Academic detailing of nurses to mitigate constipation in a community living center

Abstract

Background

Constipation, difficulty in moving one's bowels, is prevalent in the geriatric population. Despite the substantial cost and potentially severe consequences, constipation is often overlooked as a trivial problem. Thus, the opportunity exists for quality improvement within health care systems.

Objective

To describe an interdisciplinary Lean Six Sigma quality improvement project utilizing academic detailing to enhance constipation management within a Community Living Center (CLC).

Practice description

Academic detailing, a form of educational outreach, was utilized to rectify a nursing knowledge deficit identified as the root cause of constipation episodes. An academic detailer utilized developed resources to deliver key messages about specific behavior changes. At the same time, robust conversation allowed the detailer to identify and address any motivations and perceived barriers. A standardized bowel protocol was also developed to improve the efficiency of constipation management.

Practice innovation

Academic detailing of nurses to elicit behavior change.

Evaluation methods

A single-group generalized least-squares interrupted time series analysis was performed to estimate the impact of the intervention on the level and slope changes before and after implementation on the number of constipation episodes. Comparisons of as-needed constipation medication administration before and after the intervention were performed using a one-way analysis of variance model.

Results

The incidence of constipation episodes decreased by 28.4 per 1000 Bed Days of Care [BDOC] (P < 0.001) between the periods. Compared to the slope before implementation, which was increasing at a monthly rate of 3.3 per 1000 BDOC (P = 0.008), the slope after implementation was decreasing at a monthly rate of 2.5 per 1000 BDOC (P < 0.011). As-needed constipation medication administration was more prevalent postimplementation (35.09 vs 62.24 per 1000 BDOC; P < 0.001).

Conclusion

Academic detailing decreased constipation episodes within the VA Butler Healthcare System's CLC.