No place in ED for cancer patients with constipation

Constipation is a common symptom in both cancer and palliative care patients. Constipation can be defined as a reduced frequency of bowel movements in comparison to a patient's normal bowel habit, which may lead to pain and discomfort.
 
This paper will present the results of a Clinical Practice Improvement Project that a colleague and I completed. The CPI methodology was followed and our mission statement was to eliminate ED presentations at Nepean Hospital of cancer patients with constipation in 6 months.

To identify if there was a problem worth fixing my colleague and I reviewed the notifications of admission for the previous 6 months and identified 36 patients that had been admitted to the cancer ward with constipation. We were also able to identify that 15 patients had been discharged home from the cancer ward with constipation. With this information we formed a team of guidance and project team members, made up of hospital and community based staff. The team met weekly, a literature search was done, and bowel charts from other facilities and area health services were obtained and reviewed. The team compiled a bowel management form with bowel management guidelines, and an alert card for patients and these were trialed on wards, in the clinic areas, and in the community. In the final month of the 6 months we had no presentations to ED of cancer patients with constipation. Sustaining this is an ongoing challenge, which involves ongoing education for staff, patients and care givers, ongoing use of both the bowel chart and guidelines and the use of alert cards for patients.