Constipation Risk Assessment Tool 3o6e4t

Norgineto Risk for Constipation Action take Assessment when risk of Tool constipation is identified ®

Medical Condition

Toileting Facilities

✔

The Norgine Risk Assessment Tool for Constipation was developed toBed raisepan awareness of a Cancer patient’s risk of becoming constipated and to encourage proactive assessment and, if necessary, Commode by bed in hospital/care Clinical depression treatment. Healthcare professionals should monitor the risk assessmenthome/home score and take reasonable Diabetes TYPE 1 steps to reduce the score over time e.g. by increasing fluids, increasing fibre in diet, improving Supervised use of lavatory/commode Haemorrhoids, anal fissure, rectocele, mobility, reducing polypharmacy etc. For patients with a Risk Assessment score greater than Raised toilet seat, without foot stool local anal or rectal pathology 4 ticks, it is recommended that the patient is fully assessed as outlined in the check list below. TYPE 2

✔

PATIENT’S THE BRISTOL STOOL NAME FORM SCALE Separate hard lumps, like nuts (hard to )

History of constipation CH E C K L I S T Impaired cognition/dementia

Restricted to bed ✔

Complete full bowel assessment as per facility protocol Multiple Sclerosis

Restricted to wheelchair/chair TYPE 3

✔

Walks with aids/assistance

Stool type 1 orarthritis 2 prescribe appropriate laxative therapy Rheumatoid

1/3 mile (0.5km) daily

Nutritional Intake 5 Spinal on cord conditions Advise toileting position and establish regular toileting pattern At nutritional risk as identified byTYPE local (injury, disease or congenital) nutritional screening tool Review Stroke medication including over the counter medicines Fibre intake 6g or less per day1. TYPE 6 ✔ Currentmobility Medication Advise on ways to improve Difficulty in swallowing/chewing Aluminium antacids Needs assistance to eat Encourage patients to achieve at least minimum fluid intake

Anticholinergics

Improve nutrition according to nutritional intake score

Antiparkinson drugs

Commence or increase laxatives

Constipated

Commence or increase laxatives

Like a sausage

Ideal stool consistency

Maintain laxative dose

Like a sausage or snake, smooth and soft

Ideal stool consistency

Maintain laxative dose

but lumpy

PATIENT’S but with cracks RECORD on its surface NUMBER

Parkinson’s disease Monitor and record bowel movements daily using the Bristol Stool Chart and bowel record chart Walks short distances but less than TYPE 4 Post operative

Constipated

PATIENT’S DATE OF BIRTH Sausage-shaped

Mobility

✔

Advice if taking laxatives

Soft blobs with Decrease clear-cut edges I N SSlightly T R Utoo C Tsoft I O N S laxative dose (ed easily) with 1. Fluffy Tickpieces all relevant categories in each table. Decrease ragged edges, a mushy stool

Too soft

laxative dose

2. There may be more than one tick in a table.

TYPE 7

Daily Fluid Intake (see below for calculation table)

✔

Watery, no solid pieces ENTIRELY 3. LIQUID ADD ALL THE

Stop taking laxatives TOGETHER.for a day or two

Too soft

TICKS

Reproduced by kind permission of Dr KW Heaton, Reader in Medicine at the University of Bristol.

not achieved © 2000 Norgine Pharmaceuticals Ltd.4. Fill in the number of ticks in the box below. drugs In Antipsychotic addition to advice from your continence advisor, doctor, clinical nurseMinimum specialist fluids or pharmacist, certain associated risk factors may be addressed by referring a patient to a dietitian, speech and Calcium channel blockers language therapist, occupational therapist, dentist, podiatrist or physiotherapist. Calcium supplements

DAY

Number of bowel Information Continence Requirementmovements Calculation Diuretics about your local Continence Advisory Service can be found at the Fluid today 30mls fluid per 1kg of body weight 2. Foundation web site: www.contfound.org.au Iron supplements Type of bowel Non-steroidal anti-inflammatory drugs (NSAIDs) Patients minimum fluid intake should be: (see above) movement

