title: Bowel management systems in critical care: a service evaluation.
abstract: Aim Many patients who are critically ill develop faecal incontinence associated with diarrhoea, and require a bowel management system (BMS) to prevent skin excoriation. Following guidelines produced by the National Institute for Health and Care Excellence, early rehabilitation has resulted in a reduction in the number of days that patients receive mechanical ventilation. However, patients with a BMS are potentially mechanically ventilated for longer because they are cared for in bed. The aim of this evaluation was to investigate whether patients with a BMS are mechanically ventilated for longer than those without a BMS. Method This was a retrospective service evaluation, in which a database search was conducted to identify patients admitted to the critical care department in one healthcare organisation during 2013. The search was narrowed to identify patients admitted to the critical care department who had received advanced respiratory support (mechanical ventilation), to compare the mean number of mechanically ventilated days between patients with and without a BMS (n = 122). Data were analysed using the Mann-Whitney U test. Results There was a significant difference in the number of mechanically ventilated days (P<0.01), with patients with a BMS being ventilated for an average of 5 days longer than those without a BMS. Conclusion The difference in the number of mechanically ventilated days may be a result of the patient having difficulty mobilising with a BMS in situ. Subsequently, critically ill patients with a BMS are placed in a sitting position for short periods of time. Further research should explore alternative bowel care options for patients who are critically ill.
authors.affiliation: Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Gateshead, Tyne and Wear, England.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ritzema
keywords: advanced respiratory support; bowel care; bowel management; critical care; diarrhoea; faecal incontinence; gastroenterology; mechanical ventilation; service evaluation