Sacred Cow Summary of evidence presented Recommendations Rectal tubes to manage fecal incontinence Rectal tubes are the least safe intervention for fecal incontinence and the procedure is poorly defined. Fecal containment devices may be indicated when incontinence associated dermatitis is extensive or progressing. Evidence based management for fecal incontinence is focused on accurate assessment of risk, early proactive skin care and critical evaluation of when a fecal collection devise is needed. Evidence based interventions for fecal incontinence: Evaluate cause of diarrhea (patient history, medications, treatments) using a designated risk assessment tool Implement interventions to protect skin moisturizers and moisture barrier products use no-rinse bath products and wipes (rather than soap and washcloths) use single moisture-absorbing underpads limited layers of bedding avoid diapers in immobile patients. Use fecal collectors (self-adhering, external devices) when incontinence is excessive or incontinence-associated dermatitis is progressing. Avoid using traditional rectal tubes (i.e. mushroom catheter, urinary catheter with balloon) as they are the least safe approach to managing diarrhea.