CONTINENCE
THE SUBJECT OF CONTINENCE – OR MORE OFTEN, INCONTINENCE - IS OFTEN TREATED WITH HUMOUR AND DERISION, BUT AS A COMMUNITY PHARMACIST, YOU’LL BE WELL AWARE OF THE DISTRESS THAT THIS CAN CAUSE FOR YOUR PATIENTS. FORTUNATELY, THERE IS SOME GREAT WORK BEING DONE IN SCOTLAND.
TRANSVAGINAL MESH IMPLANTS UNDER SCRUTINY
S
tress urinary incontinence (SUI) and pelvic organ prolapse (POP) are conditions affecting
a signifi cant number of women and can result in a reduced quality of life. Synthetic polypropylene mesh is a permanent implantable medical device that’s often used in an attempt to correct both of these conditions.
It’s estimated that, between 2000 and 2014, up to 1500 women suffering from SUI and 350 suffering from POP had synthetic mesh implant surgery each year in Scotland.
Over a period of time, however, concerns about the safety of mesh devices had been raised by women, who experienced complications. Indeed, some women adversely affected by the implants experienced very serious complications, which altered their lives completely.
In 2017, the Scottish government published its report, ‘Scottish Independent Review of the use, safety and effi cacy of transvaginal mesh implants in the treatment of stress urinary incontinence and pelvic organ prolapse in women’. As a result of the report, NHSScotland said that it would to encourage both clinicians and patients to report incidents more often in a bid to increase their confi dence in the system. NHSScotland suggestions included:
• Further training for clinicians on adverse events reporting in addition to the letters already sent describing
20 - SCOTTISH PHARMACIST mesh adverse events
• Involvement of multi-disciplinary teams in knowing what and when to report
• The inclusion of physiotherapists in reporting information
An independent review (IR) which was carried out into the issue found that many women, who had experienced adverse events, felt that they were not being believed, adding to their distress and increasing the time before any remedial intervention could take place.
‘Improving awareness,’ the IR said, ‘amongst clinical teams of the possible symptoms of mesh complications together with good communication skills (including good listening and empathy) is an essential part of good clinical care.’
The IR concluded that an Expert Group should review the graining and information available to clinical teams in both primary and secondary care and fi nd ways of incorporating patient views in multidisciplinary team working.
The issue has now been brought centre stage again with the appointment of Professor Lorna McKee as Chair of an oversight group, which is currently being established to review data and scrutinise adverse event reporting on the use of transvaginal mesh implants in NHSScotland. Professor McKee is Emeritus Professor of Management
Award winning team: (l-r): Jean Donaldson, Associate Director of Nursing, South Lanarkshire Health and Social Care Partnership, Alice Macleod, Nurse Advisor with NHS National Services Scotland with Debra Allison of David Walker Gardens and Margaret McDonald, Summerlee House. The team triumphed in the highly-contested innovation category at the recent UK-wide GO awards which celebrate excellence in public procurement in October last year.
and Health Services Research at the University of Aberdeen.
Professor McKee will chair the Transvaginal Mesh Oversight Group – a multidisciplinary group, which will include patient and public representatives and will have the following remit:
• To review data on the use of transvaginal mesh implants in NHSScotland
• To scrutinise adverse event reporting by NHS Boards
• To consider how signifi cant new evidence can be incorporated into the agreed NHSScotland pathways of care, and
• To ensure that any patient information is up to date and appropriate
‘A number of women have suffered serious, life-changing complications as a result of transvaginal mesh implant surgery,’ said Professor McKee. ‘However, many women have also benefi tted from these procedures. It is clear that safety for women needs to be improved and we believe that the oversight group will be a crucial stage in ensuring that this happens.’
LANARKSHIRE PARTNERSHIP TEAM DRAWS GLOBAL ATTENTION
A pilot initiative, which has markedly improved the lives of people in some Lanarkshire care homes is fast
becoming the focal point of global attention.
Last year The Care Home Continence Improvement project, developed by teams in NHS Lanarkshire and NHS National Services Scotland, set out to improve approaches to continence care. Now core members of the team are set to present details of the results at a variety of high-level engagements, including an international health summit in Amsterdam.
‘This was about small changes making a big difference,’ said Jean Donaldson, Associate Director of Nursing, South Lanarkshire Health and Social Care Partnership. ‘Research has identifi ed incontinence as a risk factor that increases skin damage, infection and falls in older people. The initiative allowed care home staff to improve the quality of care through better recording of processes and introducing small changes including medication reviews and reducing caffeine intake.
‘The outcomes of the initiative – piloted at Summerlee House in Coatbridge and David Walker Gardens in Rutherglen – has led to improvements including a reduction in falls by 65 per cent, urinary infections being halved and skin damage reduced by one third. The project has also reduced the amount of continence pads used at the homes.’
A fi lm documenting the pilot project is available to view at
slhscp.org.uk •
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