A few spoonfuls a day!

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A natural bowel care program at Espanola Regional Hospital and Health Centre was recognized as a finalist at the Innovations in Health Care Expo in Toronto November 18th, but it's the residents of the centre's 62-bed nursing home who are the real winners.

Most of the residents have been able to stop taking laxatives and stool softeners and no longer have to be given suppositories and enemas since the nutrition and food services department began adding ground flax to soups, stews, casseroles, baked goods and other foods.

Jody Pilon, nutrition and food services manager at the facility, came up with the idea after listening to a physician talk about constipation and soapsuds enemas at a resident care conference in early 2006.

"I couldn't imagine some of our very demented residents having to endure that," she said. "I thought there had to be another way."

Pilon began doing some research and discovered a company in Nova Scotia called Valley Flax Flour that was milling flax and selling the product to 35 nursing homes and hospitals in the Maritimes. She purchased a binder, a video and some brochures from the company, presented the idea at a residents council meeting and ran it by the medical advisory committee.

Nervous

Everyone approved of the proposal, but some of the residents were a "a little nervous about letting go of their ex-lax," confided Pilon.
Other hospitals and nursing homes that use flax sprinkle it on breakfast cereal or add it to baked muffins, "but we're going all out," she said. "We add it to just about everything" provided it doesn't compromise taste, texture or presentation.

Initially, the hospital was using a darker flax that didn't look all that appealing in light-coloured foods like cream of mushroom soup, but Pilon was able to source a golden brown flax product that blended in with just about everything.

Prior to the use of flax, more than 30 of the residents at the Espanola Nursing Home relied on medication to induce a bowel movement. Six months after the introduction of ground flax, only seven residents remain on pharmaceuticals or suppositories.

Constipation is a common problem for seniors because of poor diet, lack of exercise and insufficient fluid intake. Ironically, regular use of laxatives is also a factor, said Pilon.

"If someone has relied on laxatives for any period of time, there's this condition called lazy bowel syndrome. The bowel muscles don't have to work, so they get lazy because the ex-lax works for them."

Bran can also be used to loosen things up, but it requires a lot of fluid to be effective and seniors are reluctant to drink too much because they're afraid of having "an accident," said Pilon. Flax isn't as dependent on fluid volume.

Two tablespoons

The hospital's goal is to administer two tablespoons of ground flax to residents every day.
"If a resident has a bowl of cereal, a bowl of soup and half a sandwich, they've had one tablespoon of flax. If they've had spaghetti sauce and a desert, they've had another two teaspoons," said Pilon. Some residents receive additional flax mixed with jam or applesauce if they're still plugged up.

Aside from serving as a natural laxative, flax is said to offer a range of other benefits, from healthier skin and hair to lower blood sugar and cholesterol.

The hospital's natural bowel care program costs all of $60 a month. The savings in medication and suppositories accrue to the province, but nurses are saving time dispensing less medication and administering fewer enemas.

Pilon didn't think there was anything special about the program until Accreditation Canada cited it as a best practice following a review last spring.

Espanola Regional Hospital and Health Centre was one of three finalists in the improving quality and patient safety category at the Innovations in Health Care Expo. The Registered Nurses Association of Ontario won the category in recognition of a program that provides expert nurses to assist staff in long-term care homes.

The only other Northern Ontario finalist, the Northern Diabetes Health Network, was recognized for its Aboriginal Diabetes Initiative in the competition's health promotion category. It was edged out by VON Canada's Caregiver-Connect.ca program, an innovative service for family caregivers.


www.esphosp.on.ca
www.flaxflour.com