A Multidisciplinary Approach to Improving Outcomes for Critical Care Patients with Fecal Incontinence

Caring for patients with fecal incontinence is challenging for nurses. In critical care units the prevalence of fecal incontinence is as high as 33%. [1]  Stool incontinence can lead to Incontinence Associated Dermatitis (IAD) and contribute to pressure ulcer (PU) development, a quality indicator and reimbursement issue for acute care hospitals. Despite our hospitals’ existing nursing policies for the management of patients with bowel dysfunction, care of these patients was inconsistent based on observations made during WOC nurse consultations, skin survey data, and PU prevalence rates.            In 2005, the WOC Nurses facilitated a multidisciplinary group to evaluate the nursing policy and educational initiatives for the care of patients with bowel dysfunction.  By 2006, the group had selected a bowel catheter system, created and revised the procedures for Management of Fecal Incontinence and Bowel Dysfunction. Nursing education was provided on an ongoing basis.            A follow-up survey was completed in 2008, to evaluate nurse satisfaction with the performance of the bowel catheter system. Odor, leakage, and associated skin breakdown were the major problems identified.  We evaluated a different bowel catheter with a collapse resistant annulus and gravity irrigation in nine patients in the Medical Intensive Care Unit. Post trial survey showed increased satisfaction with the new bowel catheter and a change to that system was made.  Follow up survey one year later indicated continued nurse satisfaction with this product, and there was continued improvement in skin survey data and PU prevalence.            Outcomes: Our educational initiatives include extensive educational support on the WOC Nurse website, an electronic competency document, and a provider entry order set. An automated WOCN consult request is generated with each catheter ordered.

Using this multidisciplinary group, and implementing the changes, the PU prevalence in the Critical Care Units has decreased from 14% in 2004 to 9 % in 2008.