Impact of a Standardised Nurse-Driven Bowel Regimen on Bowel Frequency in Critically Ill Patients

Critically ill patients are at an increased risk of constipation due to inadequate nutrition, prolonged immobility and opioid use. Constipation may increase intensive care unit (ICU) and hospital length of stay (LOS) and intra-abdominal infections.

To determine the impact of a nurse-driven bowel protocol on constipation in ICU patients.

This is a retrospective before-after cohort study of ICU patients between July 2019 and February 2020 and July 2023 and February 2024. Patients were divided into a bowel protocol and a no bowel protocol group. The primary outcome was constipation for > 72 h at any point during ICU admission. Key secondary outcomes included constipation for > 6 days during ICU admission, ICU and hospital LOS and incidence of diarrhoea.

A total of 116 patients were included, with 58 patients in each group. Patients in the bowel protocol group had a higher Simplified Acute Physiology Score II (SAPS II) score (52 vs. 48, p = 0.05) and lower rates of acute hypoxic respiratory failure (60% vs. 79%, p = 0.03). The primary outcome of constipation for > 72 h during ICU stay did not differ significantly between groups (79% vs. 78%, p = 0.82). Patients in the bowel protocol group had lower rates of constipation for > 6 days, (18% vs. 44%, p = 0.043), which remained significant after adjusting for covariates including morphine milligram equivalents (MMEs), SAPS II score and age (OR 0.30, p = 0.047, 95% CI [0.09-0.98]). No differences were seen in other secondary outcomes.

Patients receiving the bowel protocol experienced no difference in constipation but were less likely to have prolonged constipation (> 6 days) in the ICU.

Nurse-driven bowel protocols may decrease constipation in ICU patients.