June 2023 Wound and Ostomy Journal
Damage Control: Differentiating Incontinence Associated Dermatitis from Pressure Injury
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Damage Control: Differentiating incontinence associated dermatitis from pressure injury
ReplyDelete1. How does this research article compare to our practice policy and or procedure?
This article is significant especially compared to our practice,policy and procedure. Our policy for accurate classification of skin injuries is based on the NPUAP staging system. A thorough skin assessment used by nurses can accurately identify and classify skin injuries. We also follow and used the skin bundle protocol.
2. Describe the sample size used in this study?
The study did not use a sample size. The article is an informative article to provide nurses with knowledge to identify early the signs and symptoms of skin injury to implement interventions that will improve patient outcomes.
1)How does this research article compare to our practice ,policy or procedure?
ReplyDeletethe article mentions the importance of implementing an Incontinence management program and the products for IAD prevention. we also have available to us and use moisture barrier ointment. the incontinence pads we use are highly effective in wicking away moisture and preventing fungal dermatitis.
2)What are the advantages/disadvantages to the proposed recommendations in the article?
throughout the article there is an emphasis on the assessment and challenges of IAD in dark skin tone persons. failure to detect non-blanchable erythema and hyperpigmentation in those individuals puts them at greater risk for developing full-thickness skin injury
Bethany Sobesto 7/21/23
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
In the article they discuss preventing IAD. They mention gentle cleansing of the patient's skin with a soft cloth, and barrier ointments which help protect against effluent. The barrier formulations mentioned in the article include: petroleum based, dimethicone based, and zinc oxide based ointments. At PSJMC we start with a Z Guard phytoplex. If the IAD gets worse we can try Desitin cream, and if it progresses even more we can try a barrier dressing like Triad or Bordaux's Butt paste. The article also mentions incontinence pads and briefs in the management of incontinence. At PSJMC we use incontinence chucks but do not use briefs unless they are on the acute rehab unit.
Describe the method used by the author.
In the article, assessment strategies are discussed. The method used to differentiate skin injuries is to obtain a health history, have adequate lighting when assessing the patient's skin, and to inspect the skin for slight changes in color, temperature, edema, and pain. I believe this is the correct method to examine the patient's skin and figure out what kind of skin damage has occured.
1. Describe the method used by the author of the study
ReplyDeleteThe author used an evidence-based clinical review to discuss the differentiation between pressure injury and incontinence-associated dermatitis. Clinical review articles provide an in-depth understanding of a disease or condition using the most current research to support the information.
1. How does this research article compare to our practice, policy and/or procedure?
The article discusses differentiation, assessment, classification, and documentation of incontinence-associated dermatitis (IAD) and pressure injuries, emphasizing patients with dark skin. The author discussed how to stage pressure injuries and presented a comparison of pressure injuries, friction, and IAD. The author stated that correct assessment is the key to preventing skin injury and ensuring prompt and proper treatment. Our hospital emphasizes pressure ulcer prevention and treatment by initiating skin assessment upon admission, transferring to a different unit every shift, and as needed if there are any suspected skin problems. We also have nurses audit skin assessment documentation periodically. Nurses also coordinate with wound care nurses to ensure pressure-injury-free patients and obtain the best skin care treatment.
1)What are the advantages/disadvantages to the proposed recommendations in the article?
ReplyDeleteThis article explained the importance of nursing knowledge to identify skin injury because depending the cause of skin injury, the treatment will be different. Therefore, identity between incontinence associate dermatitis and pressure injury is the key factor to start proper treatment. The proposed recommendation will impact the nursing care regarding of skin injury positive way. This recommendation would make nurses understand skin injury in depth and get benefit from it to practice in the health care setting. This article also emphasizes the case of dark skin patients which is advantageous for nurses who are not familiar with it.
The disadvantage of this article is lack of scientific data to prove the recommendation is effective.
2) How does this research article compare to our practice, policy and/or procedure?
PSJMC is following the pressure injury staging guideline from NPUAP. PSJMC is implementing the similar policy to keep skin intact and preventable from any type of skin injury. Nurses are practicing according to the policy such as using Zinc cream for incontinent dermatitis after gentle cleansing, not using brief to prevent more moisture induced skin breakdown, assessing the skin carefully and taking photos as needed. Nurses are encouraged to do self-study from HealthStream for further knowledge and skills. Wound care nurses are available to coordinate nurses and healthcare team to develop care plan and implement treatment.
Discuss the sample size used in the study.
ReplyDeleteThere is no specific sample size used for this article as it is more informative to provide nurses with the knowledge to help them be ble to identify skin issues within their patient population and adequatley treat and prevent skin breakdown.
Describe the method used by the author of the study
The researcher used an evidence based clinical review of proper techniques to prevent and identify skin breakdown. They also discussed the difference between pressure injuries and incontinence-associated dermatitis. The use of a clinical review method allows to comply with the most current research provided on topics within the nursing field.
