Ms. Walsh and her team established a protocol using algorithms based on patient needs. "We created a standard of care now used throughout the hospital," she said. Patients receive a constipation management fact card and fiber fact card. Staff members carry a pocket-sized laminated card providing the algorithm for the initiation and titration of specific laxatives. The card provides directives for what to do once a normal bowel pattern returns or if it does notwhich can include increases in medications or an assessment for obstruction or impaction. The care standard also includes phone follow-ups by the nursing staff.
The program was implemented in October 2000, and, according to Ms. Walsh, several hundred people have benefited from it to date.