D031: Evidence-Based Innovation Plan for Constipation Management in Hospice Care

D031: Evidence-Based Innovation Plan for Constipation Management in Hospice Care

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Western Governors University

D031 Advancing Evidence-Based Innovation in Nursing Practice

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D031: Evidence-Based Innovation Plan for Constipation Management in Hospice Care

Management of Constipation in Hospice and Palliative Care Patients

Disruptive Innovation in Healthcare

Nurses play a pivotal role in shaping patient experiences and determining care outcomes across healthcare settings. Patient satisfaction, perceived quality of life, and clinical outcomes are strongly influenced by the consistency, competence, and responsiveness of nursing care. As a result, nurses at all professional levels—including bedside nurses, nurse leaders, and advanced practice nurses—must actively engage in evidence-based innovation. Familiarity with structured evidence-utilization frameworks, such as the Stetler Model and the Iowa Model, enables nurses to systematically identify clinical problems, evaluate evidence, and implement meaningful change (Polit & Beck, 2019).

Hospice and palliative care nurses are uniquely positioned within this innovation landscape. Their primary focus is symptom control, comfort, and quality of life at the end of life. Many patients are admitted to hospice with long-standing, poorly managed symptoms, often due to gaps in education, limited access to care, or inconsistent clinical practices. Constipation is one of the most prevalent and distressing symptoms affecting hospice and palliative care patients across age groups.

The Centers for Medicare & Medicaid Services (CMS) evaluates hospice quality through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey, a key component of the Hospice Quality Reporting Program (HQRP). This survey captures patient and family perceptions of symptom management, including bowel care (Parast et al., 2021). Survey findings consistently indicate that constipation remains an area requiring improvement. Disruptive innovations that emphasize early assessment, prevention, and continuous monitoring have the potential to significantly reduce patient discomfort and improve satisfaction.

Constipation as a Clinical Problem in Hospice and Palliative Care

What is the prevalence of constipation among hospice and palliative care patients, and why does it remain underrecognized? Evidence indicates that approximately 40% of patients report constipation during initial palliative care assessments, with prevalence increasing to nearly 66% among patients in specialized palliative care settings (McIlfatrick et al., 2019). Despite this high incidence, bowel assessments are often inconsistent, poorly documented, and not standardized across providers.

Why does inconsistent assessment contribute to poor symptom control? McIlfatrick et al. (2019) identified wide variability in how nurses assessed bowel function, documented findings, and initiated treatment. Both pharmacologic and nonpharmacologic interventions were frequently underutilized, resulting in prolonged discomfort and diminished quality of life. These findings highlight the need for standardized nursing assessments, early preventive strategies, and structured treatment algorithms.

Implementing uniform bowel assessment tools, combined with digital tracking systems and evidence-based treatment pathways, would allow nurses, patients, and families to proactively monitor bowel patterns and respond promptly to changes. Such an approach aligns with hospice goals of comfort, dignity, and patient-centered care.

Existing Disruptive Innovations Supporting Symptom Management

Several healthcare innovations demonstrate how technology can enhance safety, efficiency, and care quality. One notable example is the electronic medication administration record (eMAR). eMAR systems have reduced medication errors, improved documentation accuracy, and enabled real-time monitoring of medication administration (Covetus Technologies Pvt Ltd., 2020). For hospice patients, eMAR facilitates timely initiation and adjustment of bowel regimens while ensuring continuity among interdisciplinary team members.

Another transformative innovation is telehealth, particularly through platforms such as Zoom. Telehealth has proven effective in specialties including psychiatry, nutrition, dermatology, and chronic disease management (Siwicki, 2021). During the COVID-19 pandemic, telehealth ensured continuity of care while minimizing exposure risks. In hospice care, virtual visits allow clinicians to assess symptoms, educate caregivers, and adjust treatment plans without requiring in-person visits, thereby increasing access and responsiveness.

Nurse Innovator Role in Hospice Care

How can nurses act as innovators within hospice settings? Innovation in nursing begins with problem recognition and a willingness to challenge ineffective practices. Nurses routinely engage in micro-level innovation through critical thinking and real-time problem-solving. At the graduate level, the nurse innovator may function as a clinician-scientist, systems manager, or change agent who integrates evidence, clinical insight, and organizational awareness to improve care delivery (Johnson & Johnson, n.d.).

As a nurse scientist, the advanced practice nurse evaluates cause-and-effect relationships using clinical data and research evidence. In hospice care, this role is particularly impactful. By developing standardized bowel assessment tools embedded within eMAR systems, testing treatment algorithms, and evaluating outcomes, nurse innovators can generate reliable data to support best practices. Evidence shows that innovative nursing practices positively influence patient outcomes and organizational performance (Kirby et al., 2007).

Using Big Data for Innovation

Big data refers to the aggregation and analysis of large datasets to identify trends, correlations, and outcomes that inform decision-making. In healthcare, big data enables organizations to evaluate population-level outcomes, improve quality, and design targeted interventions. For hospice agencies, analyzing data from electronic health records, medication systems, and patient portals can reveal patterns related to constipation prevalence, treatment effectiveness, and patient satisfaction.

What are the advantages of big data in hospice care? One benefit is the ability to examine relationships between social determinants of health, symptom burden, and care outcomes, which can guide policy development and resource allocation (Leon-Sanz, 2019). For example, hospice organizations can use aggregated bowel assessment data to refine care algorithms and reduce variability.

