Task Force Develops Education Tool for Opioid-Induced Constipation

Implementing a patient education tool for opioid-induced constipation successfully reduced patient-reported unmanaged constipation.
Implementing a patient education tool for opioid-induced constipation successfully reduced patient-reported unmanaged constipation.

ORLANDO, FL—Implementing a patient education tool for opioid-induced constipation (OIC) successfully reduced patient-reported unmanaged constipation, a study reported at the ONS 40th Annual Congress.

In addition, all of the patients studied reported receiving written education as well as adherence to their opioid medication plans, said Juliana Amankwah, RN, BSN, of H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.

Up to 95% of patients with cancer require opioids for pain control and invariably experience constipation, which increases the burden of illness and decreases quality of life, with the potential to lead to nonadherence to opioids.

An interdisciplinary task force comprised of clinic nurses, clinical nurse specialists, medical assistants, a clinic manager, and a palliative physician created an evidence-based, performance improvement project to identify incidence of OIC among patients in the institute's Supportive Care Medicine (SCM) clinic.

“A review of patient-reported outcomes indicated that 47% of patients had unmanaged constipation and 0% received written education on OIC management,” Amankwah said during the presentation. “About 60% had received information education.”

Based on these results, the task force reviewed the literature and created an evidence-based OIC patient education tool that the institute's patient advisory council reviewed and approved. The tool focused on how to avoid OIC, description and recommended use of over-the-counter medications, and when to call the doctor. A process to provide the tool to every patient in the clinic was established.

“Though we know that it can be managed with nonmedication interventions, we also knew that it was important to educate on medication interventions.”

Six months after the patient education tool was implemented, 21% of patients had unmanaged constipation and 97% had received education on how to manage OIC.

“We had to do more education for patients who were new to our clinic and to those who had increases in their opioid regimen,” Amankwah said.

“At 18 months, results indicate that improvements are sustained, with 13% patient-reported unmanaged constipation, 100% patient reported adherence to their opioid medication plan, and 100% received written education on OIC management,” Amankwah reported.

As measured by an independent performance improvement group, patient satisfaction regarding information provided about medication and instructions for use at home showed improvement from baseline.

Given the project's success, nursing leadership invited the task force to disseminate the evidence-based OIC patient education tool across the institution, leading to Supportive Care Medicine nurses partnering with other oncology nursing subspecialties to implement the tool for other patient populations.

This project exemplifies how an evidence-based, performance improvement approach can positively impact a patient's symptom experience, highlighting the nurses' role in oncology care,” Amankwah said.

The SCM team plans to repeat its approach with a new project designed to decrease illness burden and improve quality of life related to distress.

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