1) How does this research compare to our practice,policy/procedure?
ReplyDeleteThe researcher describes how to perform correct assessment such as differentiating between friction and shear, staging skin injuries using a chart to ensure proper assessment which then determines appropriate treatment for the patient . PSJMC practices similar process on how to initially assess patients skin and based on our policy based on the staging guidelines of pressure injuries , we then take the next step to order appropriate initial treatments followed by wound consult .
2) What are the advantages /disadvantages to the proposed recommendations in the article:
Advantages: With the knowledge and skills of skin assessment ,nurses are able to identify skin injuries including signs and symptoms which will then prevent and treat appropriate injuries and will improve better patient outcome.
Disadvantage: need more evidence of the proposed recommendations .
1) What are the advantages/disadvantages to the proposed recommendations in the article:
ReplyDeleteThe advantages the article provide importance of nursing knowledge to identify and differentiate different skin injury and treatment for those injury. The article also explain case of dark skin patient which is very useful for those nurses not familiar with cases like that.
2) Describe the method used by the author of the study.
The method used is an evidence based clinical review which is showing us different skin injury like difference between pressure ulcers and incontinence associated dermatitis. Clinical review provide understanding of conditions using the most current research.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article helps clinicians to differentiate between incontinence-associated dermatitis and a pressure injury. The NPUAP staging is the same that we use here at PSJMC and the article also highlights the use of the Braden Scale to identify those are risk for pressure injuries which is an assessment tool we use every shift here.
2. what are the advantages and disadvantages to the proposed recommendations in the article?:
Assessment our patients' skin at admission and every shift, and knowing the difference between incontinence-related damage and pressure damage is essential. There are no disadvantages to this - only the advantage of saving our patient's from pain, extra hospital time, risk for infection, and also a HAPI which can be very costly for the hospital.
1. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
ReplyDeleteThe proposed recommendations in the article offer several advantages for nursing care of patients at risk for Incontinence-Associated Dermatitis (IAD). Implementing a structured skin care regimen, including gentle cleansing with a no-rinse formula and application of barrier ointments, is advantageous as it helps maintain skin integrity, prevents moisture-related skin damage, and reduces the risk of IAD development. Incorporating highly absorbent incontinence pads and briefs into an incontinence management program further enhances dryness and minimizes the risk of fungal dermatitis. However, potential disadvantages include variability in patient compliance and potential allergic reactions to cleansing formulas or barrier ointments. Additionally, cost considerations and accessibility of specialized products might pose challenges in certain healthcare settings. Careful individual assessment and monitoring are essential to maximize the benefits of these recommendations while addressing any associated limitations.
2. Was the correct method used? Why or why not?
The correct method was used in the article to differentiate skin injuries accurately. The approach involves a comprehensive assessment that considers risk factors, patient routines, proper lighting, color variations, palpation for temperature and texture changes, and patient-reported symptoms. This method is effective because it integrates both objective clinical observations and subjective patient experiences, ensuring a well-rounded and accurate differentiation of skin injuries, particularly for conditions like pressure injuries and Incontinence-Associated Dermatitis.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article articulates the importance of accurate classification of skin injuries, identifying the etiology and ensuring correct treatment with emphasis on dark skin is carried out by healthcare clinicians. This article suggests performing an adequate assessment, implementing gentle cleansing with a no rinse cleansing formula, application of barrier ointments and utilization of incontinence pads or briefs for incontinence management. At PSJMC, we utilize the same concepts of cleansing, application of barrier ointment and incontinence pads only, no briefs. We utilize the expertise of the wound care nurses for initial and ongoing treatment consultations. In ICU, we utilize wedges, chair pads and a newer turning and positioning system called the Tortoise, to help with pressure ulcer prevention.
2. Describe the research method used by the author of the study.
This article was a review article to improve identification, reinforce and educate on differentiating incontinence associated dermatitis from pressure injuries with emphasis on dark skin color. Healthcare clinicians may find it difficult to discern the differences between the two conditions. After reading this article, I found this article helpful to highlight the subtle variations that can occur, stressing the importance of early identification and treatment to provide high quality patient care.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteIncontinence associated dermatitis (IAD) is a type of moisture-associated skin damage. The problem is, IAD isn’t always
identified properly; it’s frequently confused with pressure injuries.
This article provides guidelines on how to differentiate the two most
common skin conditions in our patients. Proper assessment of patient
skin conditions lead to the right treatment and better outcomes.
