Introduction: Opioid analgesics are commonly used in the inpatient setting to alleviate moderate- to severe-pain. These medications can cause constipation by inhibiting gastric emptying and slowing peristalsis in the gastrointestinal tract and are not subject to tolerance with prolonged use. 40-60% of patients can develop opioid-induced constipation which may present immediately or develop gradually after usage. Due to this adverse effect, it has been suggested that a bowel regimen should be prescribed when initiating an opiate medication. One study revealed that only 14.5% of pediatric patients who were prescribed opioids were on a prophylactic bowel regimen. With this in mind, a quality improvement project was conducted to determine whether utilizing a bowel regimen checklist on Internal Medicine resident inpatient history and physicals improved prescribing frequency of bowel regimens in patients on opiate medications.
Methods: A prospective study was conducted at a tertiary care center in Pittsburgh, PA. After implementation of the checklist in the inpatient history and physical template, admissions to residency teaching teams during a 5 week period between February and March 2021 were collected.
Results: A total of 90 admission were analyzed. Of those individuals, 19 patients had an opioid analgesic as a home medication. In our population, it was discovered that 73.7% (14/19) of our patients on opiates as an outpatient had a bowel regimen. After implementing the inpatient bowel regimen checklist, a total of 83.3% (20/24) of our patients had a bowel regimen including those on opiates at home. Interestingly, 1 patient developed ileus despite being prescribed a bowel regimen.
Discussion: Continuous assessment of bowel function should be incorporated into clinical notes to prompt early management of opioid induced bowel dysfunction. In conclusion, utilizing this checklist can help remind providers of the need to prescribe bowel regimens in patients taking opiates to help decrease secondary constipation. Ultimately, increasing usage of bowel regimens in these patients can improve patient experiences and prevent discomfort caused by constipation.
