Abstract
Background Constipation causes morbidity, delays discharge, and is treatable.
Aims Reduce constipation to minimise risk of sequelae.
Objectives 1. All patients to have a stool chart to a given standard
2. Improve doctors review and reaction to charts
Methods Weekly ‘snapshot’ of all ward patients on a geriatric ward in a large teaching hospital. Exclusion: gastrointestinal tract stomas.
All patients' computer notes were assessed to determine: presence of stool charts, level of quality, and whether action was required or had taken place. Days to laxative (from admission or last bowel opening) was calculated, and notes were checked to determine if rectal examination had been undertaken.
In the latest audit cycle drug charts were checked for compliance with prescribed laxatives.
Intervention Ward staff were encouraged to:
1. Write ‘0-No BO’ if pt has not opened bowels with staff
2. Use smart link to check if already documented
Doctors encouraged to:
1. Review charts and highlight non-completion to ward staff
2. Use smart link to import stool chart to note
Results: Stool charts were available for 92% and 85% of ward patients for the first two audit rounds pre-intervention. Of these 76% and 56% were of good quality. Following intervention 93% of ward patients had a stool chart, with 80% of these of good quality. After excluding charts not requiring action, 11 charts, 11 charts and 6 charts respectively were left that possibly required action.
There were between 0 and 4 days to laxative prescribing. No rectal examinations had been documented. In audit three laxative compliance was 37%.
Conclusions There is room for further improvement in chart quality and doctor action. In the future we will explore laxative compliance and consideration of rectal examination.
Comments
Hello, Thank you for your poster. Please can I ask how a PR exam would be change management in the context of a patient not having opened their bowels for 1 or 2 days willing to take a laxative (in absence of other GI concerns)?
Reply
Thank you for your comment. Given your specific question regarding the patient with BNO 1-2 days willing to take a laxative a PR exam might not change management, especially if the patient is fairly comfortable and willing to wait for a result, and the rectum is empty.
The presence of faecal impaction however would benefit from suppository/enema (your choice of PR medications) rather than just oral laxatives, so in this case a PR exam has changed management.
More information, such as the consistency of last bowel opening according to Bristol stool chart, and the current status of patient (symptoms of need to defecate, rectal fullness/discomfort or overflow incontinence for instance) would guide your decision to offer/undertake a PR exam.
I found it interesting that no PR exams took place in the patients so far during this QIP, despite high proportion of patients on laxatives. It would be useful to highlight evidence /provide guidance to doctors considering when a PR exam is more useful i.e. more likely to change management, so I shall be considering how best to approach this.