Bowel Routine/Protocol

Our facility uses a lot of Prune Juice if someone is constipated. We usually will start with that. It is not really part of our protocol but many of the nurses will give that first. I did have one little lady who insisted that she have a little serving of butter put in hers as she said that is what worked at home for her. But she was the only one who ever told me that. I can't imagine drinking that but she always requested it.

We have used psyllium husk but what can happen is that the stool becomes too soft and ,in frail elderly,they just can't expel it because there is no bulk.Problems can also arise if your frail elderly do not drink enough fluids as this can lead to bowel obstruction.We tend to use senna laxative,prune juice,lactulose solution and if these do not work well,glycerine or bisocodol suppositories or microlax enemas.Encouraging the eating of fruit and plenty of fluids helps as well.

Most of our residents take Colace, Senna, Lactulose fairly regularly; of course, we know fluids and roughage are best, but for elderly folk who may have no appetite, may not get enough exercise, etc., what's simplest isn't always feasible...I tend to give prune juice to those I know are more susceptible to irregularities...but I cannot imagine putting butter in it--ew!!

We use a product by Hormel called Fiber Basic. It's used during the med passes and the residents really like it. Here is a link for more information: http://www.hormelhealthlabs.com/protocols_bowelmanagement.aspx

Lactulose, Miralax, Senna, Colace, Sorbitol, biscadol, dulcolax are used at my facility

ours used are prunes, lactulose, coloxyl & senna, agarol, sennokot, metamucil, pear juice, ducolax, and various enemas/supposotories etc that I can't remember as I don't personally give them.

We must be quite lucky, we have loads of folk on cocodamol etc but never have much of a problem with constipation. A few folk use movicol regulalry but we generally encourage to drink loads and take loads a fruit n veg!

When I worked in the hospital, a CNA claimed the sure cure of 1/2 glass prune juice, 1/2 glass of orange juice put together and warmed was the way to go. I've taken that idea to the NH and it does seem to work and or help. Just call it a "hot toddy", haha. Anything before using 'scripts is good. Metamucil type products usually aren't good for the elderly d/t not drinking enough fluids, that's my opinion anyway.

Great response Dayonite! Sometimes it is as simple as the morning cup of coffee and assisting the resident to the toilet. Do drugs or magic fiber mix needed...just keeping with the routines that they had at home.

In addition to any scheduled laxatives, our bowel protocol goes as follows:

Day 1 - 4 oz of prune juice

Day 2 - 2 Tbs of BAP (a puree of bran, apples and prunes)

Day 3 - 30 cc of MOM

Day 4 - dulcolax suppository

MOM and dulcolax suppository require orders obtained upon admission.