1082 OPTIMISING CONSTIPATION IN ORTHOGERIATRIC FRACTURED NECK OF FEMUR PATIENTS THROUGH NALOXEGOL USE

Abstract

Abstract Introduction Constipation is a major concern within the care of the elderly, particularly on Orthogeriatric wards where patients are given opioids, kept nil by mouth and can be immobile for days. On average patients were opening their bowels after 4.5 days and given various laxative regimes, 43% were administered a phosphate enema. The aim of this project was to reduce the number of days that patients did not open their bowels and ultimately improve their quality of care. This was implemented by reducing the use of phosphate enemas and increasing prescriptions of Naloxegol through a stepwise structure for laxative use. NICE recommends Naloxegol prescription after 4 days of patients not opening bowels (BNO) but local policy for Wythenshawe Hospital was amended in 2020 to allow for Naloxegol to be given after 3 days. Method Audit data was initially collected to produce a baseline to compare to; then an initial intervention, a presentation to all ward staff on the new regime and Naloxegol prescription was given on two occasions. Following this; data on bowel movements, urinary catheterisation and MSU result was taken from electronic patient records along with prescription data from drug charts. The data was analysed, in addition to reviewing any issues that had arisen as a result of the intervention. The second intervention, a laminated poster in the doctor's office reiterating the same information as previous was implemented 4 weeks later, again the same data was collected and analysed. Results Phosphate enema use was reduced by 83%, and Naloxegol use increased by 336%, bowels on average opened 1.5 days earlier and patients were trialled without catheter (TWOC) approximately 4 days quicker than previous. Conclusion (s) Implementing a structured regime with Naloxegol prescription on Day 3 BNO at its heart provides for a significant improvement in constipation within Orthogeriatrics.