Bowel Management

Getting Started

This program is designed for long-term care facilities. The goal is to eliminate the need for laxatives while increasing the digestive mobility of your residents. In addition to the health benefits, the use of FIBERBASICS™ will decrease labor hours and costs that are associated with constipation and irregularity. This program is designed as a medication-pass system and is recommended as the primary management program.

Before starting any bowel management program, please consult your Director of Nurses, Dietitian, Medical Director, and local Physicians.

Special consideration must be given to the following:

  • Insulin Dependent Diabetics - FIBERBASICS™ may be substituted for the following: FIBERBASICS™ serving size 1.5 tbsp. (31g/1.1 oz.) equals 1.35 Fruit exchange – always consult your Dietitian.
  • Tube Feeders – Because of the thickness of FIBERBASICS™, we recommend that it be diluted with water. One part FIBERBASICS™ to four to six parts warm water. Stir to an even consistency. For pediatric tube feeders, a high-speed blender is recommended for mixing.
  • Fiber Restricted Diets – For residents with fiber restricted diets, Hormel Health Labs recommends you consult with a physician before starting this program.
PROGRAM ONE
PROCEDURE HELPFUL HINTS
1. Review all residents using any kind of bowel intervention (i.e. laxatives, stool softeners, enemas, etc.) Bowel Interventions Survey (HL-6216) found in the Tools Chapter will assist you in this project.
2. After selecting all the residents that will participate in the program, fill out a "Resident Assessment Form" for each resident. Resident Assessment Form (HL-6217).
3. Obtain Physician orders for each resident:
  • Hold all laxative and enema orders including stool softeners and bulk laxatives.
To obtain physician's orders, use the sample Physician Letter or phone call order.
  • 2 oz. (2 rounded tbsp.) of FIBERBASICS™ daily. Adjust as follows:
  • Increase by 1 oz. per day if no bowel movement within 72-hour intervals.
Once proper bowel movement intervals have been established for two weeks or more, dose can be reduced. Minimum of 1 tbsp. is recommended for maintenance.
  • Decrease by 1 oz. per day if two or more bowel movements per day.
  • Continue with current dosage if there is a bowel movement every one to three days.
  • Glycerin suppositories - 1 per rectum every 3 days if no bowel movement.
Equivalence: 1 rounded tbsp. = 1 weight oz.
  • Tap Water Enemas - (250-500 cc) every 5 days if no bowel movement.
4. Educate all Residents and Staff that will be involved with this program on the harmful effects of laxatives and the benefits of a natural program. This includes the resident as well as CNA, CN, RCM, DON, RD, and Med. Nurse. This informational and educational step is vital for the success of this program. One of the keys of any successful program is to have all the participants educated why a new program is needed. Two key points are the harmful effects of laxatives and what constitutes regularity.
5. Medication Nurse portions FIBERBASICS™ in med. cups for individual servings and distributes during medication pass. (FIBERBASICS™ can be used for crushed medications replacing applesauce. Med. cups and 1-2 ounce melon ball scoops with the squeeze release handles are recommended for serving. Ask your Food Service Director for availability.
6. To maximize this program, every 1-3 days have food service make available to the residents, ½ cup of yogurt. One of the keys to maintaining healthy bowel function is culturing your digestive system with the bacteria lactobacillus acidophilus, which is found in yogurt. When purchasing this item, be sure they contain lactobacillus acidophilus with live cultures.
7. At nurses' discretion, monitor and track all residents on this program. Progress Notes, Bowel Function (HL-6217) side 2, and Audit Forms (HL-6218)
8. After three weeks of successful results, per Director of Nurses and Medical Director's discretion, obtain standing orders for all new residents to start this program upon admission. Many long-term care facilities use this program as a standard procedure.

PURPOSE: To ease the process of getting Physician's orders.
INSTRUCTIONS: Copy onto your facility's letterhead and send to participating Physicians.

Introduction Letter to Physician

Dear Dr. Smith:

We are currently evaluating FIBERBASICS™ Digestive Care Program in our facility. This program incorporates FIBERBASICS™, a pectin mixture of dates, prunes, and raisins. When this mixture is included in the residents diet, it utilizes the body's natural response to pectin soluble fiber. This activity renews peristalis without promoting dehydration and without the medication interaction associated with bulk laxatives. Normally 1-2 ounces a day per resident will achieve this goal and significantly reduce the need for laxatives.

We would like your residents to participate. To implement the program, we request some changes to the Physician's Orders. New Orders would read:

  • Hold all laxative and enema orders including stool softeners and bulk laxatives.
  • 2 oz. (2 rounded tbsp.) of FIBERBASICS™ daily.

Adjust as follows:

  • Increase by 1 ounce per day if no bowel movement within 72-hour intervals.
  • Decrease by 1 ounce per day if two or more bowel movements per day.
  • Continue with current dosage if there is a bowel movement every one to three days.
  • Glycerin suppositories - 1 per rectum every three days if no bowel movement.
  • Tap Water Enemas - (250-500 cc) every five days if no bowel movement.

A nurse from our facility will be contacting you soon for verification of phone orders. If you have any questions, please feel free to contact me. We look forward to your participation and support.

Sincerely,
Nursing Director


PURPOSE: To ease the process of getting Physician's orders.
INSTRUCTIONS:

Use this as an example for calling in Physician's orders.

Sample Phone Call to Physician

Hello, this is (Your Name) . I am a (Your Position) at (Facility) . We are currently starting FIBERBASICS™ Digestive Care Program in our facility. This program incorporates FIBERBASICS™, a pectin mixture of dates, prunes, and raisins. When this mixture is included in the resident's diet, it utilizes the body's natural response to pectin soluble fiber. This activity renews peristalsis without promoting dehydration and without the medication interaction associated with bulk laxatives. Normally, 1-2 ounces a day per resident will achieve this goal and significantly reduce the need for laxatives.

We would like your patient (Mr./Mrs.) (Resident) to participate in this program. In order to implement the program, we request some changes to the Physician's orders. New orders would read:

  • Hold all laxative and enema orders including stool softeners and bulk laxatives.
  • 2 oz. (2 rounded tbsp.) of FIBERBASICS™ daily.

Adjust as follows:

  • Increase by 1 ounce per day if no bowel movement within 72-hour intervals.
  • Decrease by 1 ounce per day if two or more bowel movements per day.
  • Continue with current dosage if there is a bowel movement every one to three days.
  • Glycerin suppositories - 1 per rectum every three days if no bowel movement.
  • Tap Water enemas - (250-500 cc) every five days if no bowel movement.