Article type
Abstract
Background
Critically ill patients are susceptible to constipation, with reported incidence ranging from 20% to as high as 83%. Factors such as disease severity, immobility, dehydration, and the use of opioids and sedation can further the risks. Data collected from August to October 2023 showed that 29% of the patients in the Medical Intensive Care Unit (MICU)/Medical High Dependency Unit (MHDU) were constipated. Despite the risks and consequences, there was currently no established bowel care structure in the unit. Furthermore, excessive use of laxatives will induce diarrhea. Therefore, a structured bowel management protocol is deemed essential to guide clinical practice in the critical care area.
Objectives
This pilot project aims to implement a Structured Bowel Management Protocol (SBMP) (see Figure 1) at the MICU/MHDU in a tertiary university hospital in Singapore. The goal is to reduce the incidence of constipation in critically ill patients through an evidence-based quality improvement process.
Methods
The project followed the JBI Evidence Implementation Framework and involved a multidisciplinary health care team to develop the SBMP. An audit and feedback tool were utilized to plan and develop implementation strategies. Compliance audits were conducted during the implementation and sustenance phases based on the JBI criteria, focusing on the protocol process.
Results
The SBMP was developed through extensive discussions and feedback from all stakeholders.
The results showed a significant improvement after the implementation of SBMP. The proportion of patients with normal bowel patterns increased from 37% to 69%, and the proportion experiencing constipation decreased from 29% to 14%. No patients had constipation for more than 3 days. The compliance rate of bowel care using SBMP improved from 63.3% during the implementation phase to 83.3% during the sustenance phase (see Table 1).
Conclusions
The SBMP was effective in reducing the incidence of constipation for patients in MICU/MHDU. The project team is considering conducting data analysis to identify patient groups who are prone to develop more constipation days during future research.
Critically ill patients are susceptible to constipation, with reported incidence ranging from 20% to as high as 83%. Factors such as disease severity, immobility, dehydration, and the use of opioids and sedation can further the risks. Data collected from August to October 2023 showed that 29% of the patients in the Medical Intensive Care Unit (MICU)/Medical High Dependency Unit (MHDU) were constipated. Despite the risks and consequences, there was currently no established bowel care structure in the unit. Furthermore, excessive use of laxatives will induce diarrhea. Therefore, a structured bowel management protocol is deemed essential to guide clinical practice in the critical care area.
Objectives
This pilot project aims to implement a Structured Bowel Management Protocol (SBMP) (see Figure 1) at the MICU/MHDU in a tertiary university hospital in Singapore. The goal is to reduce the incidence of constipation in critically ill patients through an evidence-based quality improvement process.
Methods
The project followed the JBI Evidence Implementation Framework and involved a multidisciplinary health care team to develop the SBMP. An audit and feedback tool were utilized to plan and develop implementation strategies. Compliance audits were conducted during the implementation and sustenance phases based on the JBI criteria, focusing on the protocol process.
Results
The SBMP was developed through extensive discussions and feedback from all stakeholders.
The results showed a significant improvement after the implementation of SBMP. The proportion of patients with normal bowel patterns increased from 37% to 69%, and the proportion experiencing constipation decreased from 29% to 14%. No patients had constipation for more than 3 days. The compliance rate of bowel care using SBMP improved from 63.3% during the implementation phase to 83.3% during the sustenance phase (see Table 1).
Conclusions
The SBMP was effective in reducing the incidence of constipation for patients in MICU/MHDU. The project team is considering conducting data analysis to identify patient groups who are prone to develop more constipation days during future research.