title: Implementation of the victoria bowel performance scale.
abstract: BACKGROUND
  There is a lack of evidence to guide constipation management in patients receiving palliative care. Data collection requires the systematic use of validated assessment tools.
  
  
  OBJECTIVE
  The objective of this study was to assess the usefulness of the Victoria Bowel Performance Scale (BPS) as an audit tool.
  
  
  METHODS
  Charts were reviewed before and after the implementation of a program to monitor constipation through repeated use of the Victoria Bowel Scale. The program was initiated at three oncology pain and symptom management clinics, four palliative care units, and four residential hospices. An additional "control" palliative care unit introduced new nursing assessment tools without the new scale.
  
  
  RESULTS
  The Victoria BPS was recorded at 86% of 192 postimplementation outpatient clinic visits and was easy to use in this setting. Documentation of bowel performance at comparable visits improved from 44% to 66% (P<0.001), and the frequency of changes to laxatives increased from 14% to 39% of visits (P<0.001). The scale was completed on 21%-55% of inpatient days, and variations in the proportion of recordings being rated as satisfactory between -1 and +1 (possible range from -4 to +4) revealed important deficiencies in bowel care, which led to change in management.
  
  
  CONCLUSIONS
  The Victoria BPS was found to be an acceptable and a useful bowel function assessment tool, uniquely incorporating the patient's usual bowel function. Modifications to the scale have been made to improve clarity and allow for the expected drop in bowel activity seen in end-of-life care. Considerable educational effort and appropriate organization of the charts are required for optimal implementation. The proportion of revised BPS scores ranging from -1 to +1 is proposed as an indicator of satisfactory bowel management for clinical, audit, and research purposes.
authors.affiliation: BC Cancer Agency, Vancouver, British Columbia, Canada. pippahawley@shaw.ca
authors.forename: Philippa
authors.initials: P
authors.lastname: Hawley
authors.forename: Doris
authors.initials: D
authors.lastname: Barwich
authors.forename: Lisa
authors.initials: L
authors.lastname: Kirk
mesh_terms: D003248:Constipation / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D005500:Follow-Up Studies; D006738:Hospices; D006801:Humans; D007297:Inpatients; D054368:Laxatives / Q000008:administration & dosage / Q000627:therapeutic use; D010166:Palliative Care / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D054368:Laxatives