Defining and reporting diarrhoea during enteral tube feeding: do health professionals agree?

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Abstract
The criteria used to define diarrhoea during enteral tube feeding (ETF) and the interrater reliability of nursing staff reporting it in clinical practice has not been investigated. A structured questionnaire was sent to a cohort of dietitians, specialist stroke nurses, intensive therapy unit (ITU) nurses and consultant gastroenterologists regarding their criteria for defining ETF diarrhoea. In a clinical study, nursing staff independently inspected faeces from patients receiving ETF and were asked whether they considered the patient to have diarrhoea. Thirty-five healthcare workers responded to the questionnaire. Faecal frequency, faecal consistency and faecal quantity were all considered important criteria in defining ETF diarrhoea. Faecal frequency was considered more important than consistency and quantity (P = 0.048), although not all professional groups agreed on the order of importance. In the clinical study, nursing staff agreed on the presence or absence of diarrhoea on 75% of occasions, with agreement being only fairly reliable (kappa = 0.48). Healthcare workers use a range of criteria to define ETF diarrhoea, but may not agree on the importance of each criteria. In order to prevent confusion between professional groups, healthcare workers should be encouraged to describe faecal characteristics rather than rely on the term 'diarrhoea'.