Opioid Induced Constipation Lisa Clince Acute Pain CNS Palmerston North Hospital 21-04-2016 MidCentral District Health Board 1
Overview Patient Experience Opioid Collaborative Constipation defined Opioid Induced Constipation 21-04-2016 MidCentral District Health Board 2
Clinical Experience Discuss a clinical experience related to constipation.. What impact did this have on the person Reflect on your feelings and actions in this situation.. 21-04-2016 MidCentral District Health Board 3
Violet s Story Learning Points Co-prescribing laxatives with opioid Targeted patient education can never be underestimate Description of bowel movement Treat constipation promptly & prior to discharge LISTEN to the patient 21-04-2016 MidCentral District Health Board 4
Opioid Collaborative The Commission is partnering with District Health Boards in implementing a national Collaborative on the Safe Use of Opioids in DHB hospitals to reduce opioid related harms. Aim: We aim to reduce the harm related to opioid use nationally by 25% in all the participating areas of District Health Board hospitals by June 2016. DHB Aim: MidCentral DHB will reduce opioid related constipation from 13% (baseline) by 50% to 6.5% in Star 2 by June 2016. 21-04-2016 MidCentral District Health Board 5
Constipation Definition Constipation is defined as bowels have not opened for 3 days 21-04-2016 MidCentral District Health Board 6
Constipation Definition Constipation is a decrease in frequency of bowel movements from what is normal for the individual; hard, difficult-to-pass stools; a decrease in stool volume; and retention of faeces in the rectum. Normal bowel elimination may vary from three times a day to once every three days ( Norton & Chelvanayagam. 2000). 21-04-2016 MidCentral District Health Board 7
Clinical Manifestations Abdominal: pain, discomfit, distension Decreased frequency Hard dry stools Staining Rectal pressure Tenesmus Increased flatulence Nausea Anorexia Headache Dizziness Increased lassitude Emotional irritation Urinary retention Palpable mass 21-04-2016 MidCentral District Health Board 8
Four Main Physiological Causes of Constipation Slow Transit Time Altered Faecal Composition Decreased ability to evacuate bowels Altered ability to recognise urge to pass a stool 21-04-2016 MidCentral District Health Board 9
Colonic Disorders Obstructing lesions Inflammatory strictures Vovulus Intussusception Irritable bowel syndrome Diverticular disease Rectocele 21-04-2016 MidCentral District Health Board 10
Drug Induced Opioids - Morphine Antiemetics - Ondansetron Psychotropics/nueroleptics-Olanzapine Antidepressants Amitriptyline Anticholinergics Hyoscine butlybromide Beta blockers - Metoprolol Antihyperglycaemic - Metformin Monomine Oxidase Inhibitors - Moclobemide Calcium Channel Antagonists -Verapamil Antihypertensive - Clonidine 21-04-2016 MidCentral District Health Board 11
Systemic Disorders Collagen vascular disease Scleroderma Amyloidosis Neurogenic disorders Hirschsprung s megacolon Autonomic neuropathy (pseudo-obstruction) Multiple Sclerosis Parkinson's disease CVA Spinal cord lesions or injury 21-04-2016 MidCentral District Health Board 12
Systemic Disorders Metabolic/endocrine Diabetes mellitus Hypothyroidism Pregnancy Hypercalcemia/hyper-parathyroidism Pheochromocytoma 21-04-2016 MidCentral District Health Board 13
What are opioids? Opioids are a class of drugs that are commonly prescribed for their analgesic, or pain-killing, properties. Opioids bind to specific opioid receptors opioid in the nervous system and other tissues. There are three principal classes of opioid receptors mu, kappa, and delta Opioids also bind to mu receptors in the gut which leads to slowed gut contractility and therefore increased transit time. Consequently, stools will become hard and drier. 21-04-2016 MidCentral District Health Board 14
Opioid Induced Constipation Constipation is a known side effect of opioid analgesics and should be addressed before opioid therapy begins. As opioid-induced constipation can be severe and adversely impact quality of life and compliance with therapy. 21-04-2016 MidCentral District Health Board 15
Clinical Experience What suggestion do you have that could minimize the impact of OIC Please write your ideas on post it and place on board 21-04-2016 MidCentral District Health Board 16
Interventions to treat OIC Prophylaxis with laxatives Patient/family education and discussion Changing lifestyle factors : Increasing dietary fiber Increasing fluid intake Increasing exercise or physical activity Increasing time and privacy for toileting 21-04-2016 MidCentral District Health Board 17