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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.
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Revision: 3 Review date: October 2021 T15/37194 Page 1 of 3
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:
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.
Constipation in patients aged 6 years and over
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
Revision: 3 Review date: October 2021 T15/37194 Page 2 of 3
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.
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