Improving bowel care after surgery for hip fracture

Constipation is a common problem in older people with hip fracture because of immobility, opioid prescription and lack of privacy. There is a dearth of meaningful evidence about the way constipation is recognised and its subsequent treatment. The orthogeriatric team in a university hospital trust investigated the effectiveness of bowel care for older inpatients after hip fracture. Three audits followed a cohort of 40 people aged 60 and older after surgical fixation of hip fracture. After the initial audit in 2010, the expectation was that all hip fracture patients should be started on laxatives on the day of surgery and a chart used to document stool type. Nursing and medical staff needed to ensure that adequate pain control was maintained while opiate analgesia was given only when necessary. Patients with hip fracture are now significantly less constipated. There is improved patient satisfaction with analgesia provision. While laxative prescription is important, a motivated ward team encouraging its uptake is vital. All patients now have a comprehensive record of bowel movements. The improvements demonstrate the importance of a multidisciplinary approach when caring for these patients.