Improving Documentation of Bowel Movements Using the Bristol Stool Chart: A Quality Improvement Project in a District General Hospital in the United Kingdom

TL;DR

This project improved hospital documentation of bowel movements using the Bristol Stool Chart, leading to better patient care and fewer hospital delays.

Contribution

A quality improvement project demonstrating that simple interventions can significantly enhance bowel movement documentation in hospitals.

Findings

Daily bowel documentation increased from 27% to 73% after interventions.

Bristol Stool Chart use improved from 57% to 87%.

Stool consistency documentation rose from 50% to 87%.

Abstract

Background

Patient-centred care is a fundamental aspect of the NHS. As healthcare professionals, we tailor the care plan to each patient’s individual needs, ensuring a patient-centred approach.

An often overlooked aspect of this care plan is the documentation of bowel movements. This is a vital part of patient care, whether patients are elderly or young and independent in their activities of daily living (ADLs).

Failure to document bowel movements can lead to misdiagnosis and worsening of conditions such as constipation and diarrhoea. This may potentially prolong hospital admission.

The Bristol Stool Chart is a valuable guide for healthcare professionals in differentiating stool types. Correct and consistent documentation allows early intervention, whether that involves prescribing or stopping laxatives, sending a stool sample for culture and sensitivity, or placing the patient in a side room to prevent the spread of infection.

Aim

This Quality Improvement Project (QIP) aims to enhance patient care by improving the documentation of bowel movements using the Bristol Stool Chart in patients admitted to the hospital. The aim is to assess the quality and consistency of bowel movement documentation in 30 patients on the Endocrine and Diabetes ward; determine compliance with documentation standards; identify gaps in recordings; identify reasons why bowel movements are not recorded; and recommend improvements.

The primary aim of this QIP was to enhance patient care by enabling prompt and appropriate treatment, preventing deterioration, and avoiding unnecessary prolonged hospital admission due to unresolved bowel issues.

Methodology

This is a retrospective study that involved 30 patients admitted to the Endocrine and Diabetes ward in a District General Hospital. Patients were selected randomly, independent of age and sex, from the electronic patient records. The QIP was designed using a Plan-Do-Study-Act cycle and was conducted over a three-month period. Patients were selected using a set of inclusion and exclusion criteria. We included patients who had a hospital stay greater than 3 days and excluded patients who were on the end-of-life (EOL) pathway or had incomplete documentation due to transfer or early discharge. Data were collected before and after the interventions to allow us to measure the efficacy of the intervention. The interventions used were posters to remind nursing staff to document bowel movements on the electronic patient chart using the Bristol Stool Chart. Staff were advised to include bowel movement documentation as a standard step in the handover checklist between shifts and to include it in the daily nursing care bundles.

Results

After implementing the interventions, significant improvements were seen in bowel documentation. Daily bowel movement documentation increased from 27% to 73%, and Bristol Stool Chart use improved from 57% to 87%. Stool frequency documentation doubled from 30% to 60%. Clinical actions decreased slightly, from 45% to 39%. Correct chart format use improved from 47% to 87%, and stool consistency documentation rose from 50% to 87%, indicating enhanced care and monitoring.

Conclusion

Overall, simple interventions resulted in significant improvement in documentation. Consistent documentation enables early intervention and helps prevent patient deterioration, as well as delays in discharge.

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