Incontinence associated dermatitis is a damage to the skin secondary
to exposure to moisture like stool or urine. Pressure injury is a
damage to the skin over a bony prominence or related to medical
device. IAD is usually around perianal and perineal areas, inner
thighs, buttocks and groin. Pressure injuries are seen on the
sacrum, the coccyx and the ischial tuberosities. Preventing/Treating
IAD includes gentle cleansing with soft cloth. Application of barrier
cream such as Phytoplex Z guard. It works by forming a barrier on the
skin to protect it from irritants/moisture. Incontinence pads are used
in the hospital. For female patients, a device called Purewick is
used. The PureWickSystem uses suction and a soft, flexible wick to
draw urine away from the body into a sealed collection canister,
helping to keep skin dry. For male, condom catheter is applied.
Recently PrimoFit was introduced to the floor. It serves as an
alternative to external collection devices. When properly positioned,
urine is diverted into the system's core and is then suctioned into a
collection canister, helping keep the skin dry. Preventing/Managing PI
include
Intact Skin w/wo Injury (Stage 1s Non-Blanching Redness, DTI ):
1-Cleanse with normal saline and pat dry; apply skin barrier
2-Apply foam bordered dressing for protection
3-Date and initial dressing
4-Change every 3 days and PRN
5-Gently peel back dressing and assess injury every shift and PRN
6. Off-loading bony prominence
Describe the sample size used in this study?
This journal article has no sample size. It provides guidelines and
photos that will help nurses assess and identify subtle differences.
between IAD and PI particularly in patients with dark skin. It also
provides information on how to prevent IAD.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article is about identifying incontinence-associated dermatitis from pressure injuries and how to prevent them from developing. Several prevention methods mentioned in the article are comparable to the way we operate in the hospital. For example, gentle cleansing with a soft cloth or utilizing a no-rinse cleanser. Wiping aggressively may cause sheering on the skin or irritate the patient’s skin which could lead to IAD. The foam cleansers stocked in our hospital help loosen debris making it easier for the patient to be cleaned without having to disturb the integrity of their skin. Also mentioned, is the use of barrier ointments. Our units are stocked with Z-guard and in some cases Desitin is ordered by the doctor for use. Another supply we use to help prevent IAD is with the use of incontinence pads. It is very important for those who are incontinent to have support with a pad to absorb unwanted moisture from the skin for a prolonged amount of time.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The advantages of implementing the article’s recommendations in preventing IAD in our hospital is to significantly decrease the frequency of incontinence associated dermatitis. IAD can be an uncomfortable experience for the patient and many issues can arise from it. Actively preventing it improves patient quality care. In the article, mentioned are ways to properly assess the patient’s skin. For example, ensuring there is adequate lighting, touching the area to identify abnormal textures or warmth, asking the patient what their hygiene routine consists of. Implementing this would help caregivers identify potential triggers and creates a window of opportunity to educate the patient and prevent IAD or pressure injuries from occurring.
In the article, the use of incontinence briefs are encouraged. I would find this to be a disadvantage in the hospital setting because briefs may cause irritation, friction or shear. An incontinence pad is less restrictive and has a big surface area to absorb excess stool and urine that may pose threat to the patient’s skin integrity. It is also very helpful for patient’s who are restricted in mobility or have an increased frequency of bowel movements.
- Alyssa Mendoza RN
Discuss the sample size used in the study
ReplyDelete- this study did not use any sample size rather it serves as an informative article/journal to educate on the differences between IAD and PI
How does this research article compare to our practice, policy and/or procedure?
- The article discusses differentiation, assessment, classification, and documentation of incontinence-associated dermatitis (IAD) and pressure injuries, emphasizing patients with dark skin. The author discussed how to stage pressure injuries and presented a comparison of pressure injuries, friction, and IAD. at PSJMC we enforce pressure ulcer prevention and treatment by initiating skin assessment upon admission, transferring to a different unit every shift, and as needed if there are any suspected skin problems. Wound care nurse consults are also ordered per policy if any new or current skin changes are noticed.
* Describe the method used by the author of the study
ReplyDeleteThis article is providing details on how to differentiate different stages of pressure ulcer and how to prevent pressure ulcers. It also provided education on IAD and how to prevent IAD to patient that is high risk.
* Discuss the sample size used in the study
This study did not have any sample size study. The article is an informative article that provides educational information on pressure ulcers and IAD.
How does this research article compare to our practice, policy and/or procedure? The applications of interventions listed in this article are the same as what we use in our hospital. we use the same classifications as this article points out.
ReplyDeleteDiscuss the limitations of the article: limited sample size, design flaws, and/or author bias:
this article did not include a sample size or group study. It was only looking at what differentiates between moisture and pressure damage and discussed accepted practices of treatment. This was an informative article rather than comparitive study.
David Kahn Rn
Delete1.Discuss the sample size used in the study.
ReplyDeleteThe article is not a study therefor their is no sample size or a group study included. Is more like an education article presenting graph and pictures to help nurses to identified skin breakdown and how to prevent them.
2.How does this research article compare to our practice, policy and/or procedure?
