Wound Ostomy Department - Providence St Joseph Medical Center
Thursday, August 15, 2024
August 2024 Wound and Ostomy Journal
Article: Impact of an evidence-based bundle on incontinence associated dermatitis prevalence in hospital patients: A quasi-experimental translational study
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Describe the method used by the author of the study; - This study was a quasi-experiment using both pre-intervention period of 12 months and a post-intervention period of 15 months. The subjects were gathered across 6 hospitals in New South Wales, Australia including subacute, rehabilitation, acute geriatrics, palliative, respiratory, gastroenterology, general medical, surgical and ICU except for long-term care facilities. Pre-intervention group and post-intervention group were selected based on willingness of participation, presence of incontinence and hospital acquired IAD. Although Post-intervention group had higher rates of incontinence, double incontinence, higher acuity, and longer LOS in hospital compared with Pre-intervention group, Post-intervention group showed a lower prevalence of IAD, which means their skin implementation showed effectiveness of their intervention.
Discuss the limitations of the article; - Since this study was a quasi-experiment, randomization was not used, which automatically let this article less credibility although the study showed their effective intervention resulted in lowering IAD.
During the pre-intervention phase of the study, a total of 964 patients were assessed, with 343 identified as incontinent. In the post-intervention phase, 933 patients were assessed, with 351 identified as incontinent. The prevalence of hospital-acquired incontinence-associated dermatitis (IAD) decreased from 6.71% in the pre-intervention group to 4.27% in the post-intervention group, reflecting a 36.3% reduction. This reduction was achieved despite the higher acuity of patients in the post-intervention group and the additional challenges presented by the COVID-19 pandemic.
Describe the method used by the author of the study
The study employed a quasi-experimental pre-and post-study design, conducted across 18 wards in six hospitals within one Australian state. The researchers implemented a comprehensive intervention that included a continence assessment and management plan, an educational brochure for patients, families, and caregivers, the use of the Ghent Global IAD Categorisation Tool (GLOBIAD), and a skin care regimen involving three-in-one barrier cream cloths. Data collection occurred during two phases, with pre-intervention assessments conducted between February and March 2020, and post-intervention assessments carried out between July and August 2021. The primary outcome measured was the prevalence of incontinence-associated dermatitis (IAD), with secondary outcomes including the length of hospital stay and the severity of IAD.
Describe the method used by the author of the study; The method used was the quasi experimental pre and post study, conducted in 18 wards, was part of a larger implementation since study incontinence associated dermatitis. Skin and incontinence assessments were conducted on patients during February and March 2020 (pre-intervention) and July and Aug 2021(post intervention). The intervention comprised continence assessment and management,an education brochure for patients, family and caregivers on IAD
Discuss the sample size used in the study A total of 1897 patients were assessed (pre-intervention=964, post intervention=933 ) A total of343 (35.6%) pre intervention patients and 351 (37.6%) post intervention patients had incontinence. The prevalence of hospital acquired IAD was 6.71% in the pre-intervention group and 4.27% in the post intervention group: a reduction of 36.3% (p=0.159) despite higher patient acuity, prevalence of double incontinece and the COVID 19 pandemic in the post intervention group compared with the pre intervention goup. Our multisite best practice IAD prevention and treatement intervention was able to reduce the prevalence and severity of hospital acquired IAD suggesting enduring effectiveness of the intervention.
1. Describe the method used by the author of the study.
A 12-month pre-intervention phase and a 15-month post-intervention period were used in this quasi-experimental investigation. With the exception of long-term care facilities, the subjects were distributed across six hospitals in New South Wales, Australia: subacute, rehabilitative, acute geriatrics, palliative, respiratory, gastrointestinal, general medical, surgical, and ICU. Based on the participants' willingness to participate, the existence of incontinence, and hospital-acquired IAD, pre- and post-intervention groups were chosen. The Post-intervention group demonstrated a lower prevalence of IAD, indicating that their skin implementation demonstrated the effectiveness of their intervention, despite having higher rates of incontinence, double incontinence, higher acuity, and longer length of stay in the hospital when compared to the Pre-intervention group.
