Promoting a new standard for fecal containment proves cost effective

Hospital-acquired complications are a major patient safety threat and a financial burden on hospital settings. Conventional technology of fecal management systems (FMS) poses an increased risk to rectal tissue/sphincter injury and are limited by sphincter tone presence and effluent consistency. These restrictions limit nurse interventions available to provide a safe microclimate for the patient’s skin. A new FMS utilizing soft stent technology rather than a balloon had become available and provided wider patient eligibility. An algorithm was designed to optimize proper FMS placement time and measure the effect on rates of incontinence associated dermatitis (IAD), catheter associated urinary tract infection (CAUTI) and hospital acquired pressure injury (HAPI). Foundation for the clinical decision making was (a) quantity/duration, (b) skin assessment, (c) rectal exam/contraindications, (d) skin prevention, (e) skin treatment, (f) selection of fecal containment device, and (h) monitoring. The project was conducted in a Level 3 Trauma, 245-bed acute-care hospital in Tucson, AZ. This algorithm was integrated into the existing Pressure Injury Prevention Protocol and education was provided to staff. The efficacy of the algorithm utilizing this new FMS system contributed to a decrease in CAUTI rates by 50%, HAPI by 100% and IAD by 76% relative to the previous three years and increased the eligibility by 1/3 with a total of 55 patients. The cost-savings were compared between the old and new vendor with a $2724/year savings. Timeliness of skin assessment for moisture and/or placement of device was the catalyst for success. Through this process it was learned that Wound, Ostomy and Continence Nurse (WOCN) advocacy for promotion of algorithm utilization was necessary. Continuous education and monitoring were essential for a successful algorithm implementation and improved clinical outcomes.