Writing an individual health care plan
Where a routine procedure is required for a child/young who has not yet achieved age expected continence, an individual health care plan should be agreed in discussion with the child/young, school staff, parents and relevant health personnel. The plan should be signed by all who contribute and reviewed on an agreed basis.
In developing the plan the following should be considered:
- Staff ratios and procedures.
- Toilet arrangements and equipment (e.g. spare clothes and disposable gloves).
- Awareness of a child’s discomfort which may affect learning.
- The importance of working towards independence.
- Who will substitute in the absence of the appointed person.
- Strategies for dealing with pressure from peers .e.g. teasing/bullying.
The individual health care plan should include the following details:
- Staff to wear disposable gloves and aprons while providing care (see also updated SMBC PPE guidance May 2020).
- Changing area to be cleaned after use according to local policy and guidelines.
- Hot water and liquid soap available to wash hands as soon as the task is completed.
- Hot air dryer or paper towels available for drying hands.
- Labelled bins for the disposal of wet & soiled nappies/pads (soiled items being ‘double bagged’).
- Supplies of suitable cleaning materials; anti-bacterial spray, sterilising fluid, hand wash etc.
- Nappy creams/lotions should be labelled with the child’s name and used only if prescribed for that child – they must not be shared. Any creams should be used sparingly as if applied too thickly they can reduce the absorbency of a nappy.
- The child’s skin should be cleaned with a disposable wipe.
- Supplies of appropriate clean clothing, nappies, disposal bags and wipes.
- Changing mat or changing bench.
- If at all possible children should be changed standing up. This makes it easier for the child to be involved in the process and start to make steps to becoming independent.
- If the child needs to be laid down to be changed, then once the child has been changed and has left the changing area, the surface should be cleaned with warm soapy water and left to dry.
- An effective system should be identified to alert staff for help in emergency.
- Easy access to a toilet and wash basin.
- A toilet cubicle of the correct size for the child.
- Space to manoeuvre, with or without mobility equipment.
- Toilet facilities near to where they are.
- Safe toileting space.
Specific advice re: interventions such as catheterisation or stoma care
If a child has a specific continence issue which needs to be addressed, such as a catheter or a stoma, the staff involved in the child’s care need to be trained and fully understand the procedure. For children who have specific intimate personal care needs, there should be a health care professional involved, who can, in conjunction with the parent, teach staff and set up an individual health care plan.