What is Incontinence?
Incontinence is an involuntary loss of urine and/or bowel motion. The amount can vary from slight to copious.  Incontinence is not a disease, but is a symptom of an underlying disorder.

The Continence Service is a community based service, providing discreet professional assessment and management of urinary and faecal incontinence.

Who may access this Service?
General Practitioners, Health Professionals, Hospital Staff and self referrals are accepted.  We encourage patients to be referred via their General Practitioner.

What does the Service provide?
Free confidential continence advice.  Assessment either in a clinic or a home environment.  Management programmes, such as bladder retaining, pelvic floor exercises.  Direct access to urologists, gynaecologists, physiotherapists, dietitians. Supplementary products supplied if criteria are met.

Provision of supplies
Supplementary incontinent pads may be supplied on completion of a comprehensive assessment and management programme, based on the degree of incontinence.

Who is eligible for supplementary continence supplies?
Children over the age of 4 years who have an incontinence problem that is inconsistent with normal development, represented by a urinary incontinence problem, i.e. 50mls per episode more than 4 times per day, and/or a problem with bowel control.  Those 10 years of age and over who have a urinary incontinence problem of over 100mls more than 4 times per day, and/or a problem with bowel control.

Referral and entry to Service
If the General Practitioner is referring it is desirable to have had:

• A multistix and/or MSU
• Medical history including prior investigation and/or surgical interventions and the duration of the problem

Exclusion to the Service
This service will not duplicate services already contracted for by the Ministry of Health.  Exclusions include:

• Patients requiring specific service for continence who are eligible for such services funded by ACC.
• Patients who have a functional loss that is being actively managed by a specialist Assessment, Treatment and Rehabilitation Team on an inpatient basis.  Assessment to provide services can be requested on discharge from the ward.
• Patients with a clinical situation/medical condition who are being managed by a specialised mental health team as a result of an acute mental health or psychiatric problem.
• Patients in a long-stay hospital or rest home may be referred for assessment and specialist advice but are not eligible for supplementary products.

• Continence Flow Chart (PDF, 15.6 KB)

What is intravenous therapy?

The administration of medication/fluid via a plastic needle (cannula) inserted into a vein in your hand or arm.

For long term requirements, a CVAD (central venous access device) can be inserted (done in Radiology Department or Operating Theatre). Most commonly, these are PICCs which are long thin tubes which have an entry point via your upper arm and advanced inside that vein, into a larger vein near your heart. These can last upwards of a year if required.

Both these device’s entry points are covered in a specialised transparent dressing to protect entry point from infection and/or being dislodged.

Who are the District Nursing service?

• We are a team of Registered Nurses who provide a professional, safe, patient focused, community based service.
• We provide skilled management of drug/fluid administration via these access devices.
• We do NOT prescribe medications.

Who may access this service?
Hospital based Doctors 

General Practitioners (GPs) will use another pathway.

What does the service provide?

• Free administration of prescribed medications for the length of time prescribed by GP/hospital doctor.
• Clinical assessment of patient's condition and response to medications.
• Give advice/recommendations for ongoing management e.g. further GP review, possible blood analysis (through GP), dietary advice, pain issues etc.
• Removal of access device at completion of prescription.

This service can be delivered either at our clinic on hospital grounds or, if necessary, in the home environment.

Who is eligible?
This depends on frequency of medications and patient location.

• Patient must be over 10 years of age.
• Patient must have telephone access.
• Patient must have stable home environment.
• The first dose of medication MUST be given supported in a medical environment, and patient to have no adverse reaction to the medication.

Who is not eligible?
Patients with history of non-compliance, drug abuse, confusion, multiple allergies or living in an unsafe environment need to have individual assessment and be seen in clinic only.

The lower limb wound assessment service offers full assessment and investigation and treatment of leg ulcers either in the District Nursing Clinic or home environment by the District Nursing Service.

What is a leg ulcer?

A leg ulcer is generally defined as a wound below the knee that has not shown signs of healing within 6 weeks. There are many causes of leg ulcers and treatment depends on the underlying cause.

