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 lead to dehydration, delirium, and the false positive labeling and unnecessary treatment of clostridium difficile carriers. This can result in increased morbidity and mortality, and a longer stay in hospital. This means that improving the assessment and 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 (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 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 of stay, which are hard to accurately measure.