April 2020 Wound and Ostomy Journal
Moisture-associated skin damage: a skin issue more prevalent than pressure ulcers.
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Describe the method used by the author of the study
ReplyDeleteThis was a cross-sectional cohort study conducted at outpatient rehab center, Bendigo Health, Australia for 12 month period. Patients 18 and older with musculoskeletal conditions and with chronic pain. The study develop several venues to educate the nursing staff and invited all participants to be included in the cohort.
Was the correct method used? Why or why not?
The method was a cross sectional and it was adequate for this sample population, but random controlled trial ids the most reliable study in research. This is because it eliminates some researcher bias that would maximize the reliability. Cross-sectional still is a good method, but it becomes bias by the participant to answer questions in a subjective matter. It does not eliminate social economic status and educational background, which can leave more under served populations.
ReplyDeleteARTICLE 1 : Moisture-associated skin damage: a skin issue more prevalent than pressure ulcers
1. How does this research article compare to our practice, policy and or procedure?
This is a good article that affirms our practices/policy and procedures. We have an excellent Wound Care Team Experts who assessed the patients when they are consulted and make recommendations for an effective treatment. In addition to that , we have unit - based team who makes weekly rounds to follow up on the status of the skin issues.
We have available foam dressings, barrier cream , etc that are available in the unit. We have a good structured skin regimen in our hospital that is implemented.
2. What are the advantages and disadvantages to the proposed recommendations in the article?
The article pointed out the Best Practice to prevent and manage IAD is by managing the incontinence and following a structured skin regimen.
This I believed are both advantageous. Keeping the skin clean & dry and free from soiled linens will be the first step to skin healing. It will also be the way to prevent the skin issues. The skin regimens as in use of foam dressing or barrier clean cream, etc will not be as effective if there's continuous exposure to moisture.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis research article conducted a quality improvement program to develop and implement an assessment tool and management guide for those patients at high risk for skin damage to the sacral region. The assessment tool used in the article is similar to Braden Scale that all nurses at PSJMC chart via EPIC every shift to predict pressure ulcer risk of their patients. Based on the Braden scale score, we as nurses can tailor preventive measures to help reduce the risk of skin breakdown of our patients. Using barrier cream and absorbent pads as stated in the management chart in the study are similar polices used at PSJMC. Although the study created tools tailored to the ICU, there are some differences in our policy and practice at PSJMC. Our policy states that we conduct a thorough skin assessment on all our patients, take photo(s) of suspected pressure injuries, place a wound consult, and take preventive precautions to prevent further skin injury. These preventive measures include off loading via turning patient every 2 hours, preventive foam to bony prominence, incontinent perianal care including barrier creams, and/or placing patient on specialty bed/mattress. The article did not mention using offloading foams/wedges or mepliex for our bedbound patients that are implemented at PSJMC. We also usually don’t consider placing rectal tube as stated in the article, unless the patient has frequent incontinent liquid stool.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One of the biggest limitations is the study was very small scaled with no budget. This did not allow for a more extensive pool of data/studies to be collected based around incontinence-associated dermatitis (IAD). The study did not talk about a baseline and how that compared to results after implementing the research. The article did not describe if the quality improvement program was effective or not in care for patient’s with IAD. The article also described that nurses were at times too busy to receive the training based on the new assessment and implementation tool without a proper solution to this problem. A design flaw for the study included the limitation of the “skin assessment tool” and “management” charts being adapted from only one study, Beeckman et al., 2015, as opposed to multiple articles/research. This creates a limitation to that specific article’s method, sample size, analysis, etc.
What are the advantages and disadvantages of implementing the article recommendations on your unit or hospital?
