Authors (including presenting author) :
Tang LN(1), Lam NT(1),Chan SW(1),Ng YB(1)
Affiliation :
(1)Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
• Monitoring patients’ bowel habits is very important in geriatric wards. Constipation in elderly patients may result in urinary retention, delirium and bowel obstruction. However, the existing documentation is lack of appropriate and consistent descriptors, especially the stool consistency and amount are relatively subjective which may affect doctor and nurses’ clinical decision. In order to enhance communication among nurses, doctors and patient care assistants (PCAs), in a more effective and objective way, an evidence-based assessment tool - Bristol Stool Scale (BSS) was used as a new communication tool in a geriatric ward (11B) in United Christian Hospital.
Objectives :
• Enhance communication on bowel monitoring among all health care workers
• Promote clinical excellence in Intake & Output (I&O) documentation
Methodology :
• Redesign a new I&O Chart
A new I&O chart was designed by combining BSS. The content and detail were revised after obtaining alignment and consensus among all users.
• Training for PCAs & Nurses
Tutorial workshops focusing on the introduction of BSS, new charting method, as well as the reinforcement of the importance of proper documentation and reporting were held in phase.
• Practice Change of Using new I&O Documentation Chart
After all staff were trained, a 1-month pilot project of using the new designed BSS for BO monitoring was launched since 1st July, 2021. On-going supervision and audit to the compliance of correctly use of the chart was provided. In addition, the after-use comment and data among all parties was collected with analysis. New I&O documentation chart was officially adopted in 11B after pilot.
Result & Outcome :
• For the workshop, 100% PCAs and Nurse showed understanding on classification of stool forms and the correct use of BSS.
• The compliance of correct documentation and reporting of using new version of I&O chart was 100%.
• 100% doctor, 95% Nurse, and 100% PCA agreed that the new chart could enhance the communication among all health care staffs on bowel monitoring so as to facilitate doctor and nurses’ clinical decision on constipation management.
