QI 1259 Improving Awareness Documentation and Care of Bowel Movements in Learning Disability and Autism (Inpatients, Respite and Community)

Abstract

Aim: To identify constipation at an early stage or any changes to bowel habits that could indicate a physical health condition. To empower patients and staff alike to have healthy and open conversations regarding their bowel movement and urine output health and when to act upon it. Historically, conversation and awareness of healthy bowel movements (BM) has been a taboo topic amongst both staff and patients in Learning Disabilities. Patients in particular can find the topic uncomfortable to talk about which can lead to gaps in healthcare; making it harder for staff and patients to understand their physical healthcare needs. Constipation is also a contributor to death with those of a learning disability (LeDeR reports), with a high use of laxatives for LD&A patients. Initially, a project was proposed to look at physical healthcare as a whole, however it was quickly understood that the topic was extremely broad and a few different projects were initiated, including this one.

Tools Used: Stakeholder Analysis - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-stakeholder-analysis.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf

Project Impact: • A Physical Health Group and Patient Forum has been started in LD&A to foster open conversations. • Patients have been taught to self-report with a user-friendly chart. • Vinyl stickers are now in all toilets to help patients identify good vs bad bowel movements. • Standardised chart to help staff monitor bowel movements in a standard way. • Staff and patients feel more empowered to talk about bowel movements.

Staff Feedback; “We have a patient on the ward who is very independent and doesn’t talk about bowel movements. We used the self-reporting chart and they thought it was great! They wrote down their BM and were happy to show us the chart. They said they don’t like to talk about it, which is why they’d never told us before.”