fecal incontinence

[2bnurse12341234]

Hello all,

I am doing a project on fecal incontinence and I am trying to understand fecal incontinence in different patient groups. Specifically, I am interested in acute care non-ambulatory patients vs non-ambulatory nursing home patients and non-ambulatory patients receiving home care.

What are the management systems currently in use for these patient groups? How long are patients incontinent for? Does Medicare cover the cost of the respective management system used? What are the main risk factors for fecal incontinence in each patient group?

Any help with this is much appreciated!

Thanks!

[NurseMellie]

Oh boy, you opened a can of worms in that one. I can only speak from the LTC aspect. Many of my residents are older like 80+ and they have developed incontinence over time typically. Could be for a variety of reasons, IE; being paralyzed, dementia, the occasional oops "I didn't make it in time". With the older population if its a functional incontinence, they most of the time will loose it. If its stress or urge, there are different techniques to limit incontinent episodes.

I put in place toileting programs and assess their bowel patterns in attempts to meet their needs better. Toileting Q2hrs is not what to do with those care plans, those are cookie cutter. My NACs provide peri-care after each incontinent episode and apply a barrier cream to help keep the skin intact. Sometimes its as simple as their stools are too soft and they need a bulking agent. Then I get some on board.

Medicare sometimes will cover the cost of briefs and supplies. Its a dignity issue with older folks. No one wants to be incontinent. You have skin breakdown, depression, UTIs etc.

[2bnurse12341234]

Thanks for the help!

I have a few more questions: is stool sampling something is done in LTC? Are any of those indwelling bowel management systems used in LTC's?

Thanks again!

[LoveMyBugs, BSN, CNA, RN]

In acute settings, incontinence can be for a variety of reasons. Disease process, traumas, TBI, age.

Some can regain function with bowel training programs and therapy.

[NRSKarenRN, BSN, RN]

Home Care:

Fecal Incontinence products are not covered by Medicare under home care benefit. Clients with PERMANENT URINARY INCONTINENCE, some states Medicaid program will cover cost chux and absorbant briefs along with indwelling catheters.; Fecal device is used for LIQUID stool, rarely permanant, unaware of product covered --will confirm with my PA DME companies.

[NurseMellie]

We will often test stool samples if we suspect Cdiff or some other GI issue such as a bleed. But devices for stool are rarely used. Ive seen 2 in my nursing career, one was in the hospital and one was on a resident who came back from the hospital with it... They don't stay in long. In ltc, supplies such as catheters and supplies are covered usually under medicare B but only like 1-2 a month and the orders/dx have to be very specific before they will cover.