2. Discuss the sample size used in the study.
343 of the 964 individuals evaluated during the study's pre-intervention phase were found to be incontinent. 351 of the 933 individuals evaluated during the post-intervention phase were found to be incontinent. Hospital-acquired incontinence-associated dermatitis (IAD) was shown to be 36.3% less common in the post-intervention group than in the pre-intervention group, with a prevalence of 4.27%. Notwithstanding the increased patient acuity in the post-intervention group and the extra difficulties brought on by the COVID-19 pandemic, this reduction was accomplished.
1. What are the advantages and disadvantages of the proposed recommendations in the article? The advantages of the proposed recommendations include a significant reduction in the prevalence and severity of incontinence-associated dermatitis, improved patient outcomes, and increased education and awareness among patients and caregivers. The comprehensive and evidence-based approach to IAD management showed effectiveness even under challenging conditions, suggesting enduring benefits. However, the intervention also has disadvantages, such as the complexity of implementation, which requires extensive resources, training, and time. Compliance can vary among staff and patients, potentially affecting results, and the findings may not be generalized to all settings.
2. Discuss the research question or main problem discussed in the study? The main problem discussed in the study was the high prevalence and severity of incontinence-associated dermatitis in hospitals, which can lead to further complications if not managed properly. The research aimed to evaluate the effectiveness of an evidence-based intervention designed to reduce IAD prevalence and severity in hospitalized patients. By implementing a comprehensive care bundle that included continence management, education, and a specialized skin care regimen, the study will demonstrate that a structured approach could effectively prevent and manage IAD in a clinical setting. Elin Danelian 3 North
1. Discuss the research question or main problem discussed in the study?
Incontinence-associated dermitis and it's resulting complications are the main problem discussed in this article. The research is aimed to evaluate the effectiveness of an evidence-based intervention designed to reduce IAD prevalence and severity in hospitalized patients. A comprehensive care bundle that included continence management, education, and a specialized skin care regimen was implemented. The study seeks to show that a structured bundle will decrease IAD prevalence.
2. Describe the method used by the author of the study.
Using a quasi-experimental study, a 12-month pre-intervention phase and a 15-month post-intervention period were conducted. The subjects were distributed across six hospitals in New South Wales, Australia: subacute, rehabilitative, acute geriatrics, palliative, respiratory, gastrointestinal, general medical, surgical, and ICU - excluding long-term care facilities. Pre- and post-intervention groups were chosen to observe incontinence and hospital acquired IAD. As a result of skin implementation, the post-intervention group demonstrated a lower prevalence of IAD, indicating that their skin implementation demonstrated the effectiveness of their intervention, even though their risk factors were much higher then the pre-intervention group.
Discuss the research question or main problem discussed in this study 1. This study was done to evaluate an intervention (Skin bundle) on the prevalence and severity of incontinent associated dermatitis. This was a pre and post study. 2.The advantages and disadvantages or the recommendations of this article The advantages of the recommendations of this article would be reduction in prevalence and severity of incontinence associated dermatitis, improved patient outcomes with decreased pressure injury, decreased pain and decreased cost to the hospital and the consumer. The disadvantages to the recommendations would be the time it a=takes to implement the bundle, resources to implement this bundle, time needed to train the staff, compliance of the staff/patient /caregivers.
This initial sample size of 946 patients allowed researchers to assess the baseline skin and continence status. The 343 incontinent patients represent a subset who had issues with continence at the start of the study. After the intervention, the sample size was slightly reduced to 933 patients. The number of incontinent patients increased slightly to 351. This could be due to various factors, including changes in patient population, improved detection of incontinence, or an actual increase in cases of incontinence.
2. Discuss the research question or main problem discussed in the study?
The research question in the study aimed to evaluate the effectiveness of a multisite intervention designed to prevent and treat incontinence-associated dermatitis (IAD) in hospital settings. Specifically, the study sought to determine whether implementing an evidence-based practice bundle would reduce the prevalence and severity of IAD when comparing pre- and post-intervention conditions.
Describe the method used by the author of the study.
The method of this research study involved using a comparison of IAD prevalence in two different settings: a pre- and and post-transitional research process at several different hospitals in Australia. The pre- intervention period lasted one year and the post- intervention period lasted fifteen months. A simple tool, titled IMBED, was introduced after the initial phase that allowed caregivers to utilize evidence-based strategies.
