Improving management of constipation in an inpatient setting using a care bundle

Area of Science:

• Geriatric Medicine
• Pharmacology
• Healthcare Management

Background:

• Constipation is a prevalent issue in geriatric inpatient settings, leading to serious complications like delirium and bowel obstruction.
• Inappropriate laxative use can cause iatrogenic diarrhea, dehydration, and misdiagnosis of Clostridium difficile, increasing patient morbidity and hospital stays.

Purpose of the Study:

• To implement and evaluate a multidisciplinary project to improve the early assessment and treatment of constipation in geriatric inpatients.
• The project aimed to optimize laxative prescribing, encourage non-pharmacological interventions, and reduce associated healthcare costs.

Main Methods:

• Educational sessions for staff on constipation management.
• Promotion of non-pharmacological interventions: hydration, exercise, and high-fiber diets.
• Implementation of laxative prescription guidance and twice-weekly ward rounds for medication review.

Main Results:

• A significant reduction in overall laxative prescriptions by one-third.
• Elimination of "as needed" (PRN) laxative prescriptions.
• Demonstrated cost savings in laxative expenditure, estimated at £1226.40 annually, excluding savings from reduced complications and length of stay.

Conclusions:

• A structured, multidisciplinary approach to constipation management can effectively optimize laxative use in geriatric inpatients.
• Early intervention and improved prescribing practices lead to reduced medication costs and potential improvements in patient outcomes.
• Further investigation into the impact on morbidity and length of hospital stay is warranted.