At PSJMC we try to keep up with new treatments and equipment to help prevent HAPI. Our wound care department has implemented monthly swat teams to help identified or prevent, wounds from happening. Like the article we have pictures, definitions and charts to help us stage wounds.
Patricia Rios
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
Accurate classification of skin injuries and identification of their etiology is essential to ensure that the correct treat and plan is initiated to halt the injury and support healing. Besides impacting patient care, inaccurate identification of skin injuries. At PSJMC, the policy requires to assess patient’s skin on admission, every shift, and upon discharge. This article has very similar NPAUP definitions as PSJMC definitions. It is believed that outcome of any skin injury dependent on the nurse assessment, and how quickly the treatment is initiated.
what are the advantages and disadvantages to the proposed recommendations in the article?
The advantage is that at PSJMC Nurses must accurately identify and classify skin injuries to ensure high-quality patient care. This requires knowledge of normal and abnormal variations in skin tones, especially in dark skin. Armed with clinical knowledge and assessment skills, nurses are prepared to identify early signs and symptoms of skin injury and to implement interventions as the article suggested. The disadvantage is not considered on this article is the staffing and demographics were no part of the study.
How does this research article compare to our practice, policy and/or procedure: in our practice we use the npuap staging system to stage pressure injuries. Nevertheless, it is not uncommon that I have seen inconsistencies in previous assessment and charting of wound type/category when comparing stage 1 vs stage 2 pressure injuries vs IAD as the article discusses as a a common confusion in nursing assessment of these wound types. In comparison with the articles suggestions, upon admission we assess the skin (using appropriate lighting), we take pictures of the wound to upload to the chart for later viewing and we are taught to stage wounds using the appropriate scaling system and help prevent by turning the patient, using foams and limiting pad use to 1 pad, and continuous daily monitoring for stage advancements or improvements; When it comes to IAD, we make sure to have a clear health history to identify the patients risk factors; and help to prevent them by using soft cloths to clean incontinent episodes as they occur, apply barrier ointments and and use incontinent pads that are changed out frequently.
ReplyDeleteWhat are the advantages and disadvantages of implementing the articles recommendation on your unit and/or hospital? Correct assessment and intervention of the wounds is critical as identifying the etiology of the wounds is essential to ensure that the correct treatment plan is implemented for our patient safety which insures that the healing process is supported and patient care is not impacted negatively; Additionally, the advantage of correct assessments will positively affect benchmarking data and payments to our facility! While there doesn’t seem to be any real disadvantages I can identify with the suggested recommendation in the article but maybe I can suggest some challenges to meeting these recommendation in our practice; for example, not having enough lighting in the rooms, lack of staffing especially at nights when we must turn patients (especially the heavy and bed bound patients ) to assess and turn every 2 hours to prevent continued progression of wounds, quickly and accurately assess multiple wounds with the fast paced nursing environment (which I think is one of the biggest challenges between identifying correctly when it comes to stage wounds and IADs) and intervene when supplies are limited and or out of stock when you needed
How does this research article compare to our practice, policy and/or procedure?:
ReplyDeleteWe assess patient’s skin on admission and each shift to find out a skin injury if it’s present. When we find the skin problem, we document the finding taking a picture of it and place Wound care consult. We rarely measure a wound for documentation. Although Wound care nurses suggest to stage pressure ulcer, we are rarely to do the staging due to fear of mistake. After the order from Wound care service, we follow the order repositioning patient q2h. We also assess the area of a skin injury with documentation once a shift and take a picture of it every Wednesday.
What are the advantages and disadvantages to the proposed recommendations in the article?
The article recommends that all nurses to identify accurately and classify skin injuries with appropriate treatments to ensure high-quality Patient care. The advantages are that we would be able to catch early signs and symptoms of skin injury initiating appropriate treatments on time, which may contribute to reduce episodes of progression of pressure injuries, which may even lead to extinction of stage 3 or stage 4 of pressure injuries. The disadvantages are that tremendous amount of training and re-training nurses for accurate identification and classification of skin injuries with appropriate treatments. Besides that, skin products are evolving due to technological advance, it’s impossible to know appropriate treatment including appropriate products to use for a patient with skin injuries. If Hospital forces nurses to have accurate knowledge of skin injuries with treatments, I am afraid that nursing turn over might shooting up. However, I believe it’s still important to know how to assess and treat skin injuries continuously, that’s why I get involving with the activities with Wound care services. Thank you very much for this educational article.
1. How does this research article compare to our practice policy and or procedure?
ReplyDeleteIdentifying the correct cause and differentiating incontinence associated dermatitis from other skin condition essential to guide prevention and treatment. This components must be considered in developing a care plan that would be beneficial to the pt
2)What are the advantages/disadvantages to the proposed recommendations in the article?