What are the risks associated with big data use? Ethical concerns include privacy breaches, unauthorized secondary data use, and loss of patient autonomy. Informed consent and strict data governance are essential to mitigate these risks (Leon-Sanz, 2019).

Ethical Use of Big Data

Ethical considerations are central to innovation in healthcare. The American Nurses Association Code of Ethics emphasizes the responsibility of nurses to advance the profession while safeguarding patient rights, privacy, and autonomy (ANA, 2017). Big data can enhance understanding of disease trajectories and social determinants, but transparency must not override confidentiality.

By adhering to ethical standards and regulatory requirements, nurses can responsibly leverage big data to design innovative, patient-centered interventions that improve symptom management without compromising trust (Howe III & Elenberg, 2020).

Using New Technology for Innovation

Health information technologies (HIT) such as eMAR systems, patient portals, and telemedicine platforms have significantly improved patient safety and care coordination. Medication errors have decreased, documentation has become more reliable, and response times have improved through digital communication tools (Alotaibi & Federico, 2017).

Telemedicine, in particular, has demonstrated clinical effectiveness comparable to in-person visits, making it a valuable tool for hospice patients who face mobility limitations or infection risks. These technologies also facilitate data collection, which supports continuous quality improvement and innovation.

Proposed Disruptive Innovation

What innovation can improve constipation management in hospice care? A standardized, organization-wide protocol initiated at admission is proposed. This protocol would include structured nursing bowel assessments within the electronic medical record, patient and caregiver education through multimedia resources, and a stepwise treatment algorithm incorporating pharmacologic and nonpharmacologic interventions.

The innovation would also include a digital bowel-tracking table accessible to patients and caregivers. This table would document bowel movements, medications, and supportive interventions and link directly to the patient’s chart. Admission nurses would initiate the tool, while case managers would provide ongoing education and monitoring. Data collected through eMAR would support outcome evaluation and continuous refinement of the protocol.

Proposed Healthcare Organization

The proposed innovation is designed for implementation at Carolina Caring, a non-profit hospice organization based in Newton, North Carolina. Established in 1979, Carolina Caring serves 12 predominantly rural counties and provides care across the lifespan in homes, long-term care facilities, hospitals, and inpatient hospice units. Services include hospice, palliative care, inpatient care, and the Program of All-Inclusive Care for the Elderly (PACE).

With a census that often exceeds 1,000 patients, Carolina Caring is well-positioned to pilot standardized symptom management innovations. The organization’s commitment to indigent care and comprehensive services aligns with the goals of equitable, high-quality hospice care.

Goal of the Innovation

The overarching goal of hospice care is to deliver safe, compassionate, and patient-centered services that prioritize comfort and dignity. CMS supports transparency and accountability through the CAHPS Hospice Survey, which assesses family perceptions of symptom management, including constipation (CMS, 2020).

How does this innovation align with organizational goals? By standardizing bowel assessments and treatment protocols, nurses can respond more quickly to patient needs, reduce symptom burden, and improve satisfaction scores. Improved documentation and timely interventions are expected to enhance both clinical outcomes and CAHPS survey results.

Relevant Sources Summary Table

Synthesis of Literature

Collectively, the literature demonstrates persistent gaps in constipation assessment, education, and treatment within hospice care. Studies consistently report inadequate documentation, delayed interventions, and insufficient caregiver education (McIlfatrick et al., 2019). Survey-based tools such as CAHPS and ICECAP-SCM further reveal that symptom management directly influences patient and family satisfaction (Parast et al., 2021; Myring et al., 2022).

The evidence supports the implementation of standardized assessments, treatment algorithms, and education to improve comfort and quality of life. Incorporating both pharmacologic and nonpharmacologic strategies is essential for comprehensive care.

Evidence for the Innovation

The reviewed evidence substantiates the need for a structured, evidence-based approach to constipation management in hospice care. Existing tools and frameworks can be adapted to create a standardized protocol that improves assessment consistency, treatment timeliness, and outcome tracking. Improved bowel management is strongly associated with enhanced patient comfort, dignity, and overall hospice experience.

Reflection on the Advanced Professional Nurse Role

Advanced professional nurses are central to driving disruptive innovation. While the responsibility to lead change can be challenging, effective delegation, stakeholder engagement, and ongoing evaluation are critical to success. Nurse leaders must establish clear standards, provide education, and foster a culture that supports innovation and continuous improvement.

Strategies for Implementation

As a nurse educator and clinical trainer, opportunities exist to translate this innovation into practice through staff education, policy development, and technology integration. Training admission nurses and case managers on standardized bowel assessments and treatment algorithms will promote consistency and confidence. Collaboration with marketing and technology teams to develop educational videos and digital tracking tools will further support patients and caregivers.

By integrating education, technology, and evidence-based practice, this disruptive innovation has the potential to significantly improve constipation management, patient comfort, and satisfaction in hospice care.

References

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American Nurses Association. (2017). Code of ethics for nurses. https://www.nursingworld.org

Centers for Medicare & Medicaid Services. (2020). CAHPS hospice survey. https://www.cms.gov

Covetus Technologies Pvt Ltd. (2020). The features and benefits of eMAR. https://www.covetus.com

Howe III, E. G., & Elenberg, F. (2020). Ethical challenges posed by big data. Innovations in Clinical Neuroscience, 17(10), 24–30.

Johnson & Johnson Nursing. (n.d.). Innovation 101. https://nursing.jnj.com

Kirby, E. G., Keeffe, M. J., & Nicols, K. M. (2007). Innovative practices and hospice performance. Health Care Management Review, 32(4), 352–359.

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