Who can refer to this service?

We encourage referral via GPs or hospital/community based health professionals. If the injury is covered by ACC, the accepted claim number must be supplied.

Is there a cost associated with the service?

No, however some types of compression hosiery may require self funding.

What does the service include?

• Full lower limb inspection and assessment.
• Comprehensive wound assessment, care planning and treatment using gold standard advanced wound care products.
• Ankle Brachial Pressure Index (ABPI) readings - often referred to as a Doppler – a non-invasive ultrasound test that assists in assessing the circulation to the lower leg. The results are used to determine the most appropriate treatment plan.
• Compression bandaging – the gold standard treatment for patients found to have venous insufficiency.
• Measurement for and fitting of compression hosiery to treat or to prevent recurrence of ulceration.
• Referral for other diagnostic testing, such as wound biopsy, ultrasound leg mapping.
• Referral to other specialist services such as Vascular Surgeons, General Surgeons, High Risk Foot Clinic, Lymphoedema services.

Stomal Therapy Service

What is a Stoma or Ostomy?

An ostomy refers to the surgically created opening in the body for the discharge of body wastes, or to provide nutrition as in a gastrostomy, or to aide breathing as in a tracheostomy.  A stoma is the actual end or opening that can be seen protruding through the abdominal wall such as a colostomy, ileostomy, urostomy or gastrostomy or from the trachea such as a tracheostomy.

An Ostomy or Stoma is formed as part of treatment to cure disease / illness or to relieve symptoms.

The Stomal Therapy service is community based but provides Stomal therapy services to all hospitals, rest homes and community clients throughout Northland.

Referrals are received from Surgeons, hospital staff from any hospital, General Practitioners, Health Professionals and self referrals are accepted when needed e.g. when on holiday and having stoma issues.

Types of Stoma /Ostomy

Colostomy: A stoma which opens from the Colon (Large Bowel) usually to left lower abdomen that passes bowel motions. Large bowel is stitched to the outer abdominal wall, this usually heals within 7-10 days, and an adhesive stoma bag is placed over the stoma to collect the bowel motion.

Ileostomy: A stoma which opens from the Ileum (Small Bowel) usually to the right lower abdomen that passes bowel motions. Small bowel is stitched to the outer abdominal wall and will heal usually within 7-10 days and an adhesive stoma bag is placed over the stoma to collect the bowel motion.

Urostomy (Ileal Conduit): A urinary stoma the ureters are joined to a piece of resected ileum (small bowel) and a conduit is formed with one end over sewn and the other brought out to the abdominal wall as a stoma in a similar position as an ileostomy. This works as an artificial bladder if your bladder has been removed. An adhesive Urostomy pouch is placed over the stoma to collect the urine.

Gastrostomy: An opening into the stomach where a tube is placed, which can be used to provide nutrition under the guidance of a dietitian.

Tracheostomy: An opening into the trachea to aide breathing, you are closely monitored by the ENT doctor and nurse specialist.

What does the service provide?

Free confidential stoma assistance and advice. Assessment and care pre-operatively, in hospital, on discharge from hospital and bi-annually or as required thereafter. Assessment and visits may be in hospital, clinic or in the home environment.

Stoma care products are provided free of charge as per the government guidelines.

As part of a wider multidisciplinary team we can refer as needed to other services if required.

Provision of supplies

Stoma supplies are supplied following comprehensive assessment by the Stomal Therapy Nurse.  Ongoing at least 2 yearly assessment is required as per government guidelines.

Who is eligible for stoma supplies?

A person of any age (babies, children and adults) who has been referred and assessed by the Stomal Therapy Nurse.

Clients must be a New Zealand citizen or resident to receive healthcare services in New Zealand.

Clients who are eligible to receive services through ACC can be assessed by the Stomal Therapy Nurse but supplies will be provided through ACC supplier.

Pressure areas, burns, Skin grafts, post-surgical, chronic and acute wounds.