Opioids

Weight in kg =

1 5. Date 2 and sign 3

D AT E

4

T O TA L N O . OF TICKS

5

6

7

S I G N AT U R E

x 30ml =

The Norgine Risk Assessment Tool for Constipation was developed by Gayle Kyle, Senior Lecturer, Thames Valley University, ([email protected] including ones not on this list) ed by an educational grant from Norgine Pharmaceuticals Pty Limited. © 2007 Norgine Pharmaceuticals Ltd. N-0301. ® Norgine is a ed trademark. 1. Australian NHMRC recommends adults consume 30g of fibre daily. 2. Ritz P(2001) Factors affecting energy amd macronutrient requirements in elderly people. Public Health Nutrition Vol 2. No.2B pp561-68

Action Action to to take take when when risk risk of of constipation constipation isis identified identified

Action to take when risk of constipation is

The TheNorgine NorgineRisk RiskAssessment AssessmentTool ToolforforConstipation Constipationwas wasdeveloped developedtotoraise raiseawareness awarenessofofa a Advice Advice if if THE THEBRISTOL BRISTOLSTOOL STOOLFORM FORMSCALE SCALE taking taking laxatives laxatives patient’s patient’srisk riskofofbecoming becomingconstipated constipatedand andtotoencourage encourageproactive proactiveassessment assessmentand, and,if ifnecessary, necessary, treatment. treatment.Healthcare Healthcareprofessionals professionalsshould shouldmonitor monitorthe therisk riskassessment assessmentscore scoreand andtake takereasonable reasonable Separate Separatehard hard Commence Commenceoror TYPE TYPE1 1 lumps, lumps,like likenuts nuts Constipated Constipated steps stepstotoreduce reducethe thescore scoreover overtime timee.g. e.g.bybyincreasing increasingfluids, fluids,increasing increasingfibre fibreinindiet, diet,improving improving increase increase laxatives laxatives The Norgine Risk Assessment Tool for Constipation was developed to raise awareness of a (hard (hardtoto) ) mobility, mobility,reducing reducingpolypharmacy polypharmacyetc. etc.For Forpatients patientswith witha aRisk RiskAssessment Assessmentscore scoregreater greaterthan than patient’s risk of becoming constipated and to encourage proactive assessment and, if necessary, 4 4ticks, ticks,it itisisrecommended recommendedthat thatthe thepatient patientisisfully fullyassessed assessedasasoutlined outlinedininthe thecheck checklistlistbelow. below. Commence Commenceoror Sausage-shaped Sausage-shaped treatment.TYPE Healthcare score and take reasonable TYPE2 2 professionals should monitor the risk assessment Constipated Constipated increase increaselaxatives laxatives TYPE 1 but butlumpy lumpy steps to reduce the score over time e.g. by increasing fluids, increasing fibre in diet, improving CH C HEECCKKLLI SI STT ✔✔ mobility, reducing polypharmacy etc. For patients a Risk Assessment score greater than Like Likeawith asausage sausage Ideal Idealstool stool Maintain Maintain TYPE TYPE 33 but butwith with cracks cracksas outlined in the check list below. 4 ticks, it is recommended that the patient is fully assessed laxative laxativedose dose TYPE 2 Complete Completefull fullbowel bowelassessment assessmentasasper perfacility facilityprotocol protocol consistency consistency ononitsitssurface surface Monitor Monitorand andrecord recordbowel bowelmovements movementsdaily dailyusing usingthe theBristol BristolStool StoolChart Chart and andbowel bowelrecord recordchart chart Stool Stooltype type1 1oror2 2prescribe prescribeappropriate appropriatelaxative laxativetherapy therapy Advise Adviseonontoileting toiletingposition positionand andestablish establishregular regulartoileting toiletingpattern pattern Review Reviewmedication medicationincluding includingover overthe thecounter countermedicines medicines Advise Adviseononways waystotoimprove improvemobility mobility Encourage Encouragepatients patientstotoachieve achieveatatleast leastminimum minimumfluid fluidintake intake Improve Improvenutrition nutritionaccording accordingtotonutritional nutritionalintake intakescore score

