Quality standard
Quality statement 4: Reviewing maintenance therapy
Quality statement 4: Reviewing maintenance therapy
Quality statement
Children and young people with idiopathic constipation starting maintenance therapy have their first treatment review by a healthcare professional within 6 weeks.
Rationale
It is important to review maintenance therapy in children and young people with idiopathic constipation to prevent faecal impaction, and to assess for possible issues, such as problems with taking medicine and toileting.
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 to ensure that children and young people with idiopathic constipation starting maintenance therapy receive their first treatment review from a healthcare professional within 6 weeks.
Data source: Local data collection.
Process
Proportion of children and young people with idiopathic constipation starting maintenance therapy who receive a review of their treatment from a healthcare professional within 6 weeks.
Numerator – the number in the denominator who receive their first treatment review from a healthcare professional within 6 weeks.
Denominator – the number of children and young people with idiopathic constipation starting maintenance therapy.
Data source: Local data collection.
Outcome
a) Rates of reimpaction.
Data source: Local data collection.
b) Production of regular soft stools.
Data source: Local data collection.
c) Rates of unplanned hospital attendance for constipation.
Data source: Hospital Admitted Patient Care Activity from NHS Digital.
What the quality statement means for different audiences
Service providers ensure that staff perform the first treatment review of maintenance therapy for children and young people with idiopathic constipation within 6 weeks of treatment starting.
Healthcare professionals perform the first treatment review for children and young people with idiopathic constipation who are starting maintenance therapy within 6 weeks.
Commissioners ensure that they commission services from providers that can demonstrate that they perform the first treatment review for children and young people with idiopathic constipation who are starting maintenance therapy within 6 weeks.
Children and young people starting laxatives for the ongoing treatment of constipation (either as their first treatment or after treatment to clear a blockage) receive a treatment review from a healthcare professional within 6 weeks.
Source guidance
Constipation in children and young people: diagnosis and management. NICE guideline CG99 (2010, updated 2017), recommendation 1.4.10
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]
Maintenance therapy
Treatment with laxatives, either following disimpaction for the ongoing treatment of idiopathic constipation or for the initial treatment of idiopathic constipation if the child or young person does not have faecal impaction. [NICE's guideline on constipation in children and young people]
Review during maintenance treatment
Review during maintenance treatment includes ensuring that the child or young person's faeces do not become impacted and assessing for possible issues in maintaining treatment, such as problems with taking medicine and toileting.
The timing of review during maintenance treatment will depend on the individual needs of the child or young person and their parents or carers. It could range from daily contact to every few weeks.
After the first review, ongoing review and reassessment should be tailored to treatment response. Maintenance therapy should continue until regular bowel habits are established, which may take several months. Some children and young people may need maintenance therapy for several years.
A pragmatic timeframe for review of maintenance treatment within 6 weeks of starting treatment is proposed for measuring the quality statement. [Adapted from NICE's guideline on constipation in children and young people, recommendations 1.4.10 and 1.4.11, and expert opinion]
Healthcare professional
The review of laxative treatment can be undertaken by a number of healthcare professionals such as GPs, school nurses, health visitors, practice nurses, continence advisers and paediatricians. [Expert opinion]