The advantages would hep health care worker the correct cause and differentiating incontinence-associated dermatitis from other skin conditions and would be essential to guide prevention and treatment.With proper knowledge would help us provide evidence information to improve clinical knowledge about Incontinence Associated Dermatitis (IAD)
1. How does this research article compare to our practice policy and or procedure? In the hospital system we use a staging system to properly identify wounds. The article speaks on staging wounds using the NPUAP pressure injury staging model. It also speaks on ways of avoiding incontinence associated dermatitis. These are essential to guiding, preventing and treating pressure injuries.
ReplyDelete2. What are the advantages/disadvantages to the proposed recommendations in the article? I do not see any disadvantages to the recommendations listed in the article. Nurses need to be able to differentiate the difference between normal an abnormal variations of skin tones, especially in darker skinned individuals. Moisture barrier ointments and gentle cleansing are also crucial for patients who are incontinent.
1.discuss the sample size used in the study.
ReplyDeleteThe article is informative & did not use a sample size. It helped identify the differences between IAD & pressure injuries by listing signs/symptoms & prevention methods.
2.Describe the method used by the author of the study
The author uses evidence based clinical review to identify the differences between IAD & pressure injuries by listing signs/symptoms & prevention methods.
-alexandria ordonez
This comment has been removed by the author.
ReplyDeleteJUNE 2023 WOUND AND OSTOMY JOURNAL
DeleteDamage Control: Differentiating Incontinence Associated Dermatitis from Pressure Injury
Discuss the sample size used in the study.
This article did not utilize a sample size and was not necessarily presented as a study with results of test subjects.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
As this is an informative article, it is hard to determine what methods and results were utilized. Bias is not out of the question when determining limitations of healthcare providers incorrectly assessing types of wounds. How was the determination made in best approach in therapy is another question to consider, since the research is dynamic and constantly changing.
-Valarie Renaux RN, ICU-
what are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteOne of the proposed recommendations is for the nurse to be able to differentiate how IAD and pressure injuries may
present on light and dark colored skin tone. I find the recommendations beneficial because pressure related injuries and IAD
are extremely common in the hospital and they can be very difficult to stage without a wound nurse.
Being more knowledgable regarding skin injuries will help initiate better care for the patient rather than just relying on the
wound nurse. I do not see any disadvantages to the proposed recommendation as this is an area that needs constant improvement.
what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The proposed recommendations of this article is for nurses to better assess and differentiate
between IAD and pressure injury. The author recommends: obtaining a comprehensive health istory, being able to identify risk factors for pressure injury
and incontinence associated dermatitis, assessing thepatients toileting and bathing schedule, assessing the pt's skin
in adequate lighting, being able to differentiate how pressure injury and IAD
may display in a person with darker skin tone, and always documentinginjury type, characteristics, measurements.
The advantage of this are that the nurse can better prevent skin injury from progressing into the next stage of injury,
implement the appropriate precautions from their assessment. This also improves the IAD and pressure related injury
stats for the hospital, lower overall healthcare costs to both patient and hospital. This in turn, ideally will provide
better outcomes for the patient.
Describe the method used by the author of the study.
-Suzanne Kang
1. What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe article recommends that all nurses to identify accurately and classify skin injuries with appropriate treatments to ensure high-quality Patient care. The advantages are that we would be able to catch early signs and symptoms of skin injury initiating appropriate treatments on time, which may contribute to reduce episodes of progression of pressure injuries, which may even lead to extinction of stage 3 or stage 4 of pressure injuries. The disadvantages are that tremendous amount of training and re-training nurses for accurate identification and classification of skin injuries with appropriate treatments. Besides that, skin products are evolving due to technological advance, it’s impossible to know appropriate treatment including appropriate products to use for a patient with skin injuries. If Hospital forces nurses to have accurate knowledge of skin injuries with treatments, I am afraid that nursing turn over might shooting up. However, I believe it’s still important to know how to assess and treat skin injuries continuously, that’s why I get involving with the activities with Wound care services. Thank you very much for this educational article.
2.Describe the method used by the author of the study?
The author uses evidence based clinical review to identify the differences between IAD & pressure injuries by listing signs/symptoms & prevention methods.
How does this research article compare to our practice, policy and procedure?
ReplyDeleteThis research article relates to our practice and policy because both use pressure injury staging to properly stage a wound. As mentioned in the article, proper staging of a wound is critical for the patient and treatment plan. At St. Joes, we incorporate the NPUAP pressure staging guidelines with the assistance of the wound care nurse for accurate staging. In addition to prevent IAD’s, we use barrier ointment, like Z-guard, and incorporate incontinent pads as mentioned in the article.
What are the advantages and disadvantages to the proposed recommendations in the article?
