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Tuesday, June 15, 2010: 9:00 AM
Background:Constipation in acute care hospitals is associated with poor health outcomes and prolonged hospital stays (Richmond and Devlin, 2003). Constipation risk assessment tools have been devised and validated (Kyle, 2007) and studies undertaken to develop bowel management protocols and guidelines … but sadly they are underused and constipation remains a problem.
Project aims: A 25% reduction in prevalence of constipation in the acute care wards by December 2009.
Methods:The NSW Health Clinical Practice Improvement Method (2002) was used and involves 5 stages (defining the project, diagnostics; interventions; implementation; sustaining improvement).
Diagnosis used audit and interviews to collect baseline data concerning point prevalence of constipation and current bowel management practices as documented in the patient’s notes.
The Eton Scale (Kyle et al 2005) risk assessment tool for constipation was trialed.
Focus groups contributed data about current practices and things perceived to influence bowel management.
In the intervention phase changes were made to factors diagnosed as being problematic, and the impact of those changes measured, using the ‘PDSA’ cycle: Plan; Do: Study : Act.
Implementation included adaptation of a risk assessment scale on the hospital’s computer system accompanied by a decision making guidelines and policies. A different type of bowel management medication was trialed and added to the hospital’s list of ‘nurse initiated drugs’. A new section for documenting bowel actions was included on the observation charts.
Sustaining improvement includes an on-line evidence-based bowel management education program for nurses and educational materials for patients including in-house telecasts.
Outcomes:
Changes in practice have included the interventions described above. Final results concerning prevalence of constipation and current bowel management practices will be available in December 2009 when data from the second audit will be compared with the baseline data from July 2008.
Project aims: A 25% reduction in prevalence of constipation in the acute care wards by December 2009.
Methods:The NSW Health Clinical Practice Improvement Method (2002) was used and involves 5 stages (defining the project, diagnostics; interventions; implementation; sustaining improvement).
Diagnosis used audit and interviews to collect baseline data concerning point prevalence of constipation and current bowel management practices as documented in the patient’s notes.
The Eton Scale (Kyle et al 2005) risk assessment tool for constipation was trialed.
Focus groups contributed data about current practices and things perceived to influence bowel management.
In the intervention phase changes were made to factors diagnosed as being problematic, and the impact of those changes measured, using the ‘PDSA’ cycle: Plan; Do: Study : Act.
Implementation included adaptation of a risk assessment scale on the hospital’s computer system accompanied by a decision making guidelines and policies. A different type of bowel management medication was trialed and added to the hospital’s list of ‘nurse initiated drugs’. A new section for documenting bowel actions was included on the observation charts.
Sustaining improvement includes an on-line evidence-based bowel management education program for nurses and educational materials for patients including in-house telecasts.
Outcomes:
Changes in practice have included the interventions described above. Final results concerning prevalence of constipation and current bowel management practices will be available in December 2009 when data from the second audit will be compared with the baseline data from July 2008.
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