Original Title: Protocoles médicaux nationaux et ordonnances associées: traitement pharmacologique visant l’élimination fécale chez une personne qui reçoit des soins palliatifs ou qui présente un profil gériatrique.

Authors' objectives: The Ministère de la Santé et des Services sociaux (MSSS) asked the Institut national d’excellence en santé et en services sociaux (INESSS) to develop, update and host the current national medical protocols and prescription templates. The Direction nationale des soins et services infirmiers of the MSSS, following a prioritization exercise, asked INESSS to develop a national medical protocol on pharmacological treatment for fecal elimination in two populations: adults receiving palliative care and the geriatric population. At the first meeting with the advisory committee’s members, it was determined that only one protocol covering both of these populations would be developed.

Authors' results and conclusions: RESULTS: The information search yielded 474 references, of which we selected six CPGs and two publications containing clinical practice recommendations regarding pharmacological treatment for fecal elimination in persons 18 years of age or older receiving palliative care or persons with a geriatric profile. The six CPGs were considered to be of adequate methodological quality for use, based on the AGREE GRS (Appraisal of Guidelines for Research and Evaluation Global Rating Scale). The other two items containing clinical practice recommendations were considered to be of inadequate methodological quality, based on the AGREE GRS, but were nonetheless included for their contextual data concerning the elderly population. CONCLUSIONS: The development of this national medical protocol and the collective prescription template on initiating and adjusting pharmacological treatment for fecal elimination in a person receiving palliative care or presenting a geriatric profile is based on clinical data and clinical practice recommendations from the literature, which have been enhanced with experiential knowledge from different experts and clinicians, and with contextual information. The triangulation of the data from these different sources enabled us to develop the protocol in light of the best available clinical practices.

Authors' methods: A systematic review of clinical practice guidelines (CPGs), expert consensus reports, consensus conference statements, guidance documents and any other publications containing clinical recommendations was conducted in accordance with INESSS’s standards. The literature search was limited to items published between January 2014 and March 2019. The items selected concern people 18 years of age or older who receive palliative care or who fit the geriatric profile and who have not had a bowel movement for 48 to 72 hours. The parameters searched for were the contraindications to pharmacological treatment, health assessment criteria, physical examinations, the conditions for initiating and adjusting medication (dosage and adjustment interval), the contraindications, the adverse effects, the precautions and the drug interactions that one should be aware of when initiating or adjusting the pharmacological treatment, and the necessary follow-up pertaining to the treatment. As well, a manual literature search was conducted by consulting the websites of North American regulatory agencies, health technology assessment agencies, government agencies, and professional associations or orders pertaining to the topic of interest. The bibliographies of the selected publications were examined for other relevant items. The data were analyzed with a view to contextualizing the practice in Québec, based mainly on legislative, regulatory and organizational contextual information specific to Québec and on experiential knowledge from the various stakeholders consulted.

Project Status: Completed

URL for protocol: https://www.inesss.qc.ca/thematiques/medicaments/protocoles-medicaux-nationaux-et-ordonnances-associees/elimination-fecale.html

Year Published: 2020

URL for published report: https://www.inesss.qc.ca/thematiques/medicaments/protocoles-medicaux-nationaux-et-ordonnances-associees/elimination-fecale.html

Requestor: Minister of Health

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: INESSS