Development of an evidence based algorithm for implementation of a fecal management system outside of the ICU

Topic  The use of fecal management devices is an effective way to manage high volume diarrhea in patients in the ICU who are bedbound.  The use of these devices may be expanded to include patients in the general hospital population when they meet criteria. 

Purpose:  To develop an algorithm to guide the use of fecal management devices for patients on a bone marrow transplant unit.  Patients who have undergone peripheral blood stem cell transplant are at risk for diarrhea secondary to graft verse host disease of the gut.  The physicians, extenders and nurses on this unit needed to be empowered to safely implement fecal management devices. Thus, an evidence based algorithm was developed to guide the use of this technology.   

Objective:  To develop an algorithm to guide the use of fecal management devices.  This algorithm will empower the bedside staff nurse to use an evidence based tool to correctly choose when a fecal management device can be safely used in the patient undergoing peripheral blood stem cell transplantation.

Outcomes:    After the development of an algorithm for use of a fecal management device, the staff nurses were in-serviced in the correct use of the product.  The algorithm was present to the medical staff and the use of a fecal management device was embraces by the medical team.  The incidences of WOC consults for incontinence associated dermatitis in this vulnerable population have anecdotally been noted to be decreased. 

Conclusion:  An evidence based algorithm for the use of a fecal management device in the patient undergoing a peripheral blood stem cell transplantation is an effective way to empower the bedside RN to safely implement technology and improve patient outcomes.