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Bringing Spinal Cord Bowel Program into the
Century
Katherine R. Huber BS, BSN, JD, CRRN
Rebecca Shaw BSN, MSN, CRNP, CRRN
University of Alabama at Birmingham Hospital
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 Our SCI bowel program was outdated and not meeting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:
Outcomes
Methods
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.
Surveyed interdisciplinary team to determine problems &
clarify realistic goals
Performed a thorough literature search to determine current
evidence based practice
Established 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.
Significant changes in SCI bowel program resulted in:
Improved bowel management success rates
Decreased time involved in establishing bowel management program
Shortened time required for daily bowel program
Improved patient satisfaction with individual programs
Improved staff satisfaction with bowel program reliability
Improved team communication and morale
Improved nursing staff work flow
Implementation
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 accidents
Decreased loss of therapy time
Increased patient satisfaction
Increased patient compliance
Improved carry over to home program
Increased interdisciplinary team involvement in planning &
implementing bowel program
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 programs
Nursing staff utilize power point presentation during structured
patient education classes weekly.
Included bowel program on patient’s daily printed therapy schedule
Revising 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.
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 tool
Implement changes in SCI bowel program power plan
Evaluate 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.