Bowel and Food Diary Care Plan

Key objectives

Give patients a digital care plan to track their in and output

Outcome measures

Equip every patient with the tools to monitor and record their in and outputs daily in between clinical appointments to help promote self-management.

Current Baselines

Patients are currently adding their in and output on pieces of paper and sending them to the team, no easy way to share with the team or other healthcare professionals. Reliant on patients bringing records with them to clinic appointments, sometimes meaning, follow-ups aren’t being efficiently or effectively managed.

Workflow

Patients are given the Bowel and food diary by The Pelvic Health Physio team so they can complete the diary in their PKB record and share it with them at the next appointment, either in person or over the phone.

Patient registers with their PKB record - Care plan template added to the patient's record in the clinic or phone consultation - patient complete care plan in PKB - Care plan can be shared and edited by patient and physio team.

Bowel and food care plan template

image-20240402-004235.png

 

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.row-eq-height {

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<div class="cp_whiteBox">

<p>This chart is designed to help assess how your bowel functions are at home, work or any place you happen to be over the period of time you are recording.</p>

<p>By filling in this chart correctly you will help us diagnose and treat your condition.</p>

<p>Please <b>complete 7 days</b> of this chart. They do not have to be consecutive days.</p>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_DayLink"><b>Jump to day: </b></label>

<a href="#cp_Day1"> 1 </a>

<a href="#cp_Day2"> 2 </a>

<a href="#cp_Day3"> 3 </a>

<a href="#cp_Day4"> 4 </a>

<a href="#cp_Day5"> 5 </a>

<a href="#cp_Day6"> 6 </a>

<a href="#cp_Day7"> 7 </a>

</div>

</div>

<div class="cp_whiteBox" id="cp_Chart">

<img src="/images/hosted/Bursswood_Visual_Bristol_Stool_Chart.png" alt="" style=" max-width: 720px; width: 100%; height: auto;"></img>

</div>

</div>

<div class="cp_whiteBox" id="cp_Day1">

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D1"><b>Day 1 - </b></label>

<b>

<select class="form-control" name="cp_D1" id="cp_D1">

<option value="--">Select</option>

<option value="Monday">Monday</option>

<option value="Tuesday">Tuesday</option>

<option value="Wednesday">Wednesday</option>

<option value="Thursday">Thursday</option>

<option value="Friday">Friday</option>

<option value="Saturday">Saturday</option>

<option value="Sunday">Sunday</option>

</select>

</b>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D1_Breakfast"><b>Breakfast</b></label>

<p><textarea class="form-control" name="cp_D1_Breakfast" id="cp_D1_Breakfast" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D1_Lunch"><b>Lunch</b></label>

<p><textarea class="form-control" name="cp_D1_Lunch" id="cp_D1_Lunch" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D1_Supper"><b>Supper</b></label>

<p><textarea class="form-control" name="cp_D1_Supper" id="cp_D1_Supper" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D1_Snacks"><b>Snacks / Drinks / Laxatives</b></label>

<p><textarea class="form-control" name="cp_D1_Snacks" id="cp_D1_Snacks" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D1_StoolType"><b>Stool Type (poo)</b></label> <a href="#cp_Chart">(Click to view Bristol Stool Chart)</a>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<select class="form-control" name="cp_D1_StoolType" id="cp_D1_StoolType">

<option value="--">Select</option>

<option value="1">Type 1</option>

<option value="2">Type 2</option>

<option value="3">Type 3</option>

<option value="4">Type 4</option>

<option value="5">Type 5</option>

<option value="6">Type 6</option>

<option value="7">Type 7</option>

</select>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D1_NoBM"><b>Number of bowel motions (how many times have you gone for a poo?)</b></label>

<p><textarea class="form-control" name="cp_D1_NoBM" id="cp_D1_NoBM" rows="1" style="width: 100%;"></textarea></p>

</div>

</div>

</div>

<br /><br />

<a href="#bottom" class="btn arrow btn-primary" title="BottomToSave" alt="Click here to go to the bottom of the plan to save">Jump to Bottom to Save</a>

<br /><br />

<div class="cp_whiteBox" id="cp_Day2">

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D2"><b>Day 2 - </b></label>

<b>

<select class="form-control" name="cp_D2" id="cp_D2">

<option value="--">Select</option>

<option value="Monday">Monday</option>

<option value="Tuesday">Tuesday</option>

<option value="Wednesday">Wednesday</option>

<option value="Thursday">Thursday</option>

<option value="Friday">Friday</option>

<option value="Saturday">Saturday</option>

<option value="Sunday">Sunday</option>

</select>

</b>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D2_Breakfast"><b>Breakfast</b></label>

