Save Money at Your Facility by Improving Your Bowel Care Program

Constipation is a psychologically and socially debilitating condition. In the long-term care setting, in particular amongst patients 65 and over, the prevalence of constipation is very common, and can be a primary cause for a patient’s need for admission or continued long-term care.

The loss of independence felt by those suffering from bowel disorders, along with the perceived negative stigma surrounding it, leads to social isolation and a decrease in quality of life for long-term care residents.

It’s essential for facilities to have a regimented bowel care program, along with safe and effective therapies, to improve the physical and mental health of residents, as well as reduce illness, injury, and cost of care.

Complications and Cost of Constipation with Long-Term Care

When it comes to patient care, constipation is associated with a myriad of physical and medical ailments, including urinary tract infections, hemorrhoids, diarrhea, anal fissures, rectal prolapse, falls, and skin breakdown.

Studies have shown the urgency to void frequently increases the risk of falls for long-term care residents and bone fracture in elderly patients.

Constipation and the resulting health complications carry a cost in terms of staff time to diagnose, treat, and manage.

The financial costs of incontinence to institutions is high, around $9,500 per patient annually, including staffing costs (nursing and care staff spend nearly an hour per day, per patient, managing fecal incontinence and related issues), laundry, and supply costs.

Making positive changes to improve staff time and resources for constipation related care improves staff morale, and effective use of nursing staff time is related to better care quality in long-term care.

Nursing assistants comprise 45% -70% of long-term care employees in America and provide up to 90% of personal care in nursing homes. Improving care efficiency for constipation care can help with reducing staff stress and burnout.

Care and Cost Reductions with an Effective Bowel Care Program

In a 2002 study, the per patient annual cost of constipation was approximately $2,253. While costs would be significantly higher today, this gives you a sense of the overall costs of constipation on healthcare facilities.

Studies have shown that patients who had complete rectal emptying with oral and rectal laxatives had 35% fewer episodes of fecal incontinence, and 42% fewer incidents of soiled laundry than those who did not take laxatives.

It’s important to be aware, however, of potential side effects surrounding more commonly used products.

Potential Problems with Stimulant Laxatives

Some of the most commonly used stimulant laxatives contain bisacodyl. While stimulant laxatives can be effective, they can come with harmful side effects including diarrhea, dehydration, malabsorption, and loss of electrolytes (especially potassium).

Stimulant laxatives are also more likely than other types of laxatives to cause intestinal cramping. Bisacodyl provides a reproducible model of acute injury to the rectal mucosa within 30 minutes of exposure, and these changes may be misinterpreted as mild, acute colitis.

Here are some additional startling facts about bisacodyl usage:

• Bisacodyl provides a reproducible model of acute injury to human rectal mucosa within 30 minutes of exposure.
• For up to 30 hours after administration of bisacodyl, there was still histological evidence of mild inflammation, specifically in neutrophils.
• Stimulant laxatives such as bisacodyl are not recommended for use as a regular part of a bowel program.
• Studies provided no evidence to indicate the usefulness of bisacodyl in bowel retraining and that the full range of possible toxic effects from long continued use was not fully known.

Enemeez © Products Can Improve Patient Progress and Reduce
Costs to Facilities

Forty-two percent of bisacodyl users experienced at least one episode of incontinence when using a suppository, whereas that number drops significantly, to only 3%, when using Enemeez® mini-enemas.

The traditional bowel management program of oral stimulants, suppositories, and digital stimulation is time consuming and labor intensive. Patients and caregivers can find this program highly unpleasant and become resistant to learning the program. This leads to more frequent bowel accidents and interferes with patients' full participation in therapy.

The Enemeez® mini-enema as an essential part of a patient’s bowel care program has gained wide acceptance with long-term care facilities. With Enemeez®, it has shown that bowel evacuation is much more efficient, with most bowel programs being completed in 15-30 minutes compared to 1-2 hours with the traditional bisacodyl suppository program.

Bowel evacuations were more complete with fewer incidence of fecal incontinence between bowel programs. Patients experienced less fatigue and were more able to participate in therapy. Less time was spent sitting on the toilet, which decreased the patients' risk for development of pressure ulcers. The mini-enema program was less labor intensive resulting in fewer nursing hours devoted to the bowel program and reduced cost for attendant care upon discharge.

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Disclaimer: The material contained is for reference purposes only. Quest Healthcare, a Division of Quest Products LLC does not assume responsibility for patient care. Consult a physician prior to use. Copyright 2021 Quest Products, LLC.

 

Sources:

1. Stewart RB, Moore MT, Marks RG, Hale WE. Correlates of constipation in an ambulatory elderly population. Am J Gastroenterol 1992;87:859–864.2.
2. Talley NJ, Fleming KC, Evans JM, O’Keefe EA, et al. Constipation in an elderly community: A study of prevalence and potential risk factors. Am J Gastroenterol 1996;91:19–25.
3. Alessi CA, Henderson CT. Constipation and fecal impaction in the long-term care patient. Clin Geriatr Med 1988;4:571–588.
4. Time and Economic Cost of Constipation Care in Nursing Homes, Lori Frank, PhD, Jordana Schmier, MA, Leah Kleinman, DrPH, Reshmi Siddique, PhD, MSc, Cornelia Beck, RN, PhD, John Schnelle, PhD, and Margaret Rothman, PhD. July/August 2002.
5. Enemeez® vs. Bisacodyl Study for Formulary Addition of Enemeez®. California SCI Model System. 10.22.10 ENZ035 02.27.19