Risky Business: Fecal Management System Use? Development of an Algorithm to Ensure Safety

Fecal incontinence can be a difficult challenge for the patient and bedside providers.  Over time fecal incontinence may complicate the patient’s course contributing to discomfort, skin breakdown, decreased strength and poor self-image. Bedside providers struggle to maintain the patient’s dignity and confront the substantial time involved in caring for patients with fecal incontinence.  There is limited research on the effective management of fecal incontinence, but best practice guidelines include the use of fecal management systems.

In our large university health system, a commercial fecal management system (FMS) was being used without clearly defined indications. The nursing policy did not effectively guide nursing to safely care for patients requiring an FMS. As the benefits of the system were realized, device utilization increased to approximately 100 per month, which in turn increased the rate of device related adverse events.

A team of invested clinicians sought to bring evidence based practice to this clinical issue by seeking an answer to the question: In the adult population what is the best practice for the use of a Fecal Management System?

After conducting a literature search, an evidence based insertion algorithm and competency plan were developed.  To ensure critical evaluation and determine patient appropriateness prior to insertion, the patient selection process must be validated by a second expert reviewer. 

Additionally to assist in timely removal of the FMS, the unit based experts ensure device necessity daily.  The IT system was leveraged to support documentation of these new requirements.

Since implementation of the new standards, the average monthly use of fecal management systems has dramatically decreased by 75% and there have been no adverse events. 

Learner Outcomes:

1. Describe evidence-based practice review in the use of fecal management systems
2. Review the nurse driven algorithm for best practices in management of a patient with fecal incontinence