I believe there are many advantages to proper stages as this has a huge impact on the treatment plan and likelihood of the injury healing properly. If the injury is staged incorrectly, it can have a drastically negative effect on the patient’s healing process. By correctly differentiating between incontinent associated dermatitis and a pressure injury, you are not only saving the hospital financially, but more importantly you are providing high-quality patient care and improving patient outcomes.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe ideas in this research article align with our practices and policies regarding wound care at PSJMC. Our hospital follows the guidelines of NPUAP pressure injury staging as well the described differential diagnosis of IAD vs. St. I, II and DPTI pressure ulcers. Nurses must take pictures of wounds under ideal lighting conditions and request a wound consult from the wound care team who specialize in diagnosing various wounds and determine proper medical treatment. We employ a combination of skin surveillance, turning and positioning, barrier cream for either prevention of IAD or Z-guard to prevent worsening of already existing IADs, and proper wound care in the case of pressure injuries.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Prompt recognition of skin wounds coupled with consistently correct differential diagnoses of IAD vs. St. I/II/DTPI pressure injuries will lead to the most effective wound treatment option, faster healing and decreased incidences of wounds that advance to St. III/IV/unstageable pressure injuries which would incur hospital costs. The recommendations made by the article implemented are advantageous and lead to overall better patient outcomes.
1. Discuss the sample size used in the study.
ReplyDeleteThe study did not have a sample size, rather it was an informative article to provide educational information to help identify the difference between incontinence associated dermatitis and pressure injuries with an emphasis on assessing patients with dark skin.
2. How does this research compare to our practice, policy/procedure?
This article relates to our practice at PSJMC because it begins with the correct assessment. Differentiating between the correct classification of skin injury and determining its etiology is very important to make sure the correct treatment plan is carried out and ultimately promotes and supports healing. Skin assessments are initiated upon admission or transfers to to identify any skin issues that may be present prior to arrival. Obtaining an adequate patient history helps steer the assessment in the right direction if the patient may be bed bound, incontinent, or has pain. Having sufficient and adequate lighting helps to identify injuries on all patients especially those with darker skin. At PSJMC we use photographs of skin injuries to follow the progression of the wound healing process after proper treatment has been implemented.
How did this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe research article describes the same methods and strategies our ministry uses in identifying and classifying skin injuries. Our hospital implements the guidelines set forth by the NPUAP. We also have a great team of wound and ostomy nurses who are very valuable resources. Part of our policy at PSJMC is taking images of skin injuries weekly, on admission, and upon transfer from another unit. Which helps to track the progression of the wounds. We also follow the wound and skin care recommendations of the wound and ostomy team.
What are the advantages and disadvantages to the proposed recommendations in the article?
I do not see any disadvantages to the recommendations. The proposed recommendations are actually very advantageous for both caregivers and patients. For the nurses, it provides the knowledge and tools in identifying and classifying skin injuries so that they are able to accurately determine the appropriate treatment and promote proper healing. For the patients, these recommendations can provide the accurate interventions and overall improve patient outcomes.
Discuss the sample size used in the study.
ReplyDeleteThis article did not mentioned sample size used. Instead it was an informative article on how assess and differentiate moisture-associated skin damage and pressure ulcers.
2)How does this research article compare to our practice, policy and/or procedure?This article is significant especially compared to our practice,policy and procedure. Our policy for accurate classification of skin injuries is based on the NPUAP staging system. A thorough skin assessment used by nurses can accurately identify and classify skin injuries. We also follow and used the skin bundle protocol.This article is very accurate compared with PSJMC with several tools available to help nurses to differentiate between incontinence skin dermatitis and pressure ulcers plus if ever in doubt we have a wound nurse available if ever in doubt of our skin assessment.
1. How does this research article compare to our practice, policy and/or procedure? This applies to our practice since we are tasked with differentiating between moisture associated dermatitis and pressure injuries.
ReplyDelete2.What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital? There are many advantages to being able to differentiate between types of wounds. By having the knowledge to differentiate between moisture associated dermatitis and pressure injuries, we can accurately assess and label wounds. This can lead to proper wound healing and increased patient satisfaction. I do not see any disadvantages to this.
1.) Discuss the sample size used in the study.
ReplyDeleteThis article did not present a sample size, however, the purpose of the article is to provide information that differentiate incontience associated dermatitis from pressure injuries. The article elucidates pressure injury staging and preventing in light skin tone and darker skin tone.
2. How does this research compare to our practice, policy/procedure?
This research is comparable to our current practice by differentiating characteristics such as location, depth, and wound bed presentation. Pressure injuries assessment is crucial in accurate classification completed by the primary registered nurse and then followed up by wound care specialist consult to further identify etiology and correct identification upon patient arrival on the unit. The wound care nurse creates a treatment plan to prevent incontinence associated dermatitis by utilizing Braden Scale Risk tool and apply barriers. The ultimate key in prevention is to identify early signs of pressure skin injury and provide continuity of care from admission to discharge planning.
1. Discuss the sample size used in the study.
ReplyDeleteThe sample size was not presented in this paper; nonetheless, the article's goal is to give information that distinguishes incontinence-associated dermatitis from pressure injuries. The article discusses, differentiates, classifies, and documents IAD and pressure injuries, emphasizing patients with dark skin.
