Improving management of constipation in an inpatient setting using a care bundle
Constipation is a common occurrence on geriatric in patient wards. It can result in delirium and other complications including bowel obstruction. Over treatment with laxatives can result in iatrogenic diahorrea, which can canada goose coats on sale lead to dehydration, buy canada goose jacket delirium, canada goose clearance and the false positive labeling and canada goose unnecessary treatment of clostridium difficile carriers. This can result in increased morbidity and mortality, and a longer stay in canada goose clearance sale hospital. This means that improving the assessment and Canada Goose Outlet treatment of constipation should improve patient outcomes and result in significant hospital cost savings.Multidisciplinary discussion and planning resulted in the delivery of our constipation project. This aimed to encourage the early assessment and treatment of constipation of inpatients on a geriatric rehabilitation ward. The goal was to prevent significant constipation by intervening early, improving the prescription of laxatives, and titrating them when the constipation has resolved. This involved educational sessions, non pharmacological alternatives to laxatives canada goose outlet (optimisation of hydration, exercise, and high fibre foods), laxative prescription guidance, and twice weekly laxative ward rounds.The profile of laxative prescription changed in keeping with our guidance. There was a reduction in overall laxative prescription by a third and the prescription of “PRN” laxatives was eliminated. This hopefully resulted in reduced morbidity for the patients and reduced length of stay. There was a cost savings on the laxative bill on average per day of the Canada Goose sale project, which when extrapolated to a 365 day year was 1226.40. This doesn’t include potential savings gained from reduced complications of constipation and reduced length Canada Goose online of stay, which are hard to accurately measure.This is an open access article distributed under the terms of the Creative Commons Attribution Non commercial License, which permits use, distribution, and reproduction in any medium, provided the original work canada goose deals is properly cited, the use is non commercial and is otherwise in compliance with the license. See:legalcodeThe problem is that patients are not actually assessed for acute constipation in hospital often enough. Constipation in elderly patients in hospital canada goose coats is common. The prevalence in inpatients aged over 65 years is estimated at 50%. There are many www.canadagoosepark.com reasons for this: reduced oral intake due to illness, dehydration, delirium, dementia, immobility, and constipating drugs (such as opioid analgesics). The lack of privacy to allow bowel movement on a busy ward can also be a problem.In elderly patients who may be confused, constipation may manifest as dehydration or nausea and may result in fecal impaction or bowel obstruction. This can result in delirium, increased length of stay in hospital, and increased morbidity and mortality. Conversely, over treatment with laxatives can result in iatrogenic diahorrea, this can lead to dehydration, delirium, and the false positive labeling and unnecessary treatment of clostridium difficile carriers. This can likewise result in increased morbidity and mortality, and a longer stay in hospital. Regular assessment for constipation of hospital in patients and appropriate titration of laxatives at an early stage will improve patient care.There was also a local view that there was an over prescription of laxatives in hospital and that they tend cheap Canada Goose not to be reviewed very often once prescribed. The National Institute for Health and Care Excellence (NICE) has produced a clinical knowledge statement on adult constipation (2013). There were some NHS trust guidelines and one policy. In general, the canada goose black friday sale non pharmacological components for preventing/treating constipation were highlighted, ie optimising patient hydration and mobility, reviewing drug charts to reduce or discontinue constipating drugs if possible, a high fibre diet, and having appropriate toileting facilities readily available.In terms of prescribed laxatives, bulking agents (eg, Fybogel) should canadian goose jacket really be prescribed first line in ambulant elderly patients. The main side effect is crampy abdominal pain and patients with irritable bowel syndrome may not tolerate them well. A a stimulant laxative (eg, Senna), or an osmotic laxative (eg, Movicol) can be used as second or third line. Stimulant laxatives should not be used long term and osmotic laxatives need a good oral fluid intake to work. Using two laxatives of the same type is generally not recommended.We acknowledge that constipation treatment may need tailored to individuals, with patients preferring certain treatments. The approach to chronic constipation will need to be different, with a plan for the medium and long term. This is particularly important at the discharge point from the hospital. However, we are only looking at acute buy canada goose jacket cheap constipation in this project. The patients are a mix of stroke and general elderly rehabilitation. We decided to keep the measurements Canada Goose Parka simple and workable. We measured the following parameters:Is the patient prescribed a laxative?What category is the laxative prescribed: bulk forming, stimulant, or osmotic laxative?Is there a PRN laxative prescribed and if so has it been dispensed?The attached table shows the results of an audit of these criteria on a selected day on our ward.The aim would be that this would prompt constipation evaluation, the timely prescription of laxatives if needed, and for laxatives to be reduced when an episode of constipation had passed.As a result of our research into best practice, we also developed guidance concerning which laxative should be prescribed for an episode of acute constipation. After some discussion with the kitchens, we offered a first line dietary high fibre option (porridge and prune juice) as an alternative to laxatives. This wont be appropriate for everyone; some patients may not like this option and it may not be suitable in some patients with an impaired swallow. However, it was a suitable alternative to medication.
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