Improving Documentation of Bowel Health in Elderly Inpatients: A Quality Improvement Project

Background:

Constipation is common in older inpatients due to immobility, illness, dietary changes and dehydration. Poor bowel health can result in pain, faecal impaction, urinary retention and even bowel obstruction. Daily stool chart documentation supports early detection and management, but compliance is often poor.

Aim:

To improve daily stool chart documentation in a geriatric ward by 10%.

Methods:

Weekly retrospective reviews of stool charts were undertaken. Compliance was calculated as stool chart entries ÷ total admission days. Interventions were introduced using PDSA methodology:

• Day 0: baseline
• Day 7: verbal reminders during handovers
• Day 14: electronic reminders to ward staff
• Day 28: visual reminders via posters on wards

Results:

Compliance improved by 6.8% compared with baseline. Electronic and visual reminders had the greatest impact. Hockley ward showed the highest overall compliance, while Stambridge had the greatest relative improvement.

Strengths & Limitations:

The project was simple, quick and repeatable, allowing earlier recognition of constipation and opportunities for education. Limitations included a small sample (3 wards, 88 patients), variable staff exposure to interventions, and lack of patient-level outcome data.

Next steps:

Plans include further cycles following teaching sessions and incorporating stool charts into Nervecentre to improve sustainability.

Conclusion:

Targeted reminders improved stool chart documentation in elderly inpatients. Integration into electronic systems may enhance sustainability and reduce constipation-related complications.