Laxative-prescribing habits: a summative impact evaluation of a constipation programme implemented in two hospitals in New Zealand.

AIMS: To evaluate the impact of a multifaceted intervention aimed at improving adherence to a list of preferred laxatives in two hospitals in New Zealand. METHODS: A constipation programme was developed at Capital & Coast District Health Board to improve adherence to safe and effective (preferred) laxatives over potentially dangerous and less effective (non-preferred) agents. The intervention included a new constipation guideline, a poster of preferred laxatives, a patient information leaflet, hospital formulary adjustments and staff education. The evaluation compared the number of dispensations of each laxative during two periods: a 12-month period prior to programme implementation and a 12-month period following programme implementation. Data were retrospectively gathered from multiple sources on all laxatives dispensed on 14 adult wards across two New Zealand hospitals. RESULTS: Prior to the programme, there were 111,771 laxatives dispensed, the majority of which (62%) were non-preferred agents. Following the programme, there were 91,005 laxatives dispensed, the majority of which (82%) were from the preferred list, indicating a large shift in prescribing habits. CONCLUSIONS: Inpatient laxative prescribing habits require attention and are amenable to quality improvement initiatives. This may reduce waste, prevent harm and improve patient outcomes.

An evolving approach to delirium: A mixed-methods process evaluation of a hospital-wide delirium program in New Zealand.

OBJECTIVE: A process evaluation was carried out to assess and potentially improve the design and implementation of a hospital-wide delirium program. METHODS: A mixed-methods sequential-explanatory design was used; retrospective chart reviews for 100 older (75+) medical inpatients were conducted to measure nurses', doctors' and coders' adherence to key program processes following which interviews were conducted to identify potential barriers to implementation. RESULTS: Delirium occurred in 49% of patients. Chart reviews revealed suboptimal adherence to the delirium risk assessment (66%), the Short Confusion Assessment Method (50% on admission, 58% during admission), documentation of delirium in clinical records (80%) and discharge letters (38%) and coding for delirium (49%). The major barriers to implementation identified were failure to recruit non-nursing staff, unclear goals and instructions, difficulties using the Short-CAM, time constraints with competing priorities and lack of outcome expectancy. CONCLUSION: A new delirium program was needed based on these findings.