Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-16-2025

Graduate Advisor

Elise Schaller, DNP, MHA, APRN, CPNP-PC

Committee

Jinnie Tkach, DNP, CPNP-AC

Jessica Mann, DNP, CPNP-AC

Abstract

Problem: Pediatric patients with congenital heart disease (CHD) are at an increased risk of constipation following cardiac surgery, which contributes to complications and delays in recovery. Standardized protocols are effective tools for prophylactic management of constipation. However, there is no current standardized protocol in place for postoperative bowel management in a pediatric cardiac intensive care unit (CICU).

Method: This quality improvement project (QI) used a descriptive design with pre- and post-implementation data collection to evaluate the effects of a postoperative bowel regimen protocol on constipation rates and compliance with ordering prophylactic bowel regimens. Convenience sampling was used to identify patients aged zero to 21 years undergoing cardiac surgery. Patients requiring extracorporeal membrane oxygenation (ECMO) within 24 hours of surgical intervention were excluded. Pre- and post-implementation data was collected via chart review and included age, sex, day bowel regimen was ordered, type of medications ordered, time of administration, and time in days to first postoperative stool.

Results: A chi-square test of independence, Mann-Whitney U test, and two Fisher’s exact tests were conducted to analyze results. Following implementation of the bowel regimen protocol, this study demonstrated a 6.96% decrease in the incidence of postoperative constipation, and provider compliance with ordering bowel regimen medications on postoperative day (POD) zero increased by 21.62%.

Implications for practice: Implementation of standardized protocols could decrease the incidence of postoperative constipation in the pediatric CICU by promoting provider adherence to ordering prophylactic bowel regimens in the early postoperative period.

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