Bringing Spinal Cord Bowel Program into the 21st CenturyKatherine R. Huber BS, BSN, JD, CRRNRebecca Shaw BSN, MSN, CRNP, CRRN

University of Alabama at Birmingham Hospital

Methods

Surveyed interdisciplinary team to determine problems & clarify realistic goalsPerformed a thorough literature search to determine current evidence based practiceEstablished a unit based PACT workgroup which included nursing, medicine, occupational therapy, physical therapy and pharmacy. Nursing education, dietary and recreational therapy were also consulted.A workable plan was developed which addressed the issues identified.

Introduction

Spinal Cord Injury patients have neurogenic bowels requiring lifelong management. Our SCI bowel program was outdated and not meeting the needs of our patients. It needed to be updated due to challenges in today’s healthcare environment which included:

Switch from 8 to 12 hour shifts

Nursing protocols no longer used

Primary nurse model no longer used

Shortened length of acute care and rehab stays

Need to include interdisciplinary team members

Patients often had bowel accidents and missed therapy sessions.

Patients & families did not learn skills needed for successful transition to home.

Outcomes

Significant changes in SCI bowel program resulted in: Improved bowel management success ratesDecreased time involved in establishing bowel management programShortened time required for daily bowel programImproved patient satisfaction with individual programsImproved staff satisfaction with bowel program reliabilityImproved team communication and moraleImproved nursing staff work flow

Purpose

To create a SCI bowel program based on evidence based practice.Meet the needs of our SCI patients and improve outcomes including:Fewer bowel accidentsDecreased loss of therapy timeIncreased patient satisfactionIncreased patient complianceImproved carry over to home programIncreased interdisciplinary team involvement in planning & implementing bowel program

Conclusions & Future Implications

Revisions in SCI bowel program are solving many of the identified problems. Quality improvement is an ongoing process.

Suggestions for the future include:Re-survey staff regarding what works & suggestions for improvement.Create & implement patient satisfaction survey toolImplement changes in SCI bowel program power planEvaluate results of surveys and revise program as needed.Collect data on current bowel program duration and number of therapy sessions missed.

Thanks to our team members: Jenny Taylor, PT; Randie Carter, OT; Matthew Joiner, RPh; Deborah Walker, NM; Tarina Mabry-Orr, NM and Keneshia Kirksey, MD.

Implementation

Established 2 separate bowel program groups, morning & bedtime, based on current functional goals.Changed timing of programs to allow OT & PT to participate with patients assigned to morning group whose goal is hands-on self management.Evening group scheduled to allow nursing time to concentrate on teaching patients to direct caregivers being trained.Changed timing of medications to accommodate nursing shifts. Gained approval for non-formulary polyethylene glycol base bisacodyl suppository based on literature review results.Revised staff and patient/family educational materials to reflect changes in programsNursing staff utilize power point presentation during structured patient education classes weekly.Included bowel program on patient’s daily printed therapy scheduleRevising EMR SCI bowel program power plan (electronic order set)Purchased durable medical equipment including padded bedside commodes and tilt & space multifunctional shower chairs to position patients upright for better bowel evacuation.