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123 Inpatient assessment and management of constipation – are we getting it right?

Introduction Constipation is a common condition that affects people in all age groups, with complications that can cause significant physical and psychological distress. Validated assessment tools and gold standards for management of constipation are not available due to the lack of robust clinical trials. We conducted an audit to compare local practice of constipation assessment and management to current best practise, aiming to identify areas for improvement and to raise awareness of the significant problem of constipation in inpatients. Our 8 standards were derived from accepted Palliative Care Guidelines and focused on history of constipation, daily bowel assessment and prescription of laxatives. Methods Data were collected retrospectively from 28 inpatients on general Oncology wards from medical and nursing notes, and medication and bedside charts, in Summer 2018. Results Unfortunately, only 1 of the 8 standards for good practise was met. Generally, management of constipation and prescription of laxatives was adequate, especially with concurrent use of opioid medication. However, documentation from medical and nursing staff of both assessment and initial and ongoing management was inconsistent and incomplete, and often assumed a level of knowledge of the patient’s condition on the part of the reader. The reasons behind these results are likely multi-factorial but may include a lack of confidence in assessing bowels and treating constipation and a lack of understanding of its importance. Recommendations Following the presentation of this audit we recommended the inclusion of dedicated constipation teaching in the Junior Doctor teaching timetable, with signposting to relevant guidelines, and a review into the use of bowel charts on the ward, to encourage daily use. We are also now in the process of updating the constipation section of our local Symptom Control Guidelines in line with current Palliative Care guidelines.