2025 Southeastern Residency Conference

Title: Evaluation of a Pharmacist Driven Intensive Care Unit Bowel Regimen 
Authors: Rachael Weingarten, PharmD; Jessica Millen, PharmD, BCPS, BCCCP; Caitlin Edwards, PharmD 
Cone Health Moses Cone Hospital
Objective: To discuss and evaluate practice change surrounding the standardization of a pharmacist driven ICU bowel regimen 
Self-Assessment Question: True/False: A pharmacist-driven bowel regimen in the ICUs may lead to a decreased time to first bowel movement?
Background: Constipation is one of the most common gastrointestinal problems in critically ill patients affecting up to 80% of adults in the intensive care unit (ICU). Studies have found that constipation is associated with poor clinical outcomes including increased infection rates, ICU mortality, prolonged duration of mechanical ventilation, and length of ICU stay. In the ICU, opioids are the cornerstone treatment for moderate to severe pain and are notorious for causing constipation. Bowel care in the ICU is often neglected, and it is unclear whether bowel protocols can prevent downstream patient outcomes. Previously at Cone Health, there was no standardized bowel regimen for the prevention and treatment of constipation in critically ill patients. In April 2024 a pharmacist-driven bowel regimen was implemented in Moses Cone Memorial Hospital ICUs to manage different forms of constipation. The purpose of this study was to evaluate the impact of this pharmacist-driven standardized ICU bowel regimen management protocol for acute opioid-induced constipation in critically ill patients.
Results: A total of 87 patient charts were evaluated and 47 patients were included in the final analysis. A total of 20 patients were included in the pre-intervention group and 27 in the post-intervention group. The average age was younger at 58 years old in the pre-intervention group compared to 62 years old in the post-intervention group. There were more caucasian patients in the post-intervention group (56% vs. 45%) and more patients admitted to the cardiovascular ICU in the pre-intervention group (60% vs. 13%). The most common additional medication contributing to constipation was diuretic therapy in both groups. The number of days without a bowel movement was 5.29 in the pre-intervention group compared to 4.1 in the post-intervention group (p-value: 0.08). 2 patients in the pre-intervention group experienced diarrhea compared to 8 patients in the post-intervention group (p-value: 0.08). There was no statistically significant difference in any of the other secondary endpoints.  
Conclusion: A standardized pharmacist-driven ICU bowel regimen demonstrated a numerical trend toward a reduction in the number of days to achieve a bowel movement.