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Nurse/Midwife Protocol: Psyllium Oral Powder for Constipation, Study Guides, Projects, Research of Medicine

A protocol for registered nurses and midwives to initiate medication for constipation using psyllium hydrophilic mucilloid oral powder. Indications, contraindications, precautions, administration guidelines, monitoring potential adverse effects, documentation requirements, and practice points. It also provides references for further reading.

Typology: Study Guides, Projects, Research

2021/2022

Uploaded on 09/12/2022

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NURSE/MIDWIFE INITIATED MEDICINE PROTOCOL
Psyllium hydrophilic mucilloid oral powder
for constipation
SESLHDPR/447
Revision: 3 Review date: October 2021 T15/37194 Page 1 of 3
This Protocol is intellectual property of South Eastern Sydney Local Health District. Protocol content cannot be duplicated.
POLICY STATEMENT
The Registered Nurse (RN) / Registered Midwife (RM) is authorised to instigate
nurse/midwife initiated medication without an authorised prescriber’s order under the
specific circumstances set out in the INDICATIONS section and provided there are no
contraindications present.
It is important for nursing and midwifery staff to remain aware that:
Minor ailments may be symptoms of other more serious diseases or may be
adverse reactions to medication already prescribed
Nurse-initiated medication may interact with the patient’s prescribed medication
The maximum daily recommended dose of the medication must not be exceeded.1
The administering nurse/midwife must record the administration on an approved paper or
electronic medication chart, clearly indicating that the medicine was nurse initiated.
If the patient continues to require the medication (i.e. more than two doses in 24 hours)
then a medical officer (MO) must be consulted and a regular or PRN order obtained.
A change in the patient’s condition such as newly occurring or increasing severity of
symptoms must be reported to the MO and investigated.
INDICATIONS
Constipation in patients aged 6 years and over
CONTRAINDICATIONS
Intestinal obstruction, partial or complete
Hypersensitivity to the active substance or to any of the excipients.
PRECAUTIONS
Dysphagiaavoid use; oesophageal obstruction may occur.
Phenylketonuriaavoid Metamucil Smooth Texture® -it contains aspartame.
Heart failure or renal impairment risk of fluid overload
Safe to use in pregnancy and breastfeeding4
HISTORY/ASSESSMENT
Assess patient’s usual bowel habits (frequency of stools, volume, colour,
consistency)
Patient’s current bowel status (last time bowel opened)
Assess for alterations in bowel patterns
Refer to medical officer if patient has the following symptoms: blood in stools,
weight loss, abdominal pain
Assess patient for faecal impaction.
Review patient’s current medication for medicines which may cause constipation
Consider risk of fluid overload
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Psyllium hydrophilic mucilloid oral powder

for constipation

SESLHDPR/

Revision: 3 Review date: October 2021 T15/37194 Page 1 of 3

POLICY STATEMENT

The Registered Nurse (RN) / Registered Midwife (RM) is authorised to instigate nurse/midwife initiated medication without an authorised prescriber’s order under the specific circumstances set out in the INDICATIONS section and provided there are no contraindications present.

It is important for nursing and midwifery staff to remain aware that:

  • Minor ailments may be symptoms of other more serious diseases or may be adverse reactions to medication already prescribed
  • Nurse-initiated medication may interact with the patient’s prescribed medication
  • The maximum daily recommended dose of the medication must not be exceeded.

The administering nurse/midwife must record the administration on an approved paper or electronic medication chart, clearly indicating that the medicine was nurse initiated.

If the patient continues to require the medication (i.e. more than two doses in 24 hours) then a medical officer (MO) must be consulted and a regular or PRN order obtained.

A change in the patient’s condition such as newly occurring or increasing severity of symptoms must be reported to the MO and investigated.

INDICATIONS

Constipation in patients aged 6 years and over

CONTRAINDICATIONS

Intestinal obstruction, partial or complete Hypersensitivity to the active substance or to any of the excipients.

PRECAUTIONS Dysphagia—avoid use; oesophageal obstruction may occur. Phenylketonuria—avoid Metamucil Smooth Texture ®^ -it contains aspartame. Heart failure or renal impairment – risk of fluid overload Safe to use in pregnancy and breastfeeding^4

HISTORY/ASSESSMENT

  • Assess patient’s usual bowel habits (frequency of stools, volume, colour, consistency)
  • Patient’s current bowel status (last time bowel opened)
  • Assess for alterations in bowel patterns
  • Refer to medical officer if patient has the following symptoms: blood in stools, weight loss, abdominal pain
  • Assess patient for faecal impaction.
  • Review patient’s current medication for medicines which may cause constipation
  • Consider risk of fluid overload

Psyllium hydrophilic mucilloid oral powder

for constipation

SESLHDPR/

Revision: 3 Review date: October 2021 T15/37194 Page 2 of 3

PROTOCOL/ADMINISTRATION GUIDELINES

Caution: CHECK for allergies and/or contraindications

Drug Dose Route Frequency Psyllium hydrophilic mucilloid oral powder

6 to 11 years: 5.5 g ( = 1.5 teaspoonsful) in 125 mL of water Oral Once 12 years and over: 11 g ( = 3 teaspoonsful) in 250 mL of water

Mix in water, stir briskly, and administer immediately. If mixture thickens, add more water and stir.

MONITORING - POTENTIAL ADVERSE EFFECTS/INTERACTIONS

Monitor bowel function and complete stool chart Common Adverse effects (>1%) : flatulence, bloating, abdominal discomfort. Rare Adverse effects (<0.1%): hypersensitivity reactions including rhinitis, urticaria, bronchospasm and anaphylactic shock, intestinal obstruction, oesophageal obstruction. Other medications must be given two hours apart from psyllium hydrophilic mucilloid (Metamucil™) to avoid interactions.

DOCUMENTATION A record of the administration must be made on the approved paper or electronic medication chart noting that the medication was nurse initiated. A further record of the medication administered including indication, dose and effect must be included in the patient’s health care record.

PRACTICE POINTS

  • Onset of action is 3 days.
  • Should not be given immediately before going to bed.
  • Ensure adequate fluid intake
  • Ensure adequate dietary fibre intake.
  • Encourage mobility, where possible.
  • Consider review by dietician, if appropriate.

REFERENCES/FURTHER READING

  1. PD2013_043 Medication Handling in NSW Public Health Facilities
  2. Product Information Metamucil®,^. MIMS online. Accessed 20/02/2018.
  3. Product Information Fibre Health®^ MIMS Online. Accessed 17/05/
  4. eTG complete. Melbourne: Therapeutic Guidelines Ltd. November 2017. Accessed 20/02/2018.
  5. Rossi S. Australian Medicines Handbook. South Australia: Australian Medicines Handbook Pty Ltd, January 2018.