Cecilia Zamarripa, MSN, RN, CWON, Department of Enterostomal Therapy Nursing, The University of Pittsburgh Medical Center, Pittsburgh, PA, Carol Mathews, BSN, RN, CWOCN, University of Pittsburgh Medical Center Presbyterian Shadyside, UPMC Shadyside, Pittsburgh, PA, Lisa Donahue, DNP, RN, CPPS, Patient Safety and Innovation, University of Pittsburgh Medical Center Presbyterian Shadyside, Pittsburgh, PA, Kristian Feterik, MD, General Internal Medicine, University of Pittsburgh Medical Center Presbyterian Shadyside, Pittsburgh, PA, Sarah Cua, RN, MSN, MBA, Transplant Intensive Care Unit, University of Pittsburgh Medical Center Presbyterian Shadyside, Pittsburgh, PA and Janet Mullen, BSN, BA, RN, CWOCN, CFCN, University of Pittsburgh Medical Center Passavant Hospital, Wound, Ostomy, Continence Nurse, Pittsburgh, PA
The use of nasopharyngeal airway devices as off label rectal trumpets to manage fecal incontinence resulted in several serious events that compromised safe patient care. Best approaches for fecal containment and skin integrity management were reviewed and revised to improve patient safety and to provide staff with safe alternatives for fecal management. Previous policy and guidelines regarding the use of all fecal containment devices were revised to reflect the changes made to promote best patient care outcomes and safe use. This process resulted in removing nasopharyngeal airway as off label rectal trumpet use. A Fecal Containment Management Order set was developed to ensure a safe patient selection and use of an optional fecal containment device.
Serious events related to bleeding associated with rectal trumpet use were noted and data collected revealed additional fecal management issues such as laxative and stool softener usage regardless of liquid stool presence. Fecal containment management policy revision, nursing and medical staff re-education and development of a proactive diarrhea management bundle (DMB) for patients with device contraindications were addressed and developed.
The alternative fecal management system listed several precautions and contraindications to the product use. Additional process changes when device is ordered includes automatic WOC Nurse consult to assess the patient and conduct a review of the electronic health record. After the initial assessment, and if the fecal containment device is contraindicated for use, the WOC Nurse completes the form that lists the potential contraindications. If contraindications, the WOC Nurse will not release the fecal containment device and the order set is discontinued. The provider may choose to override this order for the best interest of the patient but if that choice is made, the provider will be required to obtain consent from the patient/family detailing the potential risk and benefit of using the device.
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