Implementation of a Nurse-Driven Pediatric Bowel Management Algorithm: A Quality Improvement Project

In September 2018, a staff survey on a 16-bed pediatric neuro-rehab care unit (RCU) revealed nurses felt their care was limited with few resources available to treat patients experiencing constipation. Based on guidelines published by the North American and European Societies for Pediatric Gastroenterology, Hepatology, and Nutrition, an evidence-based algorithm was implemented in the RCU.

The aims of this project were to reduce the need for invasive constipation treatment and to improve nurse satisfaction.

An evidence-based interventional quality improvement project, based on the Plan-Do-Study-Act (PDSA) method, was initiated by RCU's clinical nurse leader. To measure impact on patients, use of invasive treatment was tracked in the electronic medical record. To measure impact on staff, a staff satisfaction survey was completed pre- and post- project implementation.

There was a statistically significant reduction in average rates of invasive medication administration between pre-intervention (M = 2.23, SD = 0.77) and post-intervention (M = 0.79, SD = 0.52; t (7) = 3.38, p = 0.01). A Wilcoxon Signed Rank Test revealed a statistically significant improvement in post-intervention nurse satisfaction for having tools and resources (z = -5.196, p < 0.001).

The findings of this quality improvement project showed that nurse-driven protocols based on current evidence can improve the prevention and treatment of constipation by reducing the need for invasive constipation treatment and improve nurse satisfaction.