The implementation of a bowel management protocol in an adult intensive care unit


  • Joanne McPeake,

    Corresponding author
    1. JMcPeake, MSc (Healthcare), BN (Hons), RGN, Specialist Practitioner (Critical Care), Staff Nurse, Critical Care, Intensive Care Unit, Glasgow Royal Infirmary, and Honorary Lecturer, University of Glasgow, Glasgow, UK
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  • Harper Gilmour,

    1. H Gilmour, MSc, Cstat, Senior Lecturer in Medical Statistics Public Health and Health Policy, Centre of Population Health Sciences, University of Glasgow, Glasgow, UK
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  • Graham MacIntosh

    1. G MacIntosh, MPH, BSc, PG Cert in Academic Practice, FHEA, Cert in Forensic Medicine, RN, University Teacher, Nursing & HealthCare School, University of Glasgow, Glasgow, UK
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J McPeake, Glasgow Royal Infirmary, Intensive Care Unit, First Floor, Queen Elizabeth Building, 84-106 Castle Street, Glasgow, G4 0SF, UK


Aim: A study to explore the impact of implementing a bowel management protocol in a tertiary referral intensive care unit (ICU) in the West of Scotland.

Methods: A three phase study was implemented. Phase 1 – a baseline audit reviewing 26 patients' medical notes and a baseline focus group reviewing the multidisciplinary team's (MDT's) opinions with regard to bowel care management in the ICU. Phase 2 – the implementation of a protocol, updated bowel care chart and education sessions for members of the MDT. Phase 3 – an end of study audit reviewing 27 patients' notes after the implementation of phase 2. Additionally, a further focus group examined the MDT's experiences of the protocol in clinical practice.

Results and Findings: During the phase 1 data collection period, it was evident that there was a haphazard approach to bowel care in the ICU, resulting in poor bowel care documentation and a high incidence of constipation and diarrhoea days. After the interventions of phase 2, bowel care documentation days increased by 13% (p = 0·0003), constipation incidence decreased by 20·7% (p = 0·13) and diarrhoea days reduced by 15·2% (p = 0·18).

Conclusion: Although further evaluation is planned, the protocol implemented in this particular study appears to be a useful tool for the delivery of bowel care in the ICU.

Relevance to Clinical Practice: Ensuring appropriate and timely bowel care in the ICU has major implications for the critically ill patients.