Bowel regimen

[cmanurse2004]

We are currently in the process of revamping our bowel protocol. I was wondering if anyone out there would be willing to share what their hospice uses.

[ErinS, BSN, RN]

It depends on if someone is using narcotics. If someone is on narcotics we usually start with Senna-S, 1-4 tabs daily. If that does not work we will usually use lactulose. If someone is not on narcotics, we start with prune or sometimes just fruit juice, then use colace. If colace doesn't work we move onto the Senna-S and lactulose.

If someone is unable to have a BM, but their stool is soft, we will start a bowel care regimen using suppositories or enemeeze.

I hope this helps.

[dosamigos76, RN]

I agree, Senna-S is our staple. I am also a fan of Miralax or in a pinch with new onset constipation 30mL MOM in 6 oz warm prune juice. Works like a champ!

[melsch]

This is our protocol:

Has there been a BM within the last 48 hours? If yes give two sennosides 8.5mg at hs. If NO, give two sennosides 8.5mg twice a day.

If BM within 24 hours continue and monitor if no advance to:

Increase sennosides 8.5 mg tid and add lactulose 15-30 ml BID for more rapid effect. If BM within 24 hours contiune or lower sennoside dose. If no BM advance to:

Nurse to assess for impaction - if no impaction give bisacodyl supp or fleet enema. If BM within 24 hours return to previous dosing, in order to aim for BMs q 3 days.

Of course nursing judgment re individual patients, PPS level, and intake, come into play as to how aggressive we are with using the bowel protocol.