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Creating a bowel management plan for pediatric orthopaedic spine surgery patients
Crystal Seilhamer1, Carlo Di Lorenzo2, Jessica Holstine2
1Nationwide Children's Hospital, 700 Children's Drive, T2E, Columbus, OH, 43205, USA. Crystal.seilhamer@nationwidechildrens.org.
Insights
Implementing a standardized bowel management plan significantly reduced opioid-induced constipation in pediatric spinal fusion patients. This initiative decreased emergency department visits and readmissions, improving patient care and safety.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Quality Improvement
Background:
- Opioid-induced constipation is a frequent complication in post-surgical patients.
- A lack of standardized gastrointestinal protocols exists for perioperative care in pediatric orthopaedic spine fusion patients on narcotics.
- Patients in this cohort often experience constipation and related gastrointestinal issues, leading to emergency department visits.
Purpose of the Study:
- To develop and implement a standardized bowel management plan for pediatric patients undergoing orthopaedic spine surgery.
- To decrease the incidence of constipation and associated gastrointestinal complaints.
- To minimize unplanned healthcare visits and improve overall patient care.
Main Methods:
- A collaborative approach with the gastroenterology team was used to create the bowel management plan.
- An electronic health record Smart Phrase was developed for consistent discharge instructions to enhance patient compliance.
- Informational communication was disseminated regarding constipation management updates. Compliance, emergency department visits, and re-admissions were monitored.
Main Results:
- Compliance with the bowel management plan, including inpatient and discharge instructions, reached a mean of 93%.
- Emergency Department visits or re-admissions for constipation decreased from a baseline of 1 in 11 cases to 1 in 184 cases.
- The institution maintained over two years without an emergency department visit or readmission related to constipation post-implementation.
Conclusions:
- A standardized bowel management plan enhances patient safety and reduces the healthcare burden for pediatric spinal fusion patients.
- The initiative improved awareness of post-surgical gastrointestinal symptoms and opioid side effects.
- The plan effectively decreased post-operative emergency department visits and re-admissions linked to constipation.
Purpose:
Opioid-induced constipation is a common problem in patients who have undergone surgery. No standard gastrointestinal protocol exists to manage perioperative care in pediatric orthopaedic spinal fusion patients despite data which support the need for a bowel regimen while a patient is taking narcotics. At our institution, this group of patients often present to the emergency department with constipation and other gastrointestinal complaints. We developed a quality improvement initiative to create a standardized bowel management plan for pediatric patients undergoing orthopaedic spine surgery to decrease constipation, thus improving care, and minimizing unplanned visits.
Methods:
We developed a bowel management plan in collaboration with the gastroenterology team, created an Epic Smart Phrase for discharge instructions to enhance compliance, and created and dispersed informational communication on changes to constipation management. We monitored compliance, emergency department visits, and re-admissions.
Results:
Compliance with the bowel management plan, including inpatient medication prescribing and discharge "at-home" education, has increased to a mean of 93%. Emergency Department (ED) visits or re-admissions for constipation were reduced from a baseline mean of 1 in every 11 cases, to 1 in every 184 cases. Our institution sustained more than 2 years without an ED visit or readmission related to constipation in this patient population after the bowel management plan was in place.
Conclusion:
A bowel management plan can be used in the care of pediatric spinal fusion patients to increase patient safety, decrease healthcare burden, and improve care. This project not only increased awareness of post-surgical gastrointestinal symptoms and opioid side effects, but also decreased post-operative emergency department visits and re-admissions related to constipation.
Level Of Evidence:
III, case control study.
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