Table 2 Case note comparison to guidelines

1.1 A thorough history and physical examination are recommended as essential components of the assessment process.

Was a comprehensive assessment carried out?

109 (73)

Constipation assessment scales are not recommended for routine use.

Was an assessment tool used?

144 (96)

1.3 A digital rectal examination (DRE) is required to exclude faecal impaction if it has been more than 3 days since the last bowel movement or if the patient complains of incomplete evacuation

^aDRE performed when it’s been 3 or more days since last evacuation

25 (17)

^aDRE performed when the patient complains of incomplete evacuation

2 (1)

1.5 A plain film of the abdomen (PFA) is not recommended for routine evaluation but may be useful in combination with history and examination in certain patients

Was a PFA performed?

5 (3)

2.1 Education on the importance of non-drug measures is essential to enable patients and caregivers to take an active role in constipation prevention.

^aWas education on non-drug measures recorded?

30 (20)

3.1 Attention should be paid to the provision of optimised toileting while ensuring adequate privacy and dignity.

^aWas there evidence of consideration of optimised toileting?

28 (19)

^aWas there evidence of consideration of privacy?

52 (35)

3.2 Consideration should be given to lifestyle modification (adjustment of diet and activity levels within a patient’s limitations).

^aWas there evidence of consideration of diet and fluids?

55 (37)

^aWas there evidence of consideration of mobility?

46 (31)

Where there is no evidence to differentiate between medications in terms of efficacy, tolerability and side effect profile, and where clinical expertise allows, the medication with lowest cost base should be used.

Primary Laxative (PL): Bisacodyl

5 (3)

PL: Senna

27 (18)

PL: Lactulose

3 (2)

PL: Glycerol

3 (2)

PL: Docusate

39 (26)

PL: Sodium Picosulphate

14 (9)

PL: Macrogols

33 (22.0)

PL: Other

8 (5.3)

PL: None administered

14 (9.3)

4.3 The combination of a softening & stimulating laxative is often required. Optimisation of a single laxative is recommended prior to the addition of a second agent.

Was a combination of a softening and a stimulating laxative used?

68 (45)

^aWas optimisation of a single laxative achieved prior to the addition of a second agent?

48 (32)

4.4 The laxative dose should be titrated daily or alternate days according to response.

^aWas the laxative dose titrated: Daily

20 (13)

^aWas the laxative dose titrated: On alternate days

11 (7)

5.1 The development of OIC should be anticipated. A bowel regimen should be initiated at the commencement of opioid therapy

Was a bowel regimen initiated at the commencement of opioid therapy?

79 (53)

5.2 In the management of OIC optimised monotherapy with a stimulant laxative is essential followed by the addition of a softener if required.

Was optimisation of a stimulant laxative achieved prior to the addition of a softening laxative?

17 (14.2)

6.1 A stool softener should be considered in partial intestinal obstruction (IO).

Stimulant laxatives should be avoided.

In patients with partial IO: was the use of a stool softener considered?

8 (50)

In patients with partial IO: were stimulant laxatives avoided?

1 (8)

6.2 In complete IO, the use of all laxatives should be avoided as even softening laxatives have some peristaltic action.

In patients with complete IO: were all laxatives avoided?

1 (14)