Identify and Contain: Fecal Incontinence Management and CAUTI

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Primary Author:</td>
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Katelyn Overstreet, RN BSN CCRN  </td>
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Co-Principal Investigators/Collaborators:</td>
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Amalia M. Belcher RN, MSN, CN, Kathleen Rea MSN, APRN, ACNS-BC, CNL, Kyle B. Enfield, MD, Jennifer Stengel RN BSN CCRN</td>
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Organization:</td>
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University of Virginia Health System</td>
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Abstract</h2>
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Purpose</h3>
<p>There is little existing evidence on the management of hospitalized patients with fecal incontinence (FI) to prevent Catheter Associated-Urinary Tract Infection (CA-UTI).</p>
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Background</h3>
<p>Analysis of Catheter Associated-Urinary Tract Infection data January to March 2013 revealed that 72% of patients who had diarrhea, defined as three or more semi-liquid stools in 24 hours, with an indwelling urinary catheter (IUC) in place did not have an internal or external bowel management system (BMS).</p>
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Materials & Methods</h3>
<p>An algorithm for FI management using BMS strategies was developed by an inter-professional team. Multi-modal staff education program was facilitated by advanced practice nurses and unit based clinical leaders. Application of the FI algorithm was integrated into care of acute and critically ill patients in two pilot units. Pre and post surveys were completed to assess knowledge and comfort levels with BMS. The utilization of BMS supplies was monitored. Data collected from rounds evaluated patients with IUC and BMS. Analysis of all patients with a CA-UTI in the pilot time period was conducted.</p>
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Results</h3>
<p>Education and use of the FI algorithm resulted in increased overall staff knowledge regarding: accurate identification of diarrhea; indications for initiating BMS and internal BMS change interval. Matched pair analysis of a subset of respondents showed no difference on decision making, insertion, and maintenance questions. Early success is evidenced by the critical care unit having 21% fewer infections compared to the previous calendar year and acute care having 400% fewer. The supply data was non-conclusive.</p>
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Conclusion</h3>
<p>The initial pilot period for FI management in CAUTI prevention should be extended. Data collection could be facilitated by report from the electronic medical record. The development of an algorithm for FI addressed a clinical decision making gap identified by an inter-professional team. Optimizing data collection to establish rates of BMS use and revising the staff survey would provide opportunity for additional learning. Overlap with other safety initiatives on both units may have introduced confounding variables.</p>
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Bibliography</h3>
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Beitz, J. Fecal incontinence in acutely and critically ill patients: options in management, Wound Ostomy Management. 2010; 52 (13), from http://www.owm.com/article/6544</li>
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Creehan, S. (2013). Fecal Management System Algorithm, Virginia Commonwealth University</li>
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Health System poster presentation. Palmieri, B., Benuzzi, G., Bellini, N. The anal bag: a modern approach to fecal incontinence management, Ostomy Wound Management. 2005; 51(12), from http://www.o-wm.com/article/4979</li>
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Wishin, J., Gallagher, J., McCann, E. Emerging options for the management of fecal incontinence in hospitalized patients, J Wound Ostomy Continence Nurs. 2008; 35(1):104-110</li>
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<p>© Improvement Science Research Network, 2012</p>
<p>The ISRN published this as received and with permission from the author(s).</p>