P28S01: Constipation (treatment for
secondary constipation)
Bottom line: Information on constipation was used to modify the
management of a patient (adding complementary
medication). There were no information-related patient health
outcomes.
Level 1 outcome (situational relevance): On January 22, 2009, P28 did a search at work, by
themselves, and during an encounter with a patient. P28 left the examination
room, retrieved two information hits about constipation, and went back to the room. The reported search objectives
were: to address a clinical question, to look up something they had forgotten
and to share information with a patient. It
was essentially a patient [around 50 or 60 years old]
who came in saying they have abdominal pain for the past month. I asked
them if they were having bowel movements regularly, and I think they said yes.
But then when I went to do my physical exam, I noticed that there was stool in
the vault. So essentially I thought that they had some overflow diarrhea and
constipation. And so with that diagnosis I went to e-Therapeutics.
[
] The thing is that the patient was, I think a
chronic pain patient, and so they were on narcotics like morphine derivatives
or whatever, which are known to cause constipation. [The question was about]
specific treatments available for people who had constipation secondary to a
narcotic. [
] I
know the basics of management of constipation but I wanted to make sure that
there wasnt anything else that I was missing, [
] [and see] what
would be my management options. [
] When
I look up the therapeutics, I go and try to apply that to their [the
patient] everyday life, or make
recommendations for them to hopefully get over whatever ailment they have. According to P28, e-Therapeutics+ (EE+) was equally
relevant as the information from another health professional (supervisor). e-Therapeutics kind of gave
me a ground to start on, and then after that I used the staff to kind of piggy
back onto [
]
treatments that were available for people who had constipation secondary to a
narcotic.
Level 2 outcome (cognitive impact): Two hits were associated with a report of positive
cognitive impact (see table). Regarding confirmation, reassurance and
reminder, P28 stated: I was already familiar with
the non-pharmacological therapeutic options. What e-Therapeutics had written
was essentially the same as I had thought. [
]
Im always reassured when I find that, whatever I practice or whatever I know
is kind of echoed in something that I read. Regarding practice improvement and learning, P28
stated: I learned something new
regarding the difference between bowel motility agents versus autonomic
diuretic. [
]
When I think about constipation in patients, I think I would kind of divide it
more in my head whether its something to do with a bowel motility problem
versus not enough liquid in the stool or firmness of the stool. So then I would
use different medications in different contexts.
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): eTherapeutics Tab
Keyword: Constipation Nonpharmacologic choices (P28S01H01)
2) e-Therapeutics+ (CIRT): eTherapeutics Tab
Keyword: Constipation Pharmacologic choices (P28S01H02)
Level 3 outcome
(information use): Information on constipation was retrieved, and used to modify the management of a
patient (information used as presented in e-Therapeutics+). I
went to the emergency department staff to clarify some issues and then went to
the patient and told them that they could do several things like increase their
fiber intake, [drink] more
water, or use lactose-containing products such as yogurt. [
] I
think the patient was already on a stool softener, and not really getting the
full benefit of it. So I modified it by adding the stool motility drug. [
] I
think it was Senekot if Im not mistaken. [..] Then, the patient was discharged
home.
Level 4 outcome (patient health):
Information-related patient health outcomes were unknown (no follow-up).
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Look up something forgotten Share information |
Practice improved Learned something Reminded something Confirmed Reassured |
Manage differently |
No outcome |