Using individualised bowel care plans to improve clinical outcomes in specialist intellectual disability mental health units in England and Wales: quality improvement project

Background

Constipation is a significant problem for people with intellectual disabilities, with a prevalence of 33–50%, causing at least five deaths annually in England. Individualised bowel care plans (IBCP) are recommended in England and Wales.

Aims

We evaluated the feasibility and impact of IBCPs for people with intellectual disabilities who are in in-patient psychiatric units, and the effect on clinical outcomes.

Method

People with intellectual disabilities who were at risk of constipation were recruited from four specialist in-patient psychiatric units in England and Wales. A constipation questionnaire was used to capture relevant data to devise IBCPs. Baseline, 3- and 6-monthly Health of the Nation Scales – Learning Disability (HoNOS-LD) were completed after the intervention. Descriptive statistics, Wilcoxon signed-rank, Mann-Whitney U, repeated-measures analyses of variance, with Bonferroni adjustment and Mauchly’s tests were conducted. Significance was taken at P <0.05.

Results

Of 24 people with intellectual disabilities recruited from four units, all three data points were available for 18 patients. Constipation rates showed no statistically significant decline. The total HoNOS-LD score (18 items) did not decline. HoNOS-LD item 12 for physical functioning showed significant improvement for PwID with constipation compared with those without, between baseline and 6 months.

Conclusions

This quality improvement project suggests that a bigger study of IBCPs is feasible. Most outcomes examined via the HoNOS-LD, particularly those linked with mental illness, challenging behaviour and quality of life, did not show significant change, possibly because of the small sample size. However, people with intellectual disabilities and constipation showed positive changes in their physical functioning outcomes compared with those without constipation. Further in-depth evaluation of this intervention is needed.