CHECKLIST

Like Likea asausage sausage TYPE TYPE4 4 ororsnake, snake,smooth smooth and andsoft soft Complete full bowel assessment as per facility protocol

Ideal Idealstool stool consistency consistency

✔Maintain Maintain laxative laxativedose dose

TYPE 3

Soft Softblobs blobswith with Monitor TYPE and record bowel movements daily using theedges Bristol Stool Charttoosoft TYPE5 5 clear-cut clear-cutedges Slightly Slightlytoo soft and bowel record chart (ed (edeasily) easily)

Decrease Decrease laxative laxativedose dose

TYPE 4

Stool type 1 or 2 prescribe appropriate laxative therapy Fluffy Fluffypieces pieceswith with TYPE TYPE6 6 ragged raggededges, edges,a a Too Toosoft soft mushy mushytoileting stool stool pattern Advise on toileting position and establish regular

Decrease Decrease laxative laxativedose dose

TYPE 5

Watery, Watery,nonosolid solid Review medication medicines TYPE TYPE7 7 including over the counter pieces pieces ENTIRELY ENTIRELY LIQUID LIQUID Advise on ways to improve mobility

Too Toosoft soft

TH

Stop Stoptaking takinglaxatives laxatives forfora aday dayorortwo two TYPE 6

Reproduced Reproducedbybykind kindpermission permissionofofDrDrKW KWHeaton, Heaton,Reader ReaderininMedicine Medicineatatthe theUniversity UniversityofofBristol. Bristol.

©©2000 2000Norgine NorginePharmaceuticals PharmaceuticalsLtd. Ltd. InInaddition additiontotoadvice advicefrom fromyour yourcontinence continenceadvisor, advisor,doctor, doctor,clinical clinicalnurse nursespecialist specialistororpharmacist, pharmacist,Encourage patients to achieve at least minimum fluid intake certain certainassociated associatedrisk riskfactors factorsmay maybebeaddressed addressedbybyreferring referringa apatient patienttotoa adietitian, dietitian,speech speechand and DAY DAY to nutritional 1 1 intake2score 2 33 44 55 66 Improve nutrition according language languagetherapist, therapist,occupational occupationaltherapist, therapist,dentist, dentist,podiatrist podiatristororphysiotherapist. physiotherapist. Number Numberofofbowel bowel In addition to advice from your continence advisor, doctor, clinical nurse specialist or pharmacist, Information Informationabout aboutyour yourlocal localContinence ContinenceAdvisory AdvisoryService Servicecan canbebefound foundatatthe theContinence Continence movements movementstoday today certain associated risk factors may be addressed by referring a patient to a dietitian, speech and Foundation Foundationweb website: site:www.contfound.org.au www.contfound.org.au language Type therapist, occupational therapist, dentist, podiatrist or physiotherapist. Typeofofbowel bowel movement movement(see (seeabove) above) Information about your local Continence Advisory Service can be found at the Continence Foundation web site: www.contfound.org.au

TYPE 7

77

Reproduced by k © 2000 Norgine P

D

Number of bow movements to

The TheNorgine NorgineRisk RiskAssessment AssessmentTool ToolforforConstipation Constipationwas wasdeveloped developedbybyGayle GayleKyle, Kyle,Senior SeniorLecturer, Lecturer,Thames ThamesValley ValleyUniversity, University,([email protected]

ed edbybyananeducational educationalgrant grantfrom fromNorgine NorginePharmaceuticals PharmaceuticalsPty PtyLimited. Limited.©©2007 2007Norgine NorginePharmaceuticals Pharmaceuticals Ltd. Ltd.N-0301. N-0301. ®®Norgine NorgineisTool isa aed ed trademark. trademark. The Norgine Risk Assessment for Constipation was developed by Gayle Kyle, Senior Lecturer, Thames Valley University

PCT and Phil Prynn, Continence Services Manager, Berkshire West PCT to encourage health care professionals to adopt a copies of this risk assessment tool, please email [email protected]

ed by an educational grant from Norgine Pharmaceuticals Pty Limited. © 2007 Norgine Pharmaceuticals Ltd. N-0301. ® N