Developing a critical care bowel management assessment tool to manage faecal incontinence

Abstract

Background: Critical care patients with faecal incontinence are at high risk of developing moisture lesions, pressure ulcers and secondary infection. Aims: The aims of this quality improvement programme were to identify the level of harm caused by faecal incontinence in critical care, and to review current critical care nursing practice on the use of bowel management systems, with the intent to implement changes to prevent delayed insertion. The improvement programme: A four-step approach was used to guide the improvement programme. A total of seven case studies across three critical care units were reviewed and information was collected on stool type and frequency, duration of diarrhoea and skin integrity prior to bowel management system insertion. Discussion: Critical care nurses may not always use a consistent approach to the assessment of patients at risk of moisture or pressure damage due to faecal incontinence. Lack of knowledge about the maintenance of bowel management systems was viewed as a likely reason for the inconsistent approach. A Critical Care Bowel Management Assessment Tool was created, to contribute towards a more standardised approach to bowel assessment and management. Conclusions: Inadequate assessment and management of faecal incontinence may have implications for critically ill patients. Further evaluation is required in order to demonstrate over time whether the changes made, as a result of this quality improvement programme, have led to sustainable improvement.