Safety and efficacy of a defecation care algorithm based on ultrasonographic bowel observation in Japanese home‐care settings: a single‐case, multiple‐baseline study

Abstract

Aim To verify the efficacy of defecation care based on handheld ultrasonographic observations for functional constipation by visiting nurses skilled in bowel ultrasonography. Methods Home‐care patients with suspected functional constipation receiving nursing visits were recruited in this multiple‐baseline, single‐case experiment with intervention points shifted by 1 week. A total of 15 older adults were categorized into 3‐, 4‐, 5‐ or 6‐week intervention phases. Ultrasonographic observations of fecal retention in the colorectum and defecation care based on observations during the ordinal physical assessment were reviewed. Tau‐U was used for confirming the efficacy of the intervention by measuring the number of non‐artificial and artificial defecations, as well as hard stools per week, and the amount of non‐stimulant and stimulant laxatives, enemas and suppositories per week. For evaluating safety, adverse events, such as bowel obstruction and incontinence‐associated dermatitis, were confirmed. Results No adverse events were observed. Statistical analysis showed that hard stools and artificial defecation reduced, and that their effect sizes were significant (Tau = −0.48, P < 0.01; Tau = −0.53, P < 0.01). Even the amounts of stimulant laxative and glycerin enema reduced, and their effect sizes were significant (Tau = −0.56, P < 0.01; Tau = −0.34, P = 0.04). Conclusions Thus, defecation care based on ultrasonographic assessment by nurses in home‐care settings is safe and effective for improving constipation symptoms and reducing laxative use. Geriatr Gerontol Int 2020; ••: ••–••.

Feasibility of the constipation point‐of‐care ultrasound educational program in observing fecal retention in the colorectum: A descriptive study

“…In point‐of‐care ultrasound (POCUS) conducted by visiting nurses, it is necessary to be able not only to take and interpret ultrasonographic images but also to select appropriate health management or care based on observation on the spot. Therefore, the authors' constipation POCUS educational program for observing fecal retention in the colorectum should include the following: a procedure for observing fecal retention in the colorectum for the assessment of constipation using POCUS a selection algorithm for selecting and providing defecation care based on the ultrasound findings (Matsumoto, Yoshida, et al, 2020c). …”

“…Based on the team's deliberations, the final program comprised four components: E‐learning, a hands‐on seminar, self‐learning, and OSCEs as in the previous study (Yoshida et al, 2020) (Table 1). According to the authors' previous study, 74.4% of the older adult patients in the long‐term care facility were suffering from fecal retention in the rectum, and an algorithm was developed to select care based on the ultrasonographic observation of fecal retention in the rectum (Matsumoto, Yoshida, et al, 2020c; Yabunaka et al, 2018). Based on this algorithm, this constipation POCUS educational program taught the nurses the observation of fecal retention in the rectum and ascending colon.…”

“…1. a procedure for observing fecal retention in the colorectum for the assessment of constipation using POCUS 2. a selection algorithm for selecting and providing defecation care based on the ultrasound findings (Matsumoto, Yoshida, et al, 2020c).…”

“…Previous studies have already shown the safety and effectiveness of defecation care based on ultrasonographic observations (Matsumoto et al, 2020c;Matsumoto, Yabunaka, et al, 2020b). In these studies, nurses who had sufficient training under the supervision of a sonographer had performed ultrasonography independently; however, no standardized educational program has been established.…”

Deep learning‐based classification of rectal fecal retention and analysis of fecal properties using ultrasound images in older adult patients

“…In particular, in conventional approaches, clinicians may rely too heavily on the US technician's skill in image interpretation, which may lead to poor outcomes (Burlina, Billings, Joshi, & Albayda, 2017). In recent years, nurses have reportedly used US to confirm rectal fecal retention (Matsumoto et al, 2018; Matsumoto, Yabunaka, et al, 2020; Matsumoto, Yoshida, et al, 2020; Tanaka et al, 2018), which suggests that nurses may, through training, acquire skills for obtaining US images. However, problems regarding skills in interpreting US images remain.…”