2. What are the advantages and disadvantages of the proposed recommendations in the article?
The proposed recommendations of this article have advantages rather than disadvantages. Identifying early signs and symptoms of skin injuries and providing and implementing proper treatment plans or interventions to improve patient outcomes.
Describe the method used by the author of the study
ReplyDeleteThis article is a systematic review. A systematic review is a more structured and rigorous type of literature review. It follows a predefined protocol and includes specific criteria for selecting and evaluating studies. Systematic reviews are known for their systematic and comprehensive approach to synthesizing evidence. In this case, The National Pressure Ulcer Advisory Panel (NPUAP) guidelines are reviewed.
Was the correct method used? Why or why not?
Yes, in this case, the article does not use any specific cases, rather it educates the reader of the guidelines, strategies, and benefits of the standards that are already in place. The systematic review aims to answer specific research questions by identifying, appraising, and synthesizing all relevant studies on a particular topic. Systematic reviews are often considered one of the highest levels of evidence in evidence-based practice.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis research is similar to our practice in the way that we assess our patients, their pressure injuries, as well as staging their pressure injuries. With each patient we ensure accurate identification and staging their pressure ulcers. We visually assess the skin for discoloration, palpate the skins texture, assess for blanching, and ultimately photograph the skin under proper lighting.
Discuss the sample size used in the study.
Unfortunately this article did not appear to utilize a sample size. It did however provide vital information on the staging of pressure ulcers and provided important information on differentiating between incontinence associated dermatitis and pressure injuries.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteWhile there are many ways to practice and protect the livelihood of patients developing pressure injuries, this article discusses similar practices we use in our hospital. The use of gentle cleansing like a no-rinse cleanser and using barrier ointments are current things we use. Using incontinence pads and other materials that absorb moisture are widely used in incontinence management and prevention of incontinence associated dermatitis.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Currently the suggested practice in assessing the skin of patients matches what is practiced on the unit. I do believe the recommended lighting for assessment can add more accurate classifications of skin injuries. We see in some rooms that have great lighting and others may not, a flashlight could make a huge difference in assessment as well as capturing accurate pictures for wound care teams to assess better.
Your right on it is a similar policy used in our hospital and also home health. The best way to is to assess the patient and also to be proactive. We should also do teaching with patient and instruction to let us know when they are soiled and assess the patients who are not able to check their own self. Prevention by barrier cream and good cleaning.
DeleteThe research is the same as our policy in the hospital.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article is similar to the Providence Saint Joseph Burbank policy and procedure by completing a thorough skin assessment on each and every patient. Especially when patients are admitted to the hospital two nurses complete a skin assessment in order to not miss any skin sores. Additionally, orders for wound care nurse assessment is utilized in order to avoid mis-staging a wound.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The advantages of this article is to ensure proper assessment is gathered through asking appropriate questions to the patient and as well as through visual assessment. Appropriate lighting is vital in proper assessment. I like how this article concentrates on proper assessment for both light and dark skin individuals.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteOur practice and policy at Providence St. Joseph aligns very closely to the suggestions in the article. When a patient first arrives to the floor, either as an admission or a transfer, we do a 2 person examination of the patient's skin, documenting any wounds with a photograph and in the MAR and care plan. We also inspect the patient's skin as part of our shift assessment, making note of any changes. We turn the patient every 2 hours if the patient cannot move themselves in bed. We have badge buddies that outline what the different injuries look like. Lastly, we implement a Wound Nurse Consult with any skin injuries to get a treatment plan for the wound.
2. what are the advantages and disadvantages to the proposed recommendations in the article?
The advantage of implementing the proposed recommendations are many. One of the things the article does is it helps outline what to look for on patients with darker tones: how a wound might appear as compared to those patients with lighter skin. It suggests using a lot of light when inspecting the skin, but avoid using fluorescent light. It also recommends getting a thorough history on the patient in addition to a complete assessment to identify any risk factors. It advocates using no-rinse cleansers in addition to moisture-barrier ointments to protect the skin. I didn't see any disadvantages to implementing their recommendations. I think this article should be required reading for all bedside nurses at the hospital.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis research correlates well with how we practice today in terms of methods we use as nurses to distinguish a pressure injury vs. incontinence related damage to skin. A key highlight in this article is how "correct assessment is critical" and this is why we have implemented our policy to have 2 RNs assess the skin upon admission or transfers, and have a wound care nurse consult the patient for any positive assessments.
