Nutrition Support Blog: The Details Matter
January 26, 2012
There are so many major issues that need to be addressed in the care of ICU patients that sometimes the smaller details get set aside. Unfortunately, overlooking the small things can lead to them becoming a big deal. One of these issues is the bowel management of ICU patients. I certainly never imagined that I would be so concerned about the bowel habits of my patients when I first decided to become a dietitian. However, once I became involved in nutrition support I found that this small detail in patient care can impact our ability to nourish patients, and certainly affect their quality of life, and ultimately even affect their overall care. Research has documented that bowel protocols are not routine at all hospitals, even for post surgical patients or patients on pain medications. A large observational study even documented that constipation was associated with more complicated outcomes.1,2 As many as 2/3 of ICU patients are affected by constipation during their stay!3
Unfortunately, at times constipation is not addressed until several days have passed without a bowel movement. If this “miniscule” detail goes unnoticed, the result may be days of missed nutrition due to distention, nausea or abdominal pain. If bowel regimens are ordered on an “as needed” (prn) basis rather than as a scheduled medication, too often they are not administered until constipation presents itself. If bowel regimens are scheduled and diarrhea develops, the nurses will be well aware of the bowel habits and generally know not to give the ordered medication or request the medication be switched to prn at that point. Dietitians can play a valuable role by working with the nurses and physicians to stay on top of the bowel management issue. I occasionally get teased for paying so close attention to this less than glamorous detail of patient care, but that consequence I will accept gladly for the benefit of my patients.
1. McPeake J, Gilmour H, MacIntosh G. The implementation of a bowel management protocol in an adult intensive care unit. Nurs Crit Care. 2011;16(5):235-42.
2. Gacouin A, Camus C, Gros A, Isslame S, Marque S, Lavoué S, Chimot L, Donnio PY, Le Tulzo Y. Constipation in long-term ventilated patients: associated factors and impact on intensive care unit outcomes. Crit Care Med. 2010;38(10):1933-8.
3. Nassar AP Jr, da Silva FM, de Cleva R. Constipation in intensive care unit: incidence and risk factors. J Crit Care. 2009;24(4):630.e9-12.