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Use of a Mixed Agent Prophylactic Laxative Regimen in the Medical Intensive Care Unit Leads to Reduced Length of
Christopher J Costa1, Rachael Hagen1, Raymond Foley2
1Department of Medicine, University of Connecticut Health Center, Farmington, USA.
Abstract:
Impaired GI tract function is a common and often underappreciated symptom in the Medical Intensive Care Unit (MICU). The most visible manifestation of this dysfunction is reduced bowel movements. The occurrence of impaired GI function is associated, both independently and in association with delayed enteral feeding, with increased length of stay, morbidity and mortality. We report on a process implementation project conducted at a single academic center designed to: (I) increase visibility of bowel movement charting and (II) transition from a reactive to a proactive laxative administration regimen for prophylaxis against MICU associated constipation. Scheduled laxatives, polyethylene glycol and sennoside-docusate, were added to the MICU admission orderset and bowel movement charting was moved to a more readily accessible flowsheet in the electronic medical record. Six months of pre-intervention and post-intervention admissions to the MICU were reviewed to determine patient demographics, admitting diagnosis, Sequential Organ Failure Assessment (SOFA) score, laxative utilization, and time to first bowel movement. Following implementation of these changes, prophylactic laxative utilization significantly increased (p < .001) driven largely by the agents included in the orderset. This was associated with a decrease in MICU length of stay by an average of 21 h (p = .006) and median time to first bowel movement by 4 h (p = .026), but no changes in incidence of impaired transit (as defined by greater than 72 h without a bowel movement). This data represents an exciting first step in the use of mixed agent prophylactic laxative regimens.
Insights
Implementing proactive laxative use and improved bowel movement charting in the Medical Intensive Care Unit (MICU) reduced patient length of stay and time to first bowel movement. This initiative aimed to prevent constipation and improve patient outcomes in critically ill patients.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Healthcare Process Improvement
Background:
- Impaired gastrointestinal (GI) tract function, particularly reduced bowel movements, is common in Medical Intensive Care Units (MICUs).
- This dysfunction is linked to increased length of stay, morbidity, and mortality, often exacerbated by delayed enteral feeding.
- Current management is often reactive, failing to proactively address constipation.
Purpose of the Study:
- To enhance the visibility of bowel movement charting within the electronic medical record.
- To transition from a reactive to a proactive regimen for administering laxatives to prevent MICU-associated constipation.
- To evaluate the impact of these process changes on laxative utilization, length of stay, and time to first bowel movement.
Main Methods:
- A process implementation project was conducted at a single academic center.
- Scheduled prophylactic laxatives (polyethylene glycol and sennoside-docusate) were integrated into the MICU admission orderset.
- Bowel movement charting was relocated to a more accessible flowsheet in the electronic medical record.
- Six months of pre- and post-intervention data were analyzed for patient demographics, diagnoses, SOFA scores, laxative use, and time to first bowel movement.
Main Results:
- Prophylactic laxative utilization significantly increased post-intervention (p < .001), largely due to the orderset integration.
- MICU length of stay decreased by an average of 21 hours (p = .006).
- Median time to first bowel movement decreased by 4 hours (p = .026).
- No significant change was observed in the incidence of impaired transit (defined as >72 hours without a bowel movement).
Conclusions:
- The implementation of a proactive, mixed-agent prophylactic laxative regimen and improved charting visibility is a promising first step in managing constipation in the MICU.
- These changes were associated with reduced length of stay and faster return of bowel function.
- Further investigation into optimizing prophylactic laxative strategies is warranted.
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