Safety and efficacy of a defecation care algorithm based on ultrasonographic bowel observation in Japanese home‐care settings: a single‐case, multiple‐baseline study

Aim To verify the efficacy of defecation care based on handheld ultrasonographic observations for functional constipation by visiting nurses skilled in bowel ultrasonography. Methods Home‐care patients with suspected functional constipation receiving nursing visits were recruited in this multiple‐baseline, single‐case experiment with intervention points shifted by 1 week. A total of 15 older adults were categorized into 3‐, 4‐, 5‐ or 6‐week intervention phases. Ultrasonographic observations of fecal retention in the colorectum and defecation care based on observations during the ordinal physical assessment were reviewed. Tau‐U was used for confirming the efficacy of the intervention by measuring the number of non‐artificial and artificial defecations, as well as hard stools per week, and the amount of non‐stimulant and stimulant laxatives, enemas and suppositories per week. For evaluating safety, adverse events, such as bowel obstruction and incontinence‐associated dermatitis, were confirmed. Results No adverse events were observed. Statistical analysis showed that hard stools and artificial defecation reduced, and that their effect sizes were significant (Tau = −0.48, P < 0.01; Tau = −0.53, P < 0.01). Even the amounts of stimulant laxative and glycerin enema reduced, and their effect sizes were significant (Tau = −0.56, P < 0.01; Tau = −0.34, P = 0.04). Conclusions Thus, defecation care based on ultrasonographic assessment by nurses in home‐care settings is safe and effective for improving constipation symptoms and reducing laxative use. Geriatr Gerontol Int 2020; ••: ••–•• .