I. Purpose
 

To establish a standardized approach for assessing, developing, implementing, and monitoring bowel movement regimens for residents, ensuring the promotion of comfort, dignity, and bowel health while preventing constipation, impaction, and related complications.
 

II. Policy

It is the policy of Monroe Community Hospital to ensure that each resident’s bowel function is assessed and managed through an individualized, interdisciplinary plan of care.

• Residents will have bowel patterns monitored routinely.

• A bowel regimen will be developed when clinically indicated, with input from nursing, medical, and dietary staff, and therapy disciplines as appropriate.

• Interventions will be designed to maintain or restore normal bowel function and prevent avoidable constipation, fecal impaction, or incontinence.

• Documentation and communication regarding bowel function will occur routinely and be reviewed as part of clinical rounds and interdisciplinary care planning.
   

III. Procedure

A. Assessment

1. Upon admission and quarterly, and with any significant change, the nurse will document bowel status in the electronic medical record (EMR), which includes, but is not limited to bowel sounds, nausea, decreased PO intake and abdominal pain.
    

B. Development of Bowel Plan of Care

1. The interdisciplinary care team (IDT) will develop an individualized bowel plan of care for residents when appropriate.

2. A bowel regimen care plan may include:

   • Dietary interventions: High-fiber foods, adequate fluid intake

   • Activity interventions: Encouragement of ambulation or range of motion

   • Medication interventions: Stool softeners, laxatives, or suppositories as ordered

   • Toileting schedule: Consistent timing, positioning, and privacy
      

C. Monitoring and Documentation

1. Nursing staff will document bowel movement occurrences, continence, size, consistency in the touchscreen.

2. Nursing staff will receive notification for residents who have not had documented bowel movements in the last 72 hours via unit reports that print daily.

3. If no bowel movement is documented in three consecutive days:

   • Nursing will receive an alert via the Electronic Medical Record.

   • Provider orders for interventions (e.g., laxatives, suppositories, enemas) will be implemented per standing or individualized protocol, using the least invasive measure necessary.

 

D. Communication

1. Nursing will include bowel reports in unit communication binders.

2. The interdisciplinary team will review bowel regimen effectiveness during shift-to-shift report.

3. Any significant changes (impaction, ileus, dark/bloody stools, etc.) will be promptly reported verbally to the provider and documented in the EMR.
    

E. Evaluation and Revision

1. Effectiveness of the bowel regimen will be evaluated by nursing and by the provider as clinically indicated.

2. Regimens will be modified as needed based on resident response, clinical condition, or medication changes.
    

IV. References

• CMS F-Tag 690: Bowel/Bladder Incontinence, Catheter, and Toileting Care

• CMS F-Tag 684: Quality of Care

• New York State Department of Health Long Term Care Regulations, Title 10 NYCRR Part 415

• Evidence-Based Clinical Practice Guidelines for Constipation (AMDA, 2021)