Management and Prevention of Opioid Related Constipation -Guideline

Guideline for Management and Prevention of Opioid Related Constipation

1. PURPOSE

Guidance on the management and prevention of opioid related constipation in medical patients. This guideline has been developed in association with MDHB Opioid Collaborative with the objective of reducing opioid related harm to patients. This guideline may also be used in other circumstances even with patients that are not on opioid medications.

2. SCOPE

Applies to relevant medical & nursing practitioners and nursing staff managing medical patients with opioid related constipation or other causes of constipation where appropriate.

3. ROLES & RESPONSIBILITIES

Every attempt should be made to prevent and anticipate potential constipation related to use of opioid medications. For instance, co-prescribing as needed (PRN) or regular laxatives or aperients may be appropriate whenever prescribing opioids. Furthermore, non-pharmacological methods to prevent and manage constipation should also be considered where appropriate.

A medical or nurse practitioner should assess patients before considering prescribing treatments outlined in flowchart below. Nursing staff may also administer pre-approved standing order laxatives or aperients within their scope of practice. Pre-existing medical conditions, co-morbidities and drug interactions must also be considered in managing these patients.

There is an expectation for ongoing monitoring of effect of prescribed medications. There is also an expectation that accurate documentation of bowel habit with appropriate language is practised. For instance, terminology that includes BNO for X days and use of Bristol stool chart type.

4. GUIDELINE

• Appropriate equipment (gloves/aprons etc) should be worn when in contact with faecal material or when administering rectal preparations of aperients

• In event of uncertainty, consultation should be had with MDHB Infection Control services

5. DEFINITION

CCBCalcium channel blocker

TCATricyclic antidepressant

BDTwice a day (Latin: bis die)

TDSThree times a day (Latin: ter die sumendum)

PRNAs and when necessary (Latin: pro re nata)

PRRectal examination

STATGive at once or immediately (Latin: statim)

6. RELATED MDHB DOCUMENTS

MDHB-4184Pain, Acute: Pharmacological Management in Adults

7. FURTHER INFORMATION / ASSISTANCE

Clinical Pharmacist

Opioid Collaborative Group

8. APPENDICES

Appendix 1Monitoring and laxative information

9. KEYWORDS

Constipation, opioid

APPENDIX 1

Monitoring

All nursing staff should monitor, record and review patient’s bowel status during every shift and notify the medical practitioner overseeing the patient’s care if loose stools are observed or if a new step in the flow-diagram needs to be initiated.

If a patient declines any treatments indicated in the guideline, nursing staff should notify practitioners overseeing the patient’s care. Medical practitioners should review the patient and consider appropriate alternative treatment options. It is expected that nursing staff and medical practitioner addresses patient concerns and provides information about the treatment as stipulated by the Code of Rights.

All practitioners should monitor and review patient’s bowel status daily, and stop laxatives when appropriate.

Oral Laxatives

Bulk-forming laxatives such as psyllium husk or sterculia are not recommended for patients with opioid-induced constipation due to an increased risk of bowel obstruction, especially in patients that are immobile or have poor fluid intake. However these agents are considered first-line for general constipation alongside non-pharmacological measures. It may take 72 hours before laxative effect is seen.

Rectal Laxatives

Bowel-cleansing Preparations

Document No: MDHB-7120Page 1 of 6Version: 1

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Printed 7/04/2016 7:51:00 a.m.