Solihull constipation pathway

The stool report was a study of the management of constipation across the Marie Curie centres. ³ It was a prospective, patient questionnaire study that focused on patients' perception of their constipation.

The study concluded that for the majority of patients receiving care in the Marie Curie centres, constipation was either being prevented or was reasonably well managed. Most patients expressed a degree of satisfaction with the way their constipation had been managed.

However, there was concern for a significant proportion of patients, who perceived that they had severe constipation persisting over the study period. There was a concern that laxatives were being prescribed inappropriately to some patients and not being prescribed for all patients on opioids.

The ‘Stool Report’ recommended that:

Severely constipated patients need to be monitored and supported daily;

Assessment of patients' bowel function needs to be more rigorous;

Guidelines for laxative management need to be developed;

Regular advice on constipation prevention and management should be given to patients and their carers;

Patients and their carers need to be empowered to manage their own bowel function;

Health professionals need to be made aware of the different types of laxatives and the risks for constipation.

As a result of these recommendations Marie Curie Hospice, Solihull decided to develop documentation.

AIM

To produce an evidence-based care pathway that encompassed an initial assessment and ongoing management of the constipation.

METHOD

An action research methodology was used. The main components were:

Multiprofessional working group:

This consisted of a doctor, physiotherapist, occupational therapist and inpatient palliative care nurses;

The group met regularly over a two-year period to develop documentation;

It was important to have full cooperation from the multidisciplinary team in order to implement a sustainable change.

Audit of documentation pre- and post-implementation:

Audit of documentation pre-implementation revealed that recording of bowel function was incomplete, there was no mention of any validated assessment tools such as the Bristol Stool Form Scale (BSFS) ⁴ or any management plan.

Focus group interviews with the multiprofessional team:

The interviews were designed to obtain the following information:

What information should we be recording?

Who should be recording the information?

How best could we educate the staff?

What information should we give to patients?

What information do we need to disseminate on discharge, and to whom?

Launch of pathway supported by an accompanying teaching programme: ⁵

The multidisciplinary team involved in the pathway development facilitated the teaching

All trained and untrained inpatient staff were involved in the programme

It was very important to provide the education for health-care assistants, as they are the people involved in most of the toileting. Their role in completing the documentation, therefore, was pivotal

A leaflet was developed for patient education. ⁶

RESULTS

A post-study audit showed that staff were completing the pathway.

A survey of inpatient staff showed that 80% felt that the documentation had improved the management of constipation.

CONCLUSION

This demonstrated the effectiveness of action research in developing an integrated pathway, changing the practice of constipation management.

FUTURE DEVELOPMENTS

Re-audit of current constipation management

Education package for all inpatient staff, on the proposed management flowchart

Introduction of the constipation management flowchart

Multicentre trial. ^7–18