135 A Quality Improvement Project Aimed to Reduce the Number of Patients on Bournville Ward Suffering with Constipation

Abstract

Abstract Introduction Constipation is exceedingly common on geriatric wards, with 20–50% prevalence. It is associated with complications; including pain, delirium and obstruction. Laxatives, often considered the solution, introduce their own side effects and increase polypharmacy especially in elderly populations. Queen Elizabeth Hospital Birmingham guidelines advocate use of conservative measures, including adequate fluid and fibre intake and increasing exercise, to prevent and treat constipation prior to use of laxatives. However, we had observed that these methods were frequently underutilised, and cause of constipation was rarely considered. We aimed to reduce the prevalence of inpatient constipation and associated complications through the introduction of teaching sessions and multidisciplinary team (MDT) discussions, focusing on staff and patient education on the recognition and conservative managements of constipation. Method We audited notes weekly for the recognition of constipation, appropriate bowel examination, use of conservative management including patient education and any complications. Baseline data was collected from Bournville Ward over 4 weeks (n = 44), after which, teaching sessions for all regular ward staff and weekly MDT discussion for patients recognised as constipated were introduced. Patients having not opened bowels for >2 days were targeted for early simple non-laxative interventions. A further 4-week cycle of data was collected (n = 43). Results Constipation was recognised in 57% of patients studied, of which 64% developed constipation during inpatient stay and 20% experienced associated complications. The introduction of teaching session and MDT reviews increased patient education, cause recognition and non-laxative methods use by 19%, 27% and 30% respectively. Constipation developed during inpatient stay and associated complications decreased by 6% and 4% respectively. Conclusion Despite increased patient education, cause recognition and utilisation of conservative non-laxative approaches, only a small impact was made in reducing inpatient constipation prevalence and associated complications occurring.