service are required to complete, bowel diaries and quality of life questionnaires which are completed prior to initial visit and again when treatment is completed to monitor outcomes of treatments.

On completion of treatments patients are also asked to complete a patient satisfaction survey (PROMS) to ensure quality.

We have developed a patient support group for anterior resection syndrome with extremely positive feedback we hold these meetings quarterly, all supported by companies and run by patients. We aim to arrange the same for the other conditions that we also specialise in.

We have acted upon patients feedback form the meeting and have arranged a number of fund raising events including variety nights, cake sales, tombola, boxing matches and sponsored weight loss to enable us to purchase the top of the range equipment. We continuously receive extremely positive feedback from colleagues, GP’s, and most of all patients.

Innovation

Since 2012, an innovative Integrated Care Pathway (ICP) was developed and launched for patients who are experiencing faecal incontinence/leakage. The main element of the ICP involves shifting the location of care from secondary to primary care settings. You can read the complete ICP and four stage treatment protocols Here and here

To fit in with the Trust ethos of Right Care, Right Here, we are aiming to deliver the conservative elements of the service in their entirety within the community setting.

This unique model of care has been through the pilot stage and evaluated through the University of Birmingham. Initial reports are encouraging for this new model of care and a full report of the evaluation will be published in due course. A similar pathway is in its infancy for constipation working in collaboration with County Durham NHS trust.

Our 4 staged nursing approach for constipation and faecal incontinence winning overall presentation 2015

Other trusts across the country are interested in adopting our novel 4 staged approach leading to specialist nurses spending time with the nursing team to gain experience and become a mentor.

Continuous Improvement The Finch service utilises a database which continually records and audits patient outcome data, including bowel diaries and quality of life questionnaires (QOL). This data is reviewed on a 6th monthly basis to ensure that the quality of care provided is maintained if not improved. This data is fed back to one of the monthly pelvic floor meetings which are held to ensure that there are no issues within the service and to feed back any important information relating to the service.

We are in early stages of setting up a bowel function nurses forum to enable networking, sharing best practice, problem solving but most of all standardising best care across the nation.

In order to deliver best practice, a multi-disciplinary team (MDT) approach is essential with a pelvic floor service. In order to meet this, the FINCH service has developed a monthly MDT meeting including colorectal, uro-gynaecology, urology, community continence and physiotherapists to discuss complex patients with multi-compartmental problems. This allows us to deliver the best care possible for the patients.

For further information please contact Kelly Stackhouse, Lead Nurse FINCH service  Tel. 0121 507 2497 [email protected]