what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
One major advantage of implementing methods to differentiate types of skin injuries is treatment. By recognizing the right type of wound we can implement to right treatment leading to better outcomes. With correct assessments we can recognize areas of improvement and use data to monitor successes of preventative implementations such as our waffle cushions that we use. As RNs we should be willing to learn new and improved methods to treating and preventing skin injuries in the hospital.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe policy at Providence St. Joseph Medical Center shares many similarities to the strategies and assessments listed in the article. At Providence St. Joseph, skin is assessed on admission and transfers by 2 RN’s to better assess the skin. Along with this policy, wound photos are also taken if there is any clear sign of skin damage or concern for future skin issues and a wound consult in placed. With the wound evaluation completed we can better care for the skin and prevent future breakdown of the skin. We also implement turns every two hours for those patients who are not independent in bed and need assistance. The article describes a similar assessment tool that we use when identifying wounds and how to care for them.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Some advantages of implementing this article include better assessment of wounds on initial evaluation and therefore a more appropriate treatment plan can be set in place to achieve the best possible outcomes for that specific wound. Being able to correctly identify pressure injuries from moisture related skin damage is key to the success in treating wounds. With the many steps put into place (assessment/evaluation/medication/protection/turning) and the education provided, it can help reduce the occurrence and treatment time of wounds in the hospital setting.
ReplyDelete1. Comment on the study’s sample size.
It’s essential to note that this study doesn’t revolve around a specific sample size; instead, it serves as an informative article aimed at imparting educational insights. The primary focus is to enhance the ability to differentiate between incontinence-associated dermatitis and pressure injuries, with a particular emphasis on effectively assessing patients with dark skin tones.
2. How does this research align with our current practices, policies, or procedures?
This article bears relevance to our practices here at PSJMC as it aligns with our established protocols, starting with a crucial step of accurate assessment. The ability to distinguish between various types of skin injuries and pinpoint their underlying causes is of paramount importance, as it guides the formulation of precise treatment plans that, in turn, facilitate and expedite the healing process. Our standard operating procedures involves initiating skin assessments upon admission or transfers, aiming to identify any pre-existing skin issues. In cases where patients may be bedridden, experience incontinence, or exhibit signs of discomfort, obtaining a comprehensive patient history becomes instrumental. Adequate and well-lit environments are essential for scrutinizing injuries across all patient demographics, particularly those with darker skin tones. It’s also noteworthy that, at PSJMC, we incorporate the use of photographic records to monitor the progression of wound healing once appropriate treatments have been instituted.
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ReplyDelete1.What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
ReplyDeleteThe suggested recommendations within the article offer numerous benefits for improving nursing care for patients at risk of Incontinence-Associated Dermatitis (IAD). The implementation of a structured skincare regimen, involving gentle cleansing using a no-rinse formula and the application of barrier ointments, presents several advantages. Firstly, it aids in preserving skin integrity, thereby reducing the likelihood of moisture-related skin damage and the development of IAD. Additionally, integrating highly absorbent incontinence pads and briefs into an incontinence management program contributes to enhanced dryness and a decreased risk of fungal dermatitis.
However, it is important to acknowledge potential drawbacks. These encompass the variability in patient compliance, which may impact the consistency and effectiveness of the regimen. Allergic reactions to cleansing formulas or barrier ointments can also occur, posing a risk that demands attention and alternative product options. Moreover, the consideration of costs associated with specialized products and their availability in different healthcare settings may present challenges. In order to optimize the benefits of these recommendations while mitigating potential limitations, it is imperative to conduct meticulous individual assessments and establish a robust monitoring system. This approach ensures tailored care that is responsive to each patient's needs, minimizes adverse reactions, and makes judicious use of available resources.
How does this research article compare to our practice, policy and/or procedure?
Providence Saint Joseph Medical Center is following the pressure injury staging guideline from NPUAP. PSJMC is implementing a similar policy to keep skin intact and preventable from any type of skin injury. Nurses are practicing according to the policy such as using Zinc cream for incontinent dermatitis after gentle cleansing, not using brief to prevent more moisture induced skin breakdown, assessing the skin carefully and taking photos as needed. Nurses are encouraged to do self-study from HealthStream for further knowledge and skills. Wound care nurses are available to coordinate with nurses and the healthcare team to develop a care plan and implement treatment.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteAccording to the article, "most regimens involve gentle cleansing with a soft cloth and no-rinse cleansing formula that contains surfactants to loosen irritants, and application of a barrier ointment." This is similar to our practice at PSJMC when we use the Z-guard cream after cleaning a patient to prevent the occurrence of incontinence associated dermatitis. It is important for us to use agents that are not harsh to the skin and provide a barrier to the skin to protect against fecal matter and urine. Both of which, can cause damage to the skin as we all have seen.
2. What are the advantages and disadvantages to the proposed recommendations in the article?
The advantages to the recommendations made in the article of using barrier creams can prevent the occurrence of incontinence associated dermatitis. A potential disadvantage can include inconsistencies in the regimen amongst healthcare staff that would therefore make the regimen ineffective. Additionally, the use of multiple products, which can potentially irritate the skin.