Long-Term Care Survey Alert

Published on Wed Apr 27, 2005 PDF

Eliminate constipating meds - or care plan to prevent problems.

There's a pill for every ill - but medication sometimes causes health problems that astute nursing home providers can head off with assessment and care planning.

For example, some medications can cause constipation or even set the resident up for fecal impaction, if you aren't careful.

To prevent these problems, check a resident's medications to see if any of them might be causing his constipation or have the potential to do so. The list of common culprits includes "any anticholinergic medication, many antidepressants, most antipsychotics, antihistamines - and some cardiac medications," says Charles Crecelius, MD, a certified medical director practicing in St. Louis, MO.

Residents taking opioids for pain are at high risk of developing fecal impaction, says Manisha Parulekar, MD, with Hackensack University Medical Center in Hackensack, NJ.

Consider asking the physician to put patients on a bowel regimen, such as Colace and Senna, as soon as they start an opioid medication, she advises.  "The patient must also receive adequate water to prevent constipation."

Oral iron supplementation is very constipating, cautions Nelda Mercer, RD, in Ann Arbor, MI. So make sure the resident has a true indication for supplemental iron - for example, some people continue to receive iron pills to treat an anemia from a transient cause that long ago resolved.

"If patients have iron-deficiency anemia, they have to take iron supplementation, but make sure they receive a high fiber diet, plenty of fluids and exercise," advises Mercer. Diets high in iron-rich foods can help stave off iron-deficiency anemia.

Dietary tip: Consuming a citrus fruit (such as orange juice) with iron-fortified cereal or breakfast food helps the person absorb more of the synthetic iron, says Mercer.

MDS coding tip: Don't confuse a bad case of constipation with fecal impaction (coded at H2 on the MDS). To confirm fecal impaction requires a digital rectal exam to detect hard stool. Fecal impaction can also be seen on an abdominal x-ray showing stool in the sigmoid colon or higher (even if the digital exam is negative or documentation shows the resident has had a daily bowel movement), according to the RAI user's manual.