Improving Bowel Assessment and Constipation Management in Hospitalised Elderly Patients: A Quality Improvement Project

Background

Constipation is a common yet under-recognised issue in older hospitalised adults, often driven by reduced mobility, inadequate hydration, poor dietary intake, and polypharmacy. It contributes to significant complications, including discomfort, delirium, and avoidable escalation to pharmacological interventions.

Despite national guidelines, bowel care remains inconsistently addressed in routine practice. This project aimed to evaluate current inpatient constipation management and promote guideline-aligned, holistic care for older people.

Methods

A hospital-based quality improvement project was conducted on a geriatric ward at Basildon University Hospital. Constipation was defined as fewer than three bowel movements per week, unless otherwise specified in documented bowel habits.

Retrospective data were collected for patients discharged between 1st May and 30th September 2024.

Inclusion criteria: all patients admitted or transferred to the geriatric ward during the audit period.

Exclusion criteria: patients transferred to other specialities or wards, or with incomplete documentation.

Four audit criteria were assessed:

1. Documentation of individual normal bowel habits
2. Daily bowel charting
3. Use of appropriate first-line laxatives
4. Performance of digital rectal examination (DRE) prior to phosphate enema if faecal impaction is suspected

Results

50 elderly inpatients were included:

• Normal bowel habits documented: 6%
• Bowel charting maintained: 53%
• Appropriate laxatives prescribed: 50%
• DRE prior to enema: 8.3%

Conclusion

Constipation management in geriatric inpatients remains suboptimal. Findings highlight the need for improved documentation, guideline adherence, and clinical assessment. Planned next steps include ward-specific guidance and staff education to embed safer, more effective, and dignified bowel care into routine geriatric practice.