Performance Improvement Community

Postoperative Ileus Retrospective Performance Review

Use this checklist to evaluate your current practices with patients who are at risk for the development of POI. This can be used to review specific patient charts or as a guide to think about which of the multimodal components are currently implemented in your standard protocols for patients undergoing bowel resection procedures (or other abdominal surgeries).

All fields required

Figure 2	Chart 1
Surgery
Surgery type?	Large bowel resection Small bowel resection Cholecystectomy Appendectomy Abdominal hysterectomy Nephroureterectomy Cystectomy Other
Multidisciplinary team review of procedures for implementation of a multimodal/fast-track approach?	Yes No
Preoperative Measures
Patient education	Yes No
Medications
Pain/Anxiety?	Yes No
Nausea?	Yes No
Ileus?	Yes No
Intraoperative Measures
Surgical technique	Open Laparoscopy
Anesthetic/Analgesic	Propofol Midazolam Sevoflurane Desflurane Fentanyl (or Derivative) Other
Route of administration	Inhaled Epidural Intravenous Other
Postoperative Measures
NG tube?	Yes* No
**If yes, removal when?*	Immediately Post Op Post Op Day 1 Post Op Day 2 Post Op Day 3 Post Op Day 4 Other N/A
Oral/enteral/sham feeding (when?)	Day of Surgery Post Op Day 1 Post Op Day 2 Post Op Day 3 Post Op Day 4 Other
Ambulation (when?)	Day of Surgery Post Op Day 1 Post Op Day 2 Post Op Day 3 Post Op Day 4 Other
Descriptive pain scales employed?	Yes No
Analgesia Type?	Multimodal Opioids NSAIDs Local Anesthetics Other
Analgesia Route of administration?	Intravenous (including PCA) Epidural Oral Other
Treatment for ileus?	Yes* No
**If yes, with what?*	Laxatives Metoclopramide Erythromycin Alvimopan Other N/A
Outcomes
Duration of postoperative ileus	< 24 hours 24-48 hours 3 days 4 days 5 days > 5 days
Time to oral intake/tolerating diet	< 24 hours 24-48 hours 3 days 4 days 5 days > 5 days
Pain control	Adequate Limited Inadequate Other
Time to first bowel movement	< 24 hours 24-48 hours 3 days 4 days 5 days > 5 days
Length of hospital stay	≤ 3 days 4 days 5 days 6 days 7 days > 7 days
Rehospitalization?	Yes No
Overall, do you feel that a multimodal approach was implemented for this patient?	Yes No