Change in practice to decrease use of internal fecal management system

Jeanne Arseneau, MSN, RN, CWOCN, Wound, Ostomy & Continence Department, MedStar Franklin Square Medical Center, Rosedale, MD
Change in practice to decrease use of internal fecal management system.

Fecal incontinence with diarrhea in the acute care setting requires careful and attentive management to prevent skin breakdown and infection.  The use of an internal fecal management system (IFMS) diverts liquid or semi-liquid stool into a collection bag but it has potential risks of causing serious patient harm.  At a community hospital in the Northeast, it was discovered that IFMS was used very frequently, the documentation system did not include a section for the IFMS, and the hospital policy needed updating and clarification for the role of the nurse and the medical staff. During the process of developing the new documentation and policy update, a safety alert was received from our Corporate division concerning two rectal perforations in a sister hospital. The safety alert accelerated the completion of the new documentation and the policy. Education was disseminated to the nursing and medical staff on the new policy regarding indications, contraindications, medication reconciliation, use of fecal pouch prior to considering IFMS, medical staff assessment of anal sphincter tone, and guidelines for discontinuation. The new change in practice resulted in decreasing the IFMS usage from 391 to 122 and cost savings of $43,000 for the year.