Background Constipation is a common problem in palliative care, affecting approximately 50% of patients admitted to hospices and causing a wide range of symptoms. It is important to identify, treat and document constipation systematically in order to provide immediate symptomatic relief and to prevent complication occurrence.
Aims To identify if there is documented evidence that constipated hospice inpatients are being adequately assessed, monitored and managed, and to implement improvements where necessary.
Methods Retrospective audit of constipation assessment and management in twenty consecutive patients admitted to a hospice inpatient unit, against local and national standards. Data collected included documentation of bowel habits, oral laxative prescribing and administration, and rectal interventions.
Results A number of areas for improvement were identified in both medical and nursing documentation and clinical practice. Particular areas for improvement included standardisation of documentation, the creation and implementation of appropriate care plans, review and upward titration of oral laxatives, rectal medication administration, and obtaining verbal consent and offering a chaperone prior to bowel examination or intervention.
Conclusions Lack of optimal assessment, management and documentation of constipation in hospice inpatients, will impact negatively on their physical and psychological symptom burden. In order to rectify this, a ‘Constipation Working Party’ was established comprising management, nursing and medical staff. Phase 1 of the improvement plan was the implementation of a ‘Bowel Template’ on the electronic patient record, on which all aspects of bowel care can be recorded. This has resulted in constipation documentation being more consistent, accurate and easily accessible. Phase 2 involves the development of hospice constipation guidelines, which are currently underway. Following completion and implementation of the new guidelines, a re-audit of constipation will be conducted to assess the extent to which the interventions have improved documentation and clinical practice.
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