ReplyDeleteThe advantages of standardizing the assessment and management process of MASD (moisture associated skin damage) using printed guidance with good quality pictures alongside a fact sheet are:
- Improvement in the nurse's assessment of MASD. Clear documentation and being able to differentiate MASD from pressure ulcer avoiding confusion
- Providing appropriate treatment by having clear instructions including preventive and management of MASD
- Overall, early prevention and treatment promotes and maintain skin integrity, promotes patient's comfort, prevents infection and reduces hospital cost
Discuss the limitations of article:limited sample size, design flaws and /or author bias
-Limited time for both tissue viability trainers and nurses for training sessions. Proper knowledge and skills through adequate training promotes proper implementation of this assessment and management tool.
-The study was a small scale project with no budget available.Limited ability for obtaining comprehensive data around MASD.Inadequacy of data limits the comparison of different management plans and confirmation of effectiveness of tool on time heal of MASD
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
ReplyDeleteOne of the limitations of this study was that this was a small scale project with no budget available.
This limited the the ability to obtain more data around IADs on critical care unit therefore, no baseline data available to confirm the impact of the guide on time to heal IAD.
How does this research article compare to our practice, policy and/or procedure?
This research is almost the same as our practice and policy in Providence. In our ministry,
the skin integrity of patients with urinary and fecal incontinence will be assessed every shift, perineal/Buttocks
skin care will be performed after each episode of incontinence. Under-pads that pull the moisture away from the skin will be utilized, and the use of disposable adult briefs (diapers)
will be limited. Adult briefs may only be used in the management of incontinence in the following instances: ambulating with nurse or physical therapy,
going off unit for testing and/or intractable diarrhea that is unable to be contained. External devices will be considered as options for containment of
urine and feces. We do have an excellent skin care team in every unit who assess and follows up skin status of every patient.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe population of the study was composed of critical care patients at risk of or with current incontinence-associated dermatitis (IAD). Upon an RN's physical assessment he/she can use the printed guidance tool to determine the proper intervention. Management of an IAD is very similar to our practice of assessment, skin care and barrier cream, however taking pictures and documenting an IAD as a wound is our form of an incident report. We also have a dedicated wound care team who can assess, diagnose and determine the best course of treatment. One notable difference with respect to their practice is that in the critical care setting loperamide and/or a rectal tube is considered a possible treatments for diarrhea, whereas on non-critical care units infectious processes must first be ruled out and both treatments are seldom used.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One of the major limitations of the study is within the design of its method, namely that there is no baseline data available to confirm the effectiveness of the method in decreasing the incidence of IAD. Every experiment must have a control, a baseline against which one can compare the results. The reliability of the study would have been improved if initial data was collected regarding which patients had IADs over a determined period of time (via a charge or break nurse, or designated RN), the tool was subsequently implemented and then the results compared. The other aspect that limited the design of the study was financial in that supplies that were only readily available on the unit were used, and this would have a direct effect on the type of intervention they could perform. No comparisons could be made for other new products or different procedures.
Another shortcoming of the study was ineffective implementation of the tool due to inadequate training of all staff because of the busy nature of the unit. Without proper debriefing there would be no consistency in each caregiver's interventions, which would undermine its effectiveness and ultimately the results of the study.
Sample size is also an obvious limitation of the study as only patients on one acute care unit took part.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeletePrevention and early monitoring of IAD were recommended. The advantages include:
a. prevention of IAD from developing into a pressure ulcer,
b. lessening the complication of a patient being mostly, if not, bed bound;
c. Lessening discomfort while being bedbound
Disadvantages include:
a. The in-service or training to implement the recommendation meant that nurses will either cram in between listening and understanding the in-service versus being attentive to the patients at that time
b. Prevention meant using more supplies which the hospital/facilities might probably lacking of at this time
2. Discuss the limitations of the article; limited sample size, design flaws, and/or bias.
The trainers did not have enough time to give training to the nurses, as what usually happens during our own in-service training at the hospital. The nurses have so much inpatient care to do that they are only able to give few minutes of their time to be trained. And also there were no specific baseline data available to gauge the result of the study.
Maryliza Chata, RN, BSN, CCRN