March 2019 Wound Ostomy Journal
Improving Quality by Taking Aim at Incontinence-Associated Dermatitis in Hospitalized Adults
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How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe interventions used in the study include: a defined skin care program, education to help registered nurses distinguish IAD and pressure ulcers, evaluation of absorbent products, and documentation enhancements. In the study they used skin barrier products with zinc oxide and skin cleansers with a PH similar to the PH of skin. At PSJMC, we also do these things. They also mentioned absorbent pads that pull moisture from the skin when patients are incontinent. At PSJMC, we also use these pads and discourage the use of diapers. They study mentioned documentation enhancements for recording IAD and the interventions done. In Epic we have the ability to document a skin wound and the interventions done. Recently, our documentation upgrade enabled us to document it on an avatar in Epic. In the study, they mentioned education for nurses regarding IAD identification. At PSJMC, we also get education on Healthstream and voluntary wound events like the annual wound care symposium.
Describe the method used by the author in the study.
First, a literature review was done of from 1980 to 2012. Identification of IAD and potential solutions were studied in these articles. Literature was also searched again in 2015. Using data from the literature, four interventions were used to help prevent, identify, and deal with IAD.
Bethany Sobesto 5/1/19
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ReplyDeleteSkin care bundles allow nurses to follow a relatively comprehensive program to ensure patient's skin health. The key factors that were emphasized in this study reassured all that provider education is a necessity in order to accurately identify skin breakdown; the types of products used and applied to the skin need to be evaluated and carefully chosen; and opportunities for accurate documentation need to be available. Although this study focuses on the skin bundle, it may allow for too many variables that need to be measured. For example, if the study focused on more specific product types (i.e. pads, creams, containment products) or methods for practitioner education (nurses and aids alike) or alternatives to identifying patients with IAD, there may have been a tighter control on the outcomes, thus limiting potential variables. In the end, any type of quality education and therefore focus on change with the intent of favorable outcomes can improve quality. It should be the foundation for patient care regardless of practitioner position.
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
ReplyDelete-The article talked about the six strategies to for HAPI prevention: 1) Improved risk assessment where once a HAPI has been identified, a wound nurse referral is automatically generated and the CWOCN collaborates with the RN to build an individualized plan of care. 2) Individualized Pressure Injury Risk Factor Prevention where diapers are replaced by new absorbency pads. 3)Specialized prophylactic skin product and support surfaces i.e. pressure redistribution mattresses are utilized. 4) Early Mobility 5)Staff Education and 6) The Unit Skin Champion Role. All of these steps are also being utilized currently in PSJMC.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
- Limitations of the article include: resistance from patients and family members who refused the recommended care due to personal preferences. In addition, clinical factors are also involved such as suboptimal nutritional status and vulnerability of aged skin.
1. How does this research article compared to our practice, policy and or procedure?
ReplyDeleteThis journal is about the clinical practices of nurses who are members of the Australian College of Critical Care Nurses on how to prevent and manage incontinence associated dermatitis. Nurses recalled different interventions done including application of moisturizer or combination products at the end of the daily bed back. At PSJMC, we use Phytoplex Hydraguard silicone cream and Phytoplex Protectant Z-Gaurd Paste. These products protect the skin of patients at the risk of IAD by avoiding or reducing skin exposure to moisture and irritants. 50% of the nurses recalled applying a pad, under pad or absorbent pad between the patients and sheets. Our policy on the management of skin related to urinary and fecal incontinence includes utilizing pads that pulls the moisture away from the skin. Only one pad under the patience is recommended. The pad should be checked for soiling during hourly rounding and change as necessary. Another intervention implemented is the use of wipes or wash clothes with 3% dimethicone which is efficient in reducing IAD. PSJMC uses Ready Bath Fresh bathing cloths. These cleanse, moisturize, and soothe the skin. In our policy, soft, durable wash clothes with mild pH balance cleansing agent is recommended. Hot water and excess friction should be avoided. Also consider referral to wound care specialist for assessment and treatment recommendation.
2. Discuss the sample size used in the study.
A total of 1967 survey invitations were sent but only 1051 of these were opened with 149 people clicking on the link to the survey in the invitation. The response rate is 5.6% which is slow for this study.
Michelle Rios
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
Assessing for, preventing and/or caring for IADs is an everyday practice for PSJMC ICU nurses. IADs not only affect the integrity of the patient’s largest organ, the skin, but it contributes to patient discomfort, pain, and even satisfaction of care. At PSJMC, we have the skin bundle in place (minimizing friction, elevation of heels, use of 1 chuck /1 sheet pad, turning Q2H..etc) to assist in the prevention of PIs but not necessarily a policy or protocol for the prevention and/or treatment of IADs specifically, equivalent to the study findings. Our cleaning products include lotions (hydrogel/Z guard) and wipes (CHG and non CHG) but no barrier sprays. We also do not have a formal way to “grade” the severity of IADs and rely on WOC consults for care recommendations.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
One of the limitations of this article was the limited sample size and its focus on just Australian College of Critical Care Nurses members. The sample size of this study was comprised of 111 participants, all members of ACCN. 111 is a good number, however, a total of 1967 invitations were sent and of those 1051 viewed, making it a small 5.6% response rate. Because not all of Australia’s critical care nurses are members of the professional organization, the findings cannot be generalized as the daily practice and/or experiences with IAD for all Australian ICU nurses. It was a very focused and specific group of healthcare providers that chose to engage and participate in the survey.
Melissa Bautista
ReplyDelete1) What are the advantages and disadvantages to the proposed recommendations in the article?
The article mentions that health care facilities may consider using photographs in IAD education. I believe beside RNs could benefit from this because frequently if there is a wound on the sacrum/ coccyx area the first thought is usually always pressure injury. It could also help in early identification and treatment of IAD wounds before they progress to pressure injuries.
2) Describe the method used by the author of the study
A literature review was done from 1980-2012 to identify prevalence and potential solutions for incontinence/ IAD. A second literature search was done in January 2015 to identify new evidence and practice guidelines. The study used an evidence based intervention bundle based on literary review to identify, prevent, and manage IAD in hospitalized patients.