<p><textarea class="form-control" name="cp_D2_Breakfast" id="cp_D2_Breakfast" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D2_Lunch"><b>Lunch</b></label>

<p><textarea class="form-control" name="cp_D2_Lunch" id="cp_D2_Lunch" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D2_Supper"><b>Supper</b></label>

<p><textarea class="form-control" name="cp_D2_Supper" id="cp_D2_Supper" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D2_Snacks"><b>Snacks / Drinks / Laxatives</b></label>

<p><textarea class="form-control" name="cp_D2_Snacks" id="cp_D2_Snacks" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D2_StoolType"><b>Stool Type (poo) </b></label> <a href="#cp_Chart">(Click to view Bristol Stool Chart)</a>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<select class="form-control" name="cp_D2_StoolType" id="cp_D2_StoolType">

<option value="--">Select</option>

<option value="1">Type 1</option>

<option value="2">Type 2</option>

<option value="3">Type 3</option>

<option value="4">Type 4</option>

<option value="5">Type 5</option>

<option value="6">Type 6</option>

<option value="7">Type 7</option>

</select>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D2_NoBM"><b>Number of bowel motions (how many times have you gone for a poo?)</b></label>

<p><textarea class="form-control" name="cp_D2_NoBM" id="cp_D2_NoBM" rows="1" style="width: 100%;"></textarea></p>

</div>

</div>

</div>

<br /><br />

<a href="#bottom" class="btn arrow btn-primary" title="BottomToSave" alt="Click here to go to the bottom of the plan to save">Jump to Bottom to Save</a>

<br /><br />

<div class="cp_whiteBox" id="cp_Day3">

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D3"><b>Day 3 - </b></label>

<b>

<select class="form-control" name="cp_D3" id="cp_D3">

<option value="--">Select</option>

<option value="Monday">Monday</option>

<option value="Tuesday">Tuesday</option>

<option value="Wednesday">Wednesday</option>

<option value="Thursday">Thursday</option>

<option value="Friday">Friday</option>

<option value="Saturday">Saturday</option>

<option value="Sunday">Sunday</option>

</select>

</b>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D3_Breakfast"><b>Breakfast</b></label>

<p><textarea class="form-control" name="cp_D3_Breakfast" id="cp_D3_Breakfast" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D3_Lunch"><b>Lunch</b></label>

<p><textarea class="form-control" name="cp_D3_Lunch" id="cp_D3_Lunch" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D3_Supper"><b>Supper</b></label>

<p><textarea class="form-control" name="cp_D3_Supper" id="cp_D3_Supper" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D3_Snacks"><b>Snacks / Drinks / Laxatives</b></label>

<p><textarea class="form-control" name="cp_D3_Snacks" id="cp_D3_Snacks" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D3_StoolType"><b>Stool Type (poo) </b></label> <a href="#cp_Chart">(Click to view Bristol Stool Chart)</a>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<select class="form-control" name="cp_D3_StoolType" id="cp_D3_StoolType">

<option value="--">Select</option>

<option value="1">Type 1</option>

<option value="2">Type 2</option>

<option value="3">Type 3</option>

<option value="4">Type 4</option>

<option value="5">Type 5</option>

<option value="6">Type 6</option>

<option value="7">Type 7</option>

</select>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D3_NoBM"><b>Number of bowel motions (how many times have you gone for a poo?)</b></label>

<p><textarea class="form-control" name="cp_D3_NoBM" id="cp_D3_NoBM" rows="1" style="width: 100%;"></textarea></p>

</div>

</div>

</div>

<br /><br />

<a href="#bottom" class="btn arrow btn-primary" title="BottomToSave" alt="Click here to go to the bottom of the plan to save">Jump to Bottom to Save</a>

<br /><br />

<div class="cp_whiteBox" id="cp_Day4">

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D4"><b>Day 4 - </b></label>

<b>

<select class="form-control" name="cp_D4" id="cp_D4">

<option value="--">Select</option>

<option value="Monday">Monday</option>

<option value="Tuesday">Tuesday</option>

<option value="Wednesday">Wednesday</option>

<option value="Thursday">Thursday</option>

<option value="Friday">Friday</option>

<option value="Saturday">Saturday</option>

<option value="Sunday">Sunday</option>

</select>

</b>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D4_Breakfast"><b>Breakfast</b></label>

