Prevention

1
Prevention Management of Constipation in Older
People

• Jennifer Grieve
• HP at Clarence Estate Residential Health and
  Aged Care Facility

2
Introduction

• Hall Prior Health and Aged Care Organisation
• Residential programs
• 16 health and aged care facilities
• Central hospitality service
• Clarence Estate Residential Health Aged Care
  Facility
• Rural Community, Albany W.A.
• 86 Residents
• 5 Houses
• Choice of Services in line with Commonwealth Aged
  Care Program

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Introduction

• Clinical Aged Care Fellowship Program
• Prevention Management of constipation in older
  people
• Aims of the project
• To improve the local practice in the prevention
  and management of constipation at CE
• To ensure that practice is compliant with the
  best available evidence
• To use JBI PACES Program to implement a process
  of audit and feedback as a strategy to improve
  practice

4
Method

• Determination of clinical issue
• Determination of auditable criteria in line with
  JBI BPIS Prevention Management of
  Constipation in Older People (based on
  Systematic Review)
• 8 prevention criteria
• 3 management criteria
• 2 criteria omitted

5
Method

• Pre Implementation Audit Analysis Results
• Team selected
• 3 Areas within the facility
• 43 Residents (50) randomly selected
• Issues raised related to staff education,
  documentation of dietary fibre and monitoring of
  fluids

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Method GRIP Phase

• Action planning and action taking
• Revision of educational resources
• Twenty minute at work tutorials for staff
• Revision and introduction of amended bowel
  management tool and constipation prevention and
  management care plan.

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Method GRIP Phase

• Action planning and action taking
• Liaison with catering staff to determine dietary
  fibre content in current meal plan and
  availability of alternative fluids.
• Revision of documentation of individualised
  resident aperient requirements

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Results Audit 1 2



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Results Audit 1 2


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Results Audit 1 2



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Results Audit 1 2
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Results Site Summary
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Issues arising

• PACES.
• Criteria open to interpretation
• Variable perception of importance related to
  bowel management and associated health issues.

14
Issues arising

• Staff knowledge and skills.
• Documentation related to fibre
• Documentation of aperients
• Monitoring of fluids

15
Conclusion

• Overall results extremely positive
• Streamlined process with clear framework.
• Health benefits for Residents supports safe and
  best practice
• Benefits for staff shared governance, leadership
  clinical champion opportunities, quality of
  workplace relations.

16
Conclusion

• Benefits of linking with existing CQSI Program
  Continence Management BP Project
• Focus on measuring percentage of compliance
  versus number of episodes culture of openness to
  clinical review
• Benefits of support from senior management
• Inspiring further evidence based best practice
  projects giving clinicians somewhere to go.

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Conclusion Cont.

• Constipated!
• To be or not to be?
• This is the question.