Improving bowel motion documentation and constipation care on an Ageing and Complex Medicine (ACM) ward

Introduction: Constipation is common amongst hospitalised older adults and is associated with increased length of stay, delirium and falls, yet bowel hygiene is often under-recognised and poorly documented. On the Ageing and Complex Medicine (ACM) ward at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, multiple safety concerns were identified, including difficulty locating the bowel chart in the electronic record, inconsistent documentation and patients going more than five days without a bowel opening without appropriate escalation.

Methods: A baseline review demonstrated only 51.2% accuracy in bowel motion recording, alongside staff-reported dissatisfaction with the existing chart design and limited guidance on managing constipation in frail older patients. This quality improvement project aimed to increase accurate bowel motion recording from 51.2% to 80% by June 2026 through a multifaceted intervention focused on staff education, system redesign and culture change.

Results: Interventions included compulsory teaching sessions, a ward-based awareness campaign and a redesigned bowel chart with improved visual hierarchy using colour-coded fields, implemented in response to stakeholder feedback. Post-intervention re-audit demonstrated a 20.1% relative improvement in accuracy, representing important early gains towards the target, despite the fact that the updated bowel chart within the Trust’s electronic patient record is not yet live. Cost–benefit analysis estimated constipation-related excess hospital stay at approximately £300–£350 per bed day, with potential reductions in length of stay of 1–3 days per affected patient.

Conclusion: This multidisciplinary approach shows how targeted system optimisation and improved clinical awareness can significantly enhance documentation quality and patient outcomes in a frail older population. It is anticipated that system redesign with colour coding of electronic bowel charts will allow further improvements to be achieved.