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Bowel Management Protocol: Impact on Care Transitions of Oncology Patients
Gayle Shanholtz1,2,3,4, Franz Henryk Vergara1,2,3,4, Katheryne Tifuh Amba1,2,3,4
1Gayle Shanholtz, DNP, RN, PMH-BC, NEA-BC, was a doctorate student for this project and was a nurse educator for neurology and oncology specializing in performance improvement, education, and outcome reviews to improve patient care. The school of nursing and southern hospital-site IRBs approved this project. Currently, she is the chief of acute care nursing services at the Martinsburg Veterans Affairs Medical Center in West Virginia.
Purpose Of Study:
The project aimed to determine the impact of a standardized bowel regimen protocol for patients receiving opioids on the rate of stool softener prescription, occurrence of bowel movements of oncology patients, and improving the length of stay (LOS).
Primary Practice Of Setting:
Oncology unit in a community hospital.
Methodology And Sample:
A posttest design was utilized, and a prospective medical record review of patients was completed after 8 weeks of the pilot study. The study sample (N = 164) included oncology patients admitted to a community hospital in the Southeast. The χ2 test was used to determine the impact of implementing a bowel panel order on the rate of stool softener prescriptions, the occurrence of bowel movements, and the LOS.
Results:
Only 43% (n = 40) of the patients from the comparison group were ordered laxatives, and more patients from the intervention group (68%; n = 49) received the bowel regimen protocol, whereas 26% (n = 19) of the patients used a laxative or stool softener using providers' preference and demonstrated statistical significance (p = .001). In the intervention group, 93% of the patients (n = 67) reported having bowel movements compared with the comparison group, whereas only 32% (n = 32) demonstrated statistical significance (p = .001). The average LOS in the intervention group is less than 9 days compared with the comparison group, which was at 9 days (p = .001).
Implications To Case Management Practice:
Case managers play a critical role in coordinating care, improving transitions of care, and reducing LOS. Case managers can have a significant impact by monitoring and reminding nurses to report the gastrointestinal movements of oncology patients and then escalate opioid-induced constipation with the providers immediately. Case managers can facilitate the implementation of bowel regimen protocols, which may reduce hospitalizations and enhance patient outcomes, by taking this action.
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