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Chronic Constipation and IBS-C Performance Review

Use this checklist to evaluate your current practices with patients who have chronic constipation and irritable bowel syndrome (IBS-C). This can be used to review specific patient charts, or as a guide to assess whether you are consistently validating patient concerns and developing a therapeutic relationship with your patients.

All fields required

Strategies to Support Optimal Treatment/Management
Symptom(s)?	Infrequent stools Straining Sense of difficulty passing stools Incomplete evacuation Hard/lumpy stools Prolonged time to pass stools Need for manual maneuvers to pass stools More than one of the above Other
Severity	Mild Moderate Severe Other
Take inventory of previous treatments	Yes No
Record dose and duration of previous trials?	Yes No
Use of bowel diary to monitor response to new treatment?	Yes No
Use of Bristol Stool Chart to facilitate patient dialog?	Yes No
Use of treatment algorithm to guide decision making?	Yes No
Review of treatment options, including possible side effects with patients?
Treatment options	Yes No
Side effects	Yes No
Follow-up (within 2 weeks) regarding efficacy and tolerability of treatments after initiating or making changes to therapy?	Yes No
Overall, do you feel that you incorporated most of the above strategies with this patient?	Yes No

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