Discuss the sample size used in the study.
This study analyzed patients with incontinence-associated dermatitis (IAD) in six hospitals in Australia. The study was initiated in early 2020 (February and March) and analyzed 964 patients for IAD. Of those 964, 343 were identified with incontinence issues. The study concluded with a post-intervention group of 933 analyzed and 351 identified with incontinence issues. The study concluded in mid 2021 (July and August) after best practices of prevention and treatment of IAD were rolled out.
Describe the method used by the author of the study? The study used a quasi-experimental design to evaluate the impact of an evidence-based bundle on reducing the prevalence of incontinence-associated dermatitis (IAD) in hospitalized patients. Conducted in a hospital setting, the intervention involved implementing a comprehensive care bundle that included skin care protocols, staff education, regular skin assessments, appropriate use of incontinence products, and patient education. Data on IAD prevalence were collected before and after the intervention to assess its effectiveness. The results showed a significant reduction in IAD prevalence post-intervention, demonstrating that the evidence-based bundle effectively improved patient outcomes related to IAD in the clinical setting. Discuss the limitations of the article; The study has several limitations, including its quasi-experimental design without a control group, which makes it hard to prove that the reduction in incontinence-associated dermatitis (IAD) was solely due to the intervention. There could be selection bias in choosing which patients were included, and differences in how consistently the bundle was applied by staff could affect the results. The study’s short follow-up period also raises questions about whether the positive effects are sustainable over time. Since it was conducted in a single hospital, the findings may not apply to other settings. Additionally, there could be issues with how data was collected or with the Hawthorne effect, where staff might change their behavior because they know they are being studied.
(1)Describe the method used by the author of the study -Study Design: The study employed a quality improvement (QI) methodology to evaluate the impact of an evidence-based bundle on the management of incontinence-associated dermatitis (IAD) in an acute care setting. -Intervention: The authors implemented an evidence-based care bundle designed to reduce the incidence and severity of IAD. This bundle typically includes a combination of practices, such as improving skin hygiene, using appropriate incontinence products, and employing barrier creams. -Implementation: Pre- and Post-Intervention Comparison--The study used a pre- and post-intervention design to compare IAD rates before and after the implementation of the care bundle. Data on IAD incidence and severity were collected from patient records in the acute care setting. Data Collection--Relevant data were collected through chart reviews and skin assessments performed by healthcare staff. Analysis--Statistical methods were used to analyze the data and determine the impact of the care bundle on the outcomes of interest. The authors likely employed descriptive and inferential statistics to evaluate changes in IAD rates and the effectiveness of the bundle.
(2) Discuss the research question or main problem discussed in the study? -The main research question addressed in the study is: "Does the implementation of an evidence-based care bundle reduce the incidence and severity of incontinence-associated dermatitis in an acute care setting?" -Main Problem: The study focuses on the challenge of managing incontinence-associated dermatitis (IAD) in acute care environments. IAD is a common and distressing condition for patients with incontinence, leading to increased discomfort, risk of infection, and longer hospital stays. The research aims to address this problem by testing whether a structured, evidence-based approach can improve outcomes for patients suffering from IAD. -The goal of the quality improvement study is to provide empirical evidence on the effectiveness of a care bundle in mitigating IAD, thus offering a potential strategy for enhancing patient care and reducing the burden of this condition in acute care settings.
1. Discuss the sample size used in the study: According to Barakat-Johnson et al. (2024), a total of six hospitals in five health districts participated in this study which focused on evaluating the effects of interventions on the prevalence of incontinence associated dermatitis (IAD). The hospitals are specifically located in metropolitan and rural areas and specialize in providing acute care, subacute rehabilitative medicine, palliative care, geriatrics, general medical-surgical, and intensive care. Each of the six hospitals participated by having three wards (for a total of eighteen wards) with a total of 462 beds. After determining the number of participating hospitals, the number of patient participants in the study was also included. In the table provided by Barakat-Johnson et al. (2024), 964 patient participants were assessed in the pre-intervention group while 933 patient participants were assessed in the post intervention group.
