1. Bringing Spinal Cord Bowel Program into the 21 st Century Katherine R. Huber BS, BSN, JD, CRRN Rebecca Shaw BSN, MSN, CRNP, CRRN University of Alabama at Birmingham Hospital Methods 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. 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 Our SCI bowel program was outdated and not meeting the needs of our patients.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 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 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 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. 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 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.