Improving accuracy of bowel charts: a quality improvement project

Introduction: Bowel charts can help detect changes in bowel habit, especially in patients with complex medical needs or limited communication abilities. Early recognition of constipation may prevent delirium, whereas recognising diarrhoea can prevent breakdown/infection of sores. SSKIN bundles, containing insufficient data on stool type/size, are sometimes used alongside bowel charts, leading to discrepancies. We aimed to improve accuracy of bowel charts over a 3-month period. 

Method: 10 patients from the Department of Medicine for the Elderly ward were randomly selected weekly for 6 weeks. 

Exclusion criteria: 1. No clinical indication for a bowel chart 2. End-of-life care 3. Independently mobile and no incontinence 

The following data were gathered: 1. Was there a bowel chart? 2. Had it been updated within the last week? 3. Did the entries match the SSKIN bundle?

Posters were designed and placed above folder trolleys. A ward-based presentation was delivered to discuss the results of the first cycle. A further 6 weeks of data were collected for comparison. 

Results: 49 entries were included pre-intervention and 53 were included post-intervention. Following the intervention, the percentage of patients with bowel charts increased from 94% to 100%. Up-to-date bowel charts increased from 57% to 87%. Finally, patients with bowel charts matching the SSKIN bundle increased from 22% to 47%. 

Conclusion: Increasing awareness of bowel chart documentation increased compliance and alignment with the SSKIN bundle. However, this project showed the challenges of documenting data on overlapping charts. While a unified bundle may benefit accurate documentation, ongoing education is important to maintaining the accuracy of bowel charts. Regular discussions on bowel habits at board rounds or MDTs may help to identify this area as a medical priority, highlighting the valuable work performed by the team.