<p><textarea class="form-control" name="cp_D4_Breakfast" id="cp_D4_Breakfast" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D4_Lunch"><b>Lunch</b></label>

<p><textarea class="form-control" name="cp_D4_Lunch" id="cp_D4_Lunch" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D4_Supper"><b>Supper</b></label>

<p><textarea class="form-control" name="cp_D4_Supper" id="cp_D4_Supper" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D4_Snacks"><b>Snacks / Drinks / Laxatives</b></label>

<p><textarea class="form-control" name="cp_D4_Snacks" id="cp_D4_Snacks" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D4_StoolType"><b>Stool Type (poo) </b></label> <a href="#cp_Chart">(Click to view Bristol Stool Chart)</a>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<select class="form-control" name="cp_D4_StoolType" id="cp_D4_StoolType">

<option value="--">Select</option>

<option value="1">Type 1</option>

<option value="2">Type 2</option>

<option value="3">Type 3</option>

<option value="4">Type 4</option>

<option value="5">Type 5</option>

<option value="6">Type 6</option>

<option value="7">Type 7</option>

</select>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D4_NoBM"><b>Number of bowel motions (how many times have you gone for a poo?)</b></label>

<p><textarea class="form-control" name="cp_D4_NoBM" id="cp_D4_NoBM" rows="1" style="width: 100%;"></textarea></p>

</div>

</div>

</div>

<br /><br />

<a href="#bottom" class="btn arrow btn-primary" title="BottomToSave" alt="Click here to go to the bottom of the plan to save">Jump to Bottom to Save</a>

<br /><br />

<div class="cp_whiteBox" id="cp_Day5">

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D5"><b>Day 5 - </b></label>

<b>

<select class="form-control" name="cp_D5" id="cp_D5">

<option value="--">Select</option>

<option value="Monday">Monday</option>

<option value="Tuesday">Tuesday</option>

<option value="Wednesday">Wednesday</option>

<option value="Thursday">Thursday</option>

<option value="Friday">Friday</option>

<option value="Saturday">Saturday</option>

<option value="Sunday">Sunday</option>

</select>

</b>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D5_Breakfast"><b>Breakfast</b></label>

<p><textarea class="form-control" name="cp_D5_Breakfast" id="cp_D5_Breakfast" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D5_Lunch"><b>Lunch</b></label>

<p><textarea class="form-control" name="cp_D5_Lunch" id="cp_D5_Lunch" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D5_Supper"><b>Supper</b></label>

<p><textarea class="form-control" name="cp_D5_Supper" id="cp_D5_Supper" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D5_Snacks"><b>Snacks / Drinks / Laxatives</b></label>

<p><textarea class="form-control" name="cp_D5_Snacks" id="cp_D5_Snacks" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D5_StoolType"><b>Stool Type (poo) </b></label> <a href="#cp_Chart">(Click to view Bristol Stool Chart)</a>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<select class="form-control" name="cp_D5_StoolType" id="cp_D5_StoolType">

<option value="--">Select</option>

<option value="1">Type 1</option>

<option value="2">Type 2</option>

<option value="3">Type 3</option>

<option value="4">Type 4</option>

<option value="5">Type 5</option>

<option value="6">Type 6</option>

<option value="7">Type 7</option>

</select>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D5_NoBM"><b>Number of bowel motions (how many times have you gone for a poo?)</b></label>

<p><textarea class="form-control" name="cp_D5_NoBM" id="cp_D5_NoBM" rows="1" style="width: 100%;"></textarea></p>

</div>

</div>

</div>

<br /><br />

<a href="#bottom" class="btn arrow btn-primary" title="BottomToSave" alt="Click here to go to the bottom of the plan to save">Jump to Bottom to Save</a>

<br /><br />

<div class="cp_whiteBox" id="cp_Day6">

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D6"><b>Day 6 - </b></label>

<b>

<select class="form-control" name="cp_D6" id="cp_D6">

<option value="--">Select</option>

<option value="Monday">Monday</option>

<option value="Tuesday">Tuesday</option>

<option value="Wednesday">Wednesday</option>

<option value="Thursday">Thursday</option>

<option value="Friday">Friday</option>

<option value="Saturday">Saturday</option>

<option value="Sunday">Sunday</option>

</select>

</b>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D6_Breakfast"><b>Breakfast</b></label>

