Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Dr. Whitney Kirkpatrick

Committee Member

Dr. Karen Butler


PURPOSE: The purpose of this study is to examine whether inpatients with liver disease at University of Kentucky Hospital receiving lactulose are meeting the protocol of 2-4 bowel movements per day. Research shows that lactulose is the medication of choice used to treat and prevent hepatic encephalopathy (HE). Additional lactulose interventions, a patient’s MELD score, and GCS score will be examined in this study as well. This information would be beneficial to providers and nurses because it would provide data on patients who might require more lactulose interventions than others.

METHODS: Retrospective chart reviews of 70 inpatients with liver disease receiving lactulose at the University of Kentucky from January 1, 2017 to December 31, 2017 were performed. Number of daily movements, MELD score, GCS score, PRN lactulose administration, lactulose enema administration, and narcotic administration were examined during the first five days of hospitalization.

RESULTS: In the sample, a higher percentage of patients (>50%) did not meet the protocol of 2-4 daily bowel movements during the first five days of hospitalization. There was no association shown for patients who had a higher MELD score ≥ 25 on whether or not they met the goal of 2-4 bowel movements per day or received additional lactulose interventions. Those who had a GCS of ≤ 14.5 were more likely to receive lactulose enemas on day 1 and 2 (p=0.0021, 0.0063) and no significance was shown for the remaining days or PRN lactulose. Narcotic administration did not affect this group, as there was no association shown between GCS and narcotic administration.

CONCLUSIONS: More than 50% of patients were not meeting the goal of 2-4 daily bowel movements during the first five days of hospitalization. Those who are confused seem to require additional lactulose during the early initial days of hospitalization. This information can help nurses and physicians better understand lactulose titration and administration in the hospital setting.