Quality in patient-centred care planning: nursing interventions to alleviate constipation

Transcription

1 Monday 10 June 2013 Quality in patient-centred care planning: nursing interventions to alleviate constipation Presenter: Lynne Roberts Insert name of presentation on Master

2 What was the problem? Constipation is a condition which causes abdominal pain and loss of appetite, it usually results in a hard stool being passed which causes discomfort for the patient (NICE, 2010) Laxatives can be prescribed to relieve the symptoms, but this is often a short-term solution, and is not recommended for long-term use (Peate, 2003) Assessment of the problem: During a clinical placement on a surgical ward, I noted that patients with constipation were informed regularly by healthcare staff about the importance of fluid intake and a high-fibre diet but were not given adequate information about adopting the correct toilet position as part of the care plan (Local Health Board Constipation Care Pathway, 2011) The patient s perspective was highlighted when I interviewed a young patient with history of recent surgery and prescribed analgesia, which resulted in him becoming constipated The patient felt that adopting the correct toilet position would not only relieve the constipation but it would also reduce the risk of recurrence, and reduce the dependency on laxatives to solve the problem Verbal feedback by the patient showed that he was satisfied with the care received Quality Improvement in education programmes the journey so far

3 What are we trying to accomplish? According to Peate (2003:1130), nurses are best placed to assess, plan, implement and evaluate care for patients presenting with constipation Promote natural interventions to relieve constipation Correct toilet position is a more natural method of relieving constipation (Collins & Burch, 2008) Improve quality of care for patients, and reduce costs incurred through the prescribing of laxatives, which account for a; significant proportion of the total prescribing for gastrointestinal medicines (Waterfield, 2007: 456) Promote the use of correct toilet position as suggested in the evidence base According to the evidence, the correct position requires the patient to sit on the toilet so that their knees are positioned higher than their hips, (Kyle, 2009), to lean forward with their elbows resting on the knees, and push out their abdomen and make sure the back is straight (Norton, 2006) Quality Improvement in education programmes the journey so far

4 Quality Improvement in education programmes the journey so far How will you know that a change is an improvement? Review of patient-centred care plans. Is the plan effective? Have the interventions worked? Are the patient s symptoms improved? Verbal feedback of patients satisfaction with care Patient satisfaction audits Less patients dependant on laxatives- so that interventions are more cost-effective?

5 Quality Improvement in education programmes the journey so far What changes can be made that will result in improvement? Implementing the Model for Improvement: 1.What are we trying to accomplish? Quality! Reduce dependency on laxatives to alleviate constipation 2.How will we know that a change is improvement? Patient feedback and effective care plan evaluation. 3.What changes can be made that will result in improvement? Patient-specific interventions including correct toilet position combined with assessment tools, for example, the Bristol Stool Chart. Improved awareness of environmental issues (for example, correct toilet height, appropriate use of footstools), patient education (use of information sources/ guidance e.g. leaflets/posters).

6 Lynne Roberts PDSA cycle Model for Improvement

7 Key messages What are the potential barriers? Environmental issues, for example, low toilets Lack of awareness, staff culture How could your idea be taken forward? Educate and remind staff of correct toilet positioning, produce a poster/leaflet, integrate issue into continence training, involve multidisciplinary team such as the occupational therapists and physiotherapist. Propose pilot study involving a group of patients. Conclusion: The hoped outcome from this issue would be that adopting the correct toilet position can be better promoted as a nursing intervention together with the use of the Bristol Stool Chart (Heaton, 1999). Nurses need to be proactive in implementing interventions that can improve bowel function and consequently improve patients' quality of life (RCN, 2012). Lessons Learnt: The literature shows that correct toilet position is more natural way of relieving constipation and, if appropriate, should be standardised in care plans Lynne Roberts

8 References. Collins, B. & Burch, J. (2008). Constipation, treatment and biofeedback therapy. British Journal of Nursing. 14 (1), Heaton, K. (1999). The Bristol stool form scale. In Understanding your bowels, family doctor series. London: British Medical Association. Kyle, G. (2009). Common bowel problems: constipation risk assessment. Nursing and Residential Care. 11 (2), Norton, C., (2006). Constipation in older patient s effect on quality of life. British Journal of Nursing 15 (4), Peate, I.(2003).Nursing role in the management of constipation: use of laxatives. British Journal of Nursing 12(19), Royal College of Nursing. (2012). Management of lower bowel dysfunction, including DRE and DRF; RCN guidance for nurses. London: RCN. Waterfield, J. (2007). Laxatives: choice, mode of action and prescribing issues Nurse Prescribing 5(10), Lynne Roberts