P06 A quality improvement project to improve use of bowel charts in surgical wards

Abstract

Abstract Introduction To improve the documentation of bowel movements. Methods We performed a closed loop audit examining how well patients’ bowel movements are documented in nursing and medical notes across all adult surgical wards at a district general hospital. We collected snapshot data on whether a bowel chart was present, whether bowel movements were recorded regularly and whether doctors documented bowel movements during ward rounds. We then changed the colour of bowel chart paper from white to yellow, with identical contents. This data was prospectively collected again 5 weeks later. Results The sample size included 62 inpatients. Prior to the change in bowel chart, 79% of patients’ nursing folders had a bowel chart. Documentation of bowel movements in nursing and medical notes was 25% and 30% respectively. Following the introduction of yellow coloured charts, 90% of patients’ nursing notes had a bowel chart present, with an increase in documentation in nursing and medical notes to 74% and 69% respectively. Conclusion In a surgical patient, the importance of good bowel movements is essential to management decisions and discharge planning. Locally, this has been inhibited by the difficulties of locating white bowel charts in a folder of white paper, leading to incomplete documentation and poor recognition of problems in bowel movements. Changing the colour of the bowel charts made it easier to recognise the charts, allowing nurses and doctors to use the bowel chart more efficiently, hopefully improving patient care. This change has been recognised as effective and has been rolled out trust-wide. Take-home message Bowel movements are vital to surgical decision making, but are frequently overlooked in practice; impacting patient care. Hence, the need for better recognition made by a simple intervention.