Notify the provider per the patient-specific parameters and agency policy, and document the closed loop — contact, content, response, and follow-through.
State the specific parameter that was met (the value or finding that triggered notification).
Record the date and time of contact, who was notified, exactly what was reported, the response or orders received, and the follow-through.
If a response is pending, document the scheduled follow-up time so the loop is not left open.
Common notification triggers for this system: signs of an acute abdomen (rigidity, severe pain, rebound, or guarding); GI bleeding (hematemesis, coffee-ground emesis, melena, or significant hematochezia), especially on anticoagulation; signs of bowel obstruction (severe distension, vomiting, and no bowel movement or flatus); an ischemic or significantly compromised stoma; or severe dehydration from GI losses.
Closed-loop example
“Provider notified at 11:10 of no bowel movement in four days with abdominal distension and discomfort in a patient on a scheduled opioid, with hypoactive bowel sounds and no rigidity. Order received to start a bowel regimen and increase fluids and activity, with instruction to escalate for severe pain, vomiting, or no response. The patient was taught the regimen; reassessment of bowel function arranged.”
