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1 University of Huddersfield Repository Ousey, Karen An evaluation of the management of faecal incontinence in two intensive care units Original Citation Ousey, Karen (2010) An evaluation of the management of faecal incontinence in two intensive care units. In: 7th Asia Pacific Nurses Convention (ASPAN), 30th June - 2nd July 2010, Singapore. (Unpublished) This version is available at The University Repository is a digital collection of the research output of the University, available on Open Access. Copyright and Moral Rights for the items on this site are retained by the individual author and/or other copyright owners. Users may access full items free of charge; copies of full text items generally can be reproduced, displayed or performed and given to third parties in any format or medium for personal research or study, educational or not-for-profit purposes without prior permission or charge, provided: The authors, title and full bibliographic details is credited in any copy; A hyperlink and/or URL is included for the original metadata page; and The content is not changed in any way. For more information, including our policy and submission procedure, please contact the Repository Team at: E.mailbox@hud.ac.uk.
2 Dr Karen Ousey University of Huddersfield
3 Acknowledgements The authors would like to thank Convatec UK Ltd who kindly supported this work via an Unrestricted Educational Grant.
4 Background Little research in the management of acute incontinence. Consensus meeting NICE Guidance (2007): Healthcare professionals should consider a faecal collection device for people in intensive care settings and people receiving palliative care with faecal incontinence and associated loose stools
5 Sample Intensive care services delivered by Calderdale and Huddersfield NHS Foundation Trust Huddersfield and Calderdale has a population of 435,000. Current estimates of in-patient activity, in the intensive care units combined, suggest a 200 patient throughput in a 3 month period and of these, 20-25% will have faecal incontinence problem.
6 Aims and objectives of study An evaluation of current practice in faecal incontinence (FI) management in two intensive therapy units To establish the current evidence base in faecal incontinence management in acute settings. To observe current faecal incontinence management in intensive care. To explore the impact of faecal incontinence to patients, staff and the organisation. To establish or re-develop an audit -driven protocol for intervention in faecal incontinence. To involve clinical nursing staff in the service evaluation /audit and research process.
7 Data (Stage 1) Prevalence of FI in ITU. Cause of FI. FI management. No. of FI episodes Pharmacology. Biochemistry. Nursing time.
8 Results Dates Unit In Patient No. Patients with FI Estimated prevalence per unit % (interval) 16/3/09 16/4/09 CRI HRI /4/09 16/6/09 CRI HRI Total Total Estimated Prevalence of FI (3 months) 22 (22.39) Mean Age; FI patients: 63 M: F: 40: 60 (%).
9 Reason for ITU Admission Cause n % Respiratory Sepsis 7 15 Surgery 7 15 Renal 3 7 Cardiac arrest 3 7 Overdose 1 Misc. other 12
10 Faecal Incontinence: Cause. Cause n % Unknown Antibiotics Feed 7 16 c.diff. 2 4 Other 5 11
11 No. of FI episodes (24 hour estimate)
12 FI Management Management n % Hygiene Incontinence pad 9 20 Faecal collection bag 8 19 Flexi-Seal 7 15 BMS 7 15
13 Waterlow Score Management Mean Score Risk Flexi-Seal Very High BMS Very High Faecal High collector Hygiene High Incopad Very High Total Very High
14 Skin Breakdown 10 ( 22%) of patients had peri-anal skin breakdown after the onset of FI: FI management of the 10 with skin breakdown: Flexi-Seal: 0 (0%) Hygiene: 3 (30%). Incontinence Pad: 2 (20%) Faecal collection Bag: 2 (20%) BMS: 3 (30%)
15 Management Options Intervention Protocol. Individualised patient assessment. Justification for management choice: Flexi-Seal Collection system. Faecal collection bag. BMS Collection system. Digni care Incontinence pads. Hygiene.
16 Intervention guidancemanagement of faecal incontinence in acute settings Acute, consistent faecal incontinence (FI) Individual Patient Assessment of Continence Needs: [ Dignity ] Reason for admission. Family/carer input. Post-surgery/trauma? Concordance/patient comfort- Cause of FI? Any indications for bowel manipulation/ drug intervention?, e.g. constipation C.Difficile-? Treatment I.V.Antibiotics-? Review Enteralfeed-? Change Other Infection Control Waterlow Score Bristol Stool Chart Bowel Management System Check: Contra-indications? (check product manual) Trained to use? Patient/family Consent Faecal Management System- (Flexi-Seal): Check: Contra-indications? (check product manual) Trained to use? Patient/ family Consent Faecal Collection Bag- Check: Skin integrityany excoriation? Patient/ family Consent Incontinence pads/hygiene Check: Skin integrity Patient/ family Consent Record: Fluid balance FI management Care plan Review: 6-12 hourly Faecal incontinence still present? Stool consistency? Waterlow score change? Patient comfort/ concordance Discharge: FI still present?: Liaise management
17 Summary Systematic approach to FI management is required. There is an education and training need. Resource/cost issues. Effective and individualised, patient concordant, management is achievable. National guideline.
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