Enhancement Programme to Promote Standardization of Stool Charting

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Authors (including presenting author) :
Portia Y Y, Lee, K F Lee, Judy K L Fung
Affiliation :
Department of Medicine, Tung Wah Hospital
Introduction :
In rehabilitation setting, bladder & bowel training are essential components of the patient rehabilitation process. Inconsistent documentation of stool charting may adversely affect the medical condition of the patients. For instance, some health care workers only chart the frequency of bowel open without mentioning the texture in the integrated MEWS chart. Some even use not approved abbreviated short forms such as "YSS","YSM" in the intake & output chart. The inconsistent documentation may hampers patient's management in the rehabilitation process & progress.
Objectives :
1. To enhance the nursing and supporting staff’s knowledge in classification of the form stool 2. To standardize the stool charting so as to facilitate the accuracy for nursing and supporting staff in charting of the stool in medical records 3. To provide better clinical communication aids with other health care workers 4. To facilitate an effective bladder and bowel training programme 5. To promote the other medical wards to implement the programme (Plan in 2019)
Methodology :
1. Training workshop was designed to pilot wards base on a. Bristol stool chart -to classify the external appearance of stool into 7 categories. b. King’s stool chart -to measure stool output in variety groups 2. A 7-days stool charting form was designed to standardize stool charting 3. Photo & handmade ceramics stool model were used during training workshop to facilitate better & deeper understanding of stool charting 4. Pre & post workshop tests were done for evaluation 5. Plan to introduce to all medical wards in 2019
Result & Outcome :
By promoting and improving the accuracy of stool form description before and after the training workshop, the result of pre-workshop questionnaire was not satisfactory, especially in type 5 stool. Only 14% of attendees answered the question correctly. Whereas, after the training workshop, the accuracy was drastically increased to 100% (Appendix 1). Majority (86%) of the attendees were satisfied with the overall design and the objective of the training workshop. In which, 14% of the attendees strongly agree with the design and the objective of the workshop. All of them expressed that the training workshop is useful and practicable to their daily work (Appendix 2). By using of stool chart in clinical documentation, 90% of nursing staff and 100% of supporting staff were evaluated. Overall compliance rate was 100%. Only one staff need to review the stool chart for reference and two staffs need prompting about cues of stool chart so as to recognize the type of the stool correctly(Appendix 3).

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