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...
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Cambridge University Press
2025-09-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472425108144/type/journal_article |
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| author | Alexandra Gabrielsson Richard Laugharne Jon Painter Harriet Slater Catherine Bright Andrew Dossett Romanie Dekker Alex Bordessa-Kelly Kloe Edwards Jarod Newbury Salman Azfar Paul Bassett Samuel Tromans Indermeet Sawhney Phil Elliot Mahesh Odiyoor Kiran Purandare Rohit Shankar |
| author_facet | Alexandra Gabrielsson Richard Laugharne Jon Painter Harriet Slater Catherine Bright Andrew Dossett Romanie Dekker Alex Bordessa-Kelly Kloe Edwards Jarod Newbury Salman Azfar Paul Bassett Samuel Tromans Indermeet Sawhney Phil Elliot Mahesh Odiyoor Kiran Purandare Rohit Shankar |
| author_sort | Alexandra Gabrielsson |
| collection | DOAJ |
| description |
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.
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| format | Article |
| id | doaj-art-b39cb5e4d14d49ffa92ca9aac3c7642a |
| institution | Kabale University |
| issn | 2056-4724 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj-art-b39cb5e4d14d49ffa92ca9aac3c7642a2025-08-20T04:03:16ZengCambridge University PressBJPsych Open2056-47242025-09-011110.1192/bjo.2025.10814Using individualised bowel care plans to improve clinical outcomes in specialist intellectual disability mental health units in England and Wales: quality improvement projectAlexandra Gabrielsson0Richard Laugharne1https://orcid.org/0000-0001-9916-343XJon Painter2https://orcid.org/0000-0003-1589-4054Harriet Slater3Catherine Bright4Andrew Dossett5Romanie Dekker6Alex Bordessa-Kelly7Kloe Edwards8Jarod Newbury9Salman Azfar10Paul Bassett11Samuel Tromans12https://orcid.org/0000-0002-0783-285XIndermeet Sawhney13Phil Elliot14Mahesh Odiyoor15Kiran Purandare16https://orcid.org/0000-0003-0714-6048Rohit Shankar17https://orcid.org/0000-0002-1183-6933Hertfordshire Partnership University NHS Trust, Hatfield, UKCornwall Partnership NHS Foundation Trust, Truro, UK Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UKSchool of Health and Social Care, Sheffield Hallam University, Sheffield, UKAneurin Bevan University Health Board, Newport, UKAneurin Bevan University Health Board, Newport, UKSussex Partnership NHS Foundation Trust, Chichester, UKMildmay Oaks, Hook, UKHertfordshire Partnership University NHS Trust, Hatfield, UKAneurin Bevan University Health Board, Newport, UKSussex Partnership NHS Foundation Trust, Chichester, UKMildmay Oaks, Hook, UKStats Consultancy, Buckinghamshire, UKUniversity of Leicester, Leicester, UK Leicestershire Partnership NHS Trust, Leicester, UKHertfordshire Partnership University NHS Trust, Hatfield, UKCheshire and Wirral Partnership NHS Foundation Trust, Chester, UKCheshire and Wirral Partnership NHS Foundation Trust, Chester, UKCentral and Northwest London Foundation NHS Trust, London, UKCornwall Partnership NHS Foundation Trust, Truro, UK Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK 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. https://www.cambridge.org/core/product/identifier/S2056472425108144/type/journal_articlePremature mortalityin-patientchallenging behaviourneurodevelopmental disordersquality of life |
| spellingShingle | Alexandra Gabrielsson Richard Laugharne Jon Painter Harriet Slater Catherine Bright Andrew Dossett Romanie Dekker Alex Bordessa-Kelly Kloe Edwards Jarod Newbury Salman Azfar Paul Bassett Samuel Tromans Indermeet Sawhney Phil Elliot Mahesh Odiyoor Kiran Purandare Rohit Shankar Using individualised bowel care plans to improve clinical outcomes in specialist intellectual disability mental health units in England and Wales: quality improvement project BJPsych Open Premature mortality in-patient challenging behaviour neurodevelopmental disorders quality of life |
| title | Using individualised bowel care plans to improve clinical outcomes in specialist intellectual disability mental health units in England and Wales: quality improvement project |
| title_full | Using individualised bowel care plans to improve clinical outcomes in specialist intellectual disability mental health units in England and Wales: quality improvement project |
| title_fullStr | Using individualised bowel care plans to improve clinical outcomes in specialist intellectual disability mental health units in England and Wales: quality improvement project |
| title_full_unstemmed | Using individualised bowel care plans to improve clinical outcomes in specialist intellectual disability mental health units in England and Wales: quality improvement project |
| title_short | Using individualised bowel care plans to improve clinical outcomes in specialist intellectual disability mental health units in England and Wales: quality improvement project |
| title_sort | using individualised bowel care plans to improve clinical outcomes in specialist intellectual disability mental health units in england and wales quality improvement project |
| topic | Premature mortality in-patient challenging behaviour neurodevelopmental disorders quality of life |
| url | https://www.cambridge.org/core/product/identifier/S2056472425108144/type/journal_article |
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