<p><textarea class="form-control" name="cp_D6_Breakfast" id="cp_D6_Breakfast" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D6_Lunch"><b>Lunch</b></label>

<p><textarea class="form-control" name="cp_D6_Lunch" id="cp_D6_Lunch" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D6_Supper"><b>Supper</b></label>

<p><textarea class="form-control" name="cp_D6_Supper" id="cp_D6_Supper" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D6_Snacks"><b>Snacks / Drinks / Laxatives</b></label>

<p><textarea class="form-control" name="cp_D6_Snacks" id="cp_D6_Snacks" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D6_StoolType"><b>Stool Type (poo) </b></label> <a href="#cp_Chart">(Click to view Bristol Stool Chart)</a>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<select class="form-control" name="cp_D6_StoolType" id="cp_D6_StoolType">

<option value="--">Select</option>

<option value="1">Type 1</option>

<option value="2">Type 2</option>

<option value="3">Type 3</option>

<option value="4">Type 4</option>

<option value="5">Type 5</option>

<option value="6">Type 6</option>

<option value="7">Type 7</option>

</select>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D6_NoBM"><b>Number of bowel motions (how many times have you gone for a poo?)</b></label>

<p><textarea class="form-control" name="cp_D6_NoBM" id="cp_D6_NoBM" rows="1" style="width: 100%;"></textarea></p>

</div>

</div>

</div>

<br /><br />

<a href="#bottom" class="btn arrow btn-primary" title="BottomToSave" alt="Click here to go to the bottom of the plan to save">Jump to Bottom to Save</a>

<br /><br />

<div class="cp_whiteBox" id="cp_Day7">

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D7"><b>Day 7 - </b></label>

<b>

<select class="form-control" name="cp_D7" id="cp_D7">

<option value="--">Select</option>

<option value="Monday">Monday</option>

<option value="Tuesday">Tuesday</option>

<option value="Wednesday">Wednesday</option>

<option value="Thursday">Thursday</option>

<option value="Friday">Friday</option>

<option value="Saturday">Saturday</option>

<option value="Sunday">Sunday</option>

</select>

</b>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D7_Breakfast"><b>Breakfast</b></label>

<p><textarea class="form-control" name="cp_D7_Breakfast" id="cp_D7_Breakfast" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D7_Lunch"><b>Lunch</b></label>

<p><textarea class="form-control" name="cp_D7_Lunch" id="cp_D7_Lunch" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D7_Supper"><b>Supper</b></label>

<p><textarea class="form-control" name="cp_D7_Supper" id="cp_D7_Supper" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D7_Snacks"><b>Snacks / Drinks / Laxatives</b></label>

<p><textarea class="form-control" name="cp_D7_Snacks" id="cp_D7_Snacks" rows="2" style="width: 100%;"></textarea></p>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D7_StoolType"><b>Stool Type (poo) </b></label> <a href="#cp_Chart">(Click to view Bristol Stool Chart)</a>

</div>

</div>

<div class="row">

<div class="col-sm-12">

<select class="form-control" name="cp_D7_StoolType" id="cp_D7_StoolType">

<option value="--">Select</option>

<option value="1">Type 1</option>

<option value="2">Type 2</option>

<option value="3">Type 3</option>

<option value="4">Type 4</option>

<option value="5">Type 5</option>

<option value="6">Type 6</option>

<option value="7">Type 7</option>

</select>

</div>

</div>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<label for="cp_D7_NoBM"><b>Number of bowel motions (how many times have you gone for a poo?)</b></label>

<p><textarea class="form-control" name="cp_D7_NoBM" id="cp_D7_NoBM" rows="1" style="width: 100%;"></textarea></p>

</div>

</div>

</div>

<div class="cp_whiteBox" id="bottom">

<label for="cp_DayLink"><b>Jump to day: </b></label>

<a href="#cp_Day1"> 1 </a>

<a href="#cp_Day2"> 2 </a>

<a href="#cp_Day3"> 3 </a>

<a href="#cp_Day4"> 4 </a>

<a href="#cp_Day5"> 5 </a>

<a href="#cp_Day6"> 6 </a>

<a href="#cp_Day7"> 7 </a>

<div class="row" style="margin-top: 15px">

<div class="col-sm-12">

<a href="#cp_Chart">Jump to Bristol Stool Chart</a>

</div>

</div>

</div>

</div>