Improving the Assessment and Management of Constipation in Elderly Inpatients: A Quality Improvement Project in a...

Constipation is one of the most common gastrointestinal problems affecting patients with frailty. Several factors in frail patients contribute to this issue, such as decreased mobility, low oral intake, comorbidities, polypharmacy, and susceptibility to drug side effects due to exhausted physiologic reserves. Constipation causes significant morbidity, including abdominal pain, overflow diarrhoea, urinary retention, delirium, and reduced quality of life; if not managed appropriately, it can lead to increased mortality. Therefore, timely recognition and a standardised, structured, stepwise approach are critical to preventing these outcomes. From anecdotal clinical experience in the frailty ward, while emphasis is placed on managing complex medical conditions, a comprehensive, standardised, and structured approach to managing constipation is sometimes overlooked, particularly among junior colleagues. This quality improvement project (QIP) aimed to improve compliance with national guidelines for managing frail patients with constipation by resident doctors.

The QIP was conducted at Fairfield General Hospital in the frailty ward from March 2026 to August 2026, employing the Plan-Do-Study-Act (PDSA) methodology. The objective was to improve compliance with the national guidelines for the management of constipation in frail patients, focusing on key gaps identified in the baseline audit, namely the pertinent abdominal and per rectal (PR) exam, review of constipating medications, and first-line laxative prescribing.

A baseline audit revealed an abdominal exam documentation rate of 33% (n=5); a review of constipating medications was performed 26% (n=4) of the time, and appropriate first-line laxatives were prescribed in 46% (n=7) of cases. Following this, targeted interventions such as ward-based teaching sessions as per national guidelines, drop-in sessions, and a six-point, user-friendly, standardised checklist were implemented over a period of two months. A retrospective cross-sectional study reviewing 15 case notes revealed marked improvements across all audited parameters: abdominal exam documentation improved to 86%, medication review to 80%, and first-line laxative prescribing to 80%.

Compliance with national standards in managing constipation in frail patients among newly rotated residents can be improved through teaching sessions focused on national best practice guidelines. Furthermore, the use of a user-friendly, standardised, and accessible checklist in our QIP was associated with improved compliance with best practices and enhanced quality of care.