Author Gaye Kyle, MA, BA, RGN, is senior lecturer, Faculty of Health and Human Sciences, Thames Valley University.
Abstract Kyle, G. (2007) Norgine risk assessment tool for constipation. Nursing Times; 103: 47, 48–49.
This article examines the condition of constipation and provides an outline on how to use the Norgine risk assessment tool. An extended version of this article is available on nursingtimes.net.
Constipation is an unpleasant and often distressing symptom that can happen to anyone at any time. It is rarely a life-threatening symptom, yet the distress it causes leads to reduced patient comfort and diminished quality of life (Glia and Lindberg, 1997). Constipation continues to be a major health concern for providers of care, especially for patients in high-risk groups such as older, less mobile people, the neurologically impaired, those with multiple healthcare needs and those in institutional care. The causes of constipation are multifactoral and can be influenced by physical, psychological, physiological, emotional and environmental factors.
The aim of a bowel assessment is to establish a symptom profile and to identify the most likely cause for the bowel symptoms. The assessment of constipation is based on a consideration of all the possible causes, checking in particular that it is not caused by an underlying, undiagnosed medical condition.
Evidence-based bowel care pathways (Bayliss et al, 2000) are widely used in the UK for assessing patients with bowel dysfunction. In the absence of a bowel pathway, the assessment criteria are available at nursingtimes.net.
A patient with constipation may experience a variety of symptoms. These can range from headache and fatigue to feelings of bloatedness and loss of appetite, leading to nausea and vomiting. Clinical signs of a patient with constipation are a distended abdomen, reduction in bowel sounds and, on digital rectal examination, possibly a gaping anus or impacted faeces.
Risk assessment tools have been described as the backbone of any prevention (Thompson, 2005). Therefore, a prerequisite for the prevention of constipation is the development of such a tool. In the past no risk assessment tool for constipation existed. The development and validation of the Norgine risk assessment tool gives healthcare professionals the necessary information to develop a proactive approach to the management of constipation (Kyle, 2007). The purpose of the Norgine risk assessment tool is to determine whether a patient is at risk of constipation.
The tool is easy to understand, quick to use and appears to provide a reliable prediction of a patient’s risk of developing constipation (Kyle, 2007). Most importantly, it raises nurses’ awareness of constipation and in doing so encourages them to adopt a proactive approach rather than waiting until a patient has discomfort and distress from this common symptom.
How and when to use the Norgine risk assessment tool
The risk assessment tool is designed for use with all adult patients as part of their routine initial assessment or reassessment process.
Fig 1 shows the risk assessment criteria. Each category should be checked (medical records may be used for information on medical conditions) and a tick added if the patient/client meets the criteria (there may be more than one tick per category). All the ticks should be added together. The higher the score – that is, the number of ticks – the greater the risk the patient has of developing constipation. The total score is written in the relevant box together with the date and the assessor’s signature.
A patient who scores highly on the tool may not necessarily develop constipation but will still require monitoring because of the risk.
Once a patient’s score has been calculated using the Norgine tool, advice on how to assess and prevent the development of constipation is given on the reverse.
A multidisciplinary approach optimises care and is inherent in the advice/actions given on the back of the risk assessment tool. This includes a checklist (Fig 2), the Bristol stool form scale and a chart to monitor the frequency of bowel function and consistency of stools.
The Norgine risk assessment tool for constipation is newly developed so minimum data exists on its validity or reliability (Kyle, 2007). The absence of any other risk assessment tools for constipation has meant that the tool cannot be judged against a gold-standard tool. The tool was developed using the evidence from a systematic review of the literature on constipation (Kyle, 2007).
On a cautionary note, some clinical areas may be tempted to adapt the Norgine tool to their specific patient needs – it should be stressed that this would negate any current validation of the tool. The Norgine tool is a dynamic document and it is anticipated that it will evolve and change over time, necessitating further research.
Kyle, G. (2007) Developing a constipation risk assessment tool. Continence UK; 1: 1, 38–45.
Thompson, D. (2005) An evaluation of the Waterlow pressure ulcer risk assessment tool. British Journal of Nursing; 14: 8, 455–459.