Quality standard
Quality statement 6: Referral if no response to treatment
Quality statement 6: Referral if no response to treatment
Quality statement
Children and young people with idiopathic constipation that does not respond to initial treatment within 3 months are referred to a healthcare professional with expertise in the problem.
Rationale
For the majority of children and young people, idiopathic constipation responds well to laxative treatment delivered within primary care. However, children and young people with constipation that has not responded to initial treatment may need specialist help and support, and further investigations may be needed.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements and written clinical protocols to ensure that children and young people with idiopathic constipation that does not respond to initial treatment within 3 months are referred to a healthcare professional with expertise in the problem.
Data source: Local data collection.
Process
Proportion of children and young people with idiopathic constipation that does not respond to initial treatment within 3 months who are referred to a healthcare professional with expertise in the problem.
Numerator – the number in the denominator who are referred to a healthcare professional with expertise in the problem.
Denominator – the number of children and young people with idiopathic constipation that does not respond to initial treatment within 3 months.
Data source: Local data collection.
Outcome
Rates of recurrent presentation to general practice.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers ensure that staff refer children and young people with idiopathic constipation that does not respond to initial treatment within 3 months to a healthcare professional with expertise in the problem.
Healthcare professionals refer children and young people with idiopathic constipation that does not respond to initial treatment within 3 months to a healthcare professional with expertise in the problem.
Commissioners ensure that they commission services from providers who can demonstrate that children and young people with idiopathic constipation that does not respond to initial treatment within 3 months are referred to a healthcare professional with expertise in the problem.
Children and young people whose constipation does not improve after 3 months of laxative treatment are referred to an expert in constipation in children and young people.
Source guidance
Constipation in children and young people: diagnosis and management. NICE guideline CG99 (2010, updated 2017), recommendation 1.8.4
Definitions of terms used in this quality statement
Idiopathic constipation
Constipation that cannot (currently) be explained by any anatomical, physiological, radiological or histological abnormalities. [NICE's guideline on constipation in children and young people, Introduction]
Healthcare professional with expertise in the problem
A healthcare professional with interest, experience and/or training in the diagnosis and treatment of constipation in children and young people. This may be, but is not limited to, a specialist continence nurse, community paediatrician or GP with a special interest. [Adapted from NICE's guideline on constipation in children and young people]
Respond to initial treatment
Progress and improvement in symptoms from the point of initiation of maintenance treatment when treatment has been adhered to, based on the clinical judgement of a health professional and informed by the child, young person or the parents or carers. The Bristol Stool Form Scale may also be used in determining whether symptoms have improved. [Expert opinion]