Pittman J, Beeson T, Terry C, Kessler W, Kirk L, et al.
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy an.... Date of publication 2012 Nov 1;volume 39(6):633-9.
1. J Wound Ostomy Continence Nurs. 2012 Nov-Dec;39(6):633-9. doi:
10.1097/WON.0b013e31826a4b9c.
Methods of bowel management in critical care: a randomized controlled trial.
Pittman J(1), Beeson T, Terry C, Kessler W, Kirk L.
Author information:
(1)Indiana University Health-Methodist Hospital, Indianapolis 46206, USA.
jpittma3@iuhealth.org
PURPOSE: The purpose of this study was to compare 3 methods of bowel management
to control fecal incontinence in adult critical care patients and their effect
on incontinence-associated dermatitis, pressure ulcer prevalence, and clinician
satisfaction.
SUBJECTS AND SETTING: Fifty-nine adult patients in critical care with liquid
fecal incontinence were recruited from 6 critical care units in a large Midwest
healthcare system.
METHODS: Subjects were randomly assigned to 1 of 3 groups: bowel management
system catheter, rectal/nasopharyngeal trumpet, or usual care. Subjects were
assessed daily for incontinence-associated dermatitis, pressure ulcer
prevalence, and other clinical data. Direct care nurse satisfaction with each
method was evaluated by self-administered survey.
RESULTS: Incontinence-associated dermatitis severity and pressure ulcer
prevalence did not differ across groups at baseline. Over time, the change in
incontinence-associated dermatitis severity score was significantly different
across groups (P < .001). There were no significant differences in proportion of
patients experiencing pressure ulcers during the study among groups. Clinicians
reported significantly greater satisfaction with the bowel management system (P
= .007) and rectal trumpet (P = .001) as compared to usual care. In addition,
economic and safety benefits were identified with use of internal fecal devices.
Specifically, an economic savings of $3100 to $3400 per 29 days of care was
identified. Subjects experienced no adverse side effects when internal devices
were used.
CONCLUSION: Results of this randomized controlled trial provide new information
for the care of patients with fecal incontinence in the critical care setting.
Incontinence-associated dermatitis severity scores differed across groups over
time, pressure ulcer prevalence did not differ across groups over time, use of
an internal device or bowel management system improved clinician satisfaction,
and the use of internal fecal methods was more cost-effective than usual care.
DOI: 10.1097/WON.0b013e31826a4b9c
PMID: 22948494 [Indexed for MEDLINE]
