Registered Nurses´ Association of Ontario
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Sample Bowel Elimination Record
Below is an abbreviated form of the Sample Bowel Elimination Record. For the full example see the guideline at the following link: http://www.rnao.org/Page.asp?PageID=924&ContentID=809.
Client: ________________
Date: ________________
Shift: ________________
| See legend below | |
|---|---|
| BM | |
| Time | |
| Continent | |
| Nature | |
| Amount | |
| Toilet | |
| Fluid Intake | |
| 24 hour intake | |
| Fibre intake | |
| Treatment | |
| Referrals / Consults | |
| Total # of BMs | |
| # Episodes of constipation/fecal soiling | |
| Initials |
Legend
- BM (Bowel Movement):
Enter time: Continent: = Continent; I = Incontinent - Amount: S = small (< 250 ml); M = normal ( > 250 - < 500 ml); L =large ( > 500 ml); FO = oozing; FS = staining
- Nature: N = normal (soft, formed, brown stool; not foul smelling); H = hard, dry; W = watery, liquid; P = pasty; B = bulky and unformed
- Toilet: T = toilet; C = commode; B = bedpan; SL = side lying
- Fluid intake: Record actual amount consumed per shift. Calculate 24-hour intake.
- Fibre intake: Record number of fibre items consumed.
- Treatments: PRN laxatives, suppositories, enemas, rectal stimulation. Enter time treatment given and initials. Regularly prescribed laxatives are recorded on Medication Administration Record (MAR).
- Referrals: D = Dietitian; NCA = Nurse Continence Advisor; OT = Occupational Therapy; P = Pharmacy; PT = Physiotherapy
- Enter total # of BMs: Enter total episodes of constipation/fecal soiling:
