Congress Abstracts 2006

70

A PROACTIVE APPROACH TO PREVENTING CONSTIPATION IN POSTOPERATIVE ONCOLOGY PULMONARY RESECTION PATIENTS. Kai Brown, RN, BSN, Annette Bisanz, RN, MPH, Garrett Walsh, MD, Ara Vaporciyan, MD, and Wayne Hofstetter, MD, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Optimal patient care and efficient use of health-care resources requires a detailed analysis of all aspects of a patient's hospital stay. Prolonged ileus and constipation can result in a significant increase in the hospital length of stay and increased operative morbidity in patients undergoing pulmonary resections for thoracic malignancies. Patients routinely receive perioperative opiates by an intravenous, epidural or oral routes which often is a major factor leading to diminished bowel function. Our current pathways utilize docusate only as the scheduled drug given to prevent constipation.

While we have recognized that reduced bowel function is a recurring problem. We reviewed the charts of 82 consecutive patients undergoing pulmonary resection. We found that 63% of patients needed additional medications more than docusate to treat constipation.

We have, therefore developed a structured bowel management care plan that uses stimulant cathartics to prophylactically treat and avoid constipation in this patient population. This new standard outlines day-to-day pharmacologic interventions, beginning postoperative day one until the day of discharge. We educated the staff about the new plan by using a Power Point and poster presentation, and an algorithm was developed to help staff implement the new care plan.

From January to March 2006, we will treat 100 patients using the new care plan and compare results to the previously studied cohort of 82 patients. Patient charts will be reviewed for the following information: (1) Did patients require any additional bowel stimulant medications, other than the scheduled stimulant cathartics? (2) Did the staff administer the medications as outlined in the algorithm? (3) Was the length of hospitalization affected by this change compared to our baseline population studied? The overall goal of the new care plan is to decrease the incidence of constipation from 63% to at least 30%.

This performance-improvement project demonstrates the role of a staff oncology nurse in making positive changes to enhance the quality of patient care.