2. Discuss the limitations of the article: Although the study included a large sample size of patient participants across six hospitals located in various health districts, the study was limited in the choosing of the participating hospitals. Despite how Barakat-Johnson et al. (2024) stated that intervention is necessary to prevent and address IAD in acute care hospitals and long-term facilities, the study focused only on implementing the interventions in acute care hospitals rather than long-term facilities such as nursing homes. Another limitation lies in the choice of the design study. With regards to reliability, quasi-experimental studies are valid; however, they are not as reliable when compared to randomized controlled trials (RCTs).
1) Discuss the research question or main problem in the study: The study was directed to assess and evaluate the interventions used on prevalence and severity of incontinence-associated dermatitis (IAD). Pre and post intervention was utilized in the study. Interventions included the assessment and management, educate for patients and family/caregiver on IAD, the GLOBIAD tool, and skin care regimen. 2) Discuss the sample size: Sample size consisted of 1897 patients: 964 pre-intervention and 933 post intervention. They were conducted during Feb/March 2020 for those pre-intervention patients and during July/August 2021 post intervention. A total of six hospitals in five health districts participated in this study.
1. What are the advantages and disadvantages to the proposed recommendations in the article? The evidence-based bundle for managing incontinence-associated dermatitis (IAD) showed benefits, including a reduction in IAD prevalence and improved patient comfort. It also enhances care consistency and could be cost-effective. However, the reduction was not statistically significant, and implementing the bundle requires significant resources and effort. Additionally, the specific context of the study may limit the generalizability of the results, and new protocols could disrupt existing care routines. 2. Discuss the research question or main problem discussed in the study? The main problem discussed in the study is the prevalence and management of incontinence-associated dermatitis (IAD) in hospital patients. Specifically, the research question investigates whether implementing an evidence-based healthcare bundle can effectively reduce the prevalence of IAD compared to standard care practices. IAD is a painful skin condition often linked to incontinence and hospital-acquired pressure injuries. It is frequently overlooked, misdiagnosed, or underreported, which leads to delayed treatment and increased patient discomfort. The study aims to address these issues by evaluating the impact of a multifaceted intervention bundle designed to improve the prevention and management of IAD in hospital settings. The bundle includes strategies such as enhanced skin care protocols, better incontinence management, and staff education. The central research question, therefore, is whether the implementation of this evidence-based bundle leads to a significant reduction in the prevalence of IAD among hospital patients compared to the baseline rates observed before the intervention.
Describe the method used by the author of the study.
The study was a quasi-experimental pre and post translational research study to determine the prevalence of IAD using Promoting Action on Research Implementation in Health Services (PARIHS) framework. The study was conducted from October 2019 to September 2020 for pre-intervention then May 2021 to July 2022 for post intervention. This study took place across six hospitals across New South Wales. A total of 1897 patients were assessed.
Discuss the research question or main problem discussed in the study?
The main problem of the study was to evaluate the effect of an intervention on the prevalence and severity of IAD across six hospitals. The intervention used were as follows: barrier cream cloths, minimize bed protection layer, use of appropriate continence aid, use of continence assessment tools, staff education and patient education resources. The study suggested effectiveness of the interventions despite having higher prevalence of incontinence, it exhibited lower rates of IAD from 6.71% pre-intervention to 4.27% in post-intervention group, a reduction rate of 36.3%.
The study looked at incontinence-associated dermatitis (IAD) interventions. The sample size was conducted in Australia across 18 wards. The sample size consisted of a pre and post intervention group for a total of 1897 patients: 964 pre-intervention and 933 post-intervention. However, since not all patients had incontinence, only a total of 343 pre-intervention and 351 post-intervention patients were relevant to the study. IAD rates were 6.71% in the pre-intervention group and 4.27% in the post-intervention group which calculates to a 36.3% reduction in the post group with the study’s suggested intervention bundle.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Some advantages include correctly identifying high-risk patients and implementing evidence-based interventions in a timely manner to prevent further skin deterioration. Correctly identifying IAD will help the patient recover faster and provide relief over short and long-term treatment while in the hospital setting. Timely interventions will help to ensure there are no gaps in treatment. For example, if the RN is not comfortable relying information to the MD/NP as to what they are assessing, they may just let the specialized wound team know about it and they have “done their job.” Being able to identify and recommend treatment to the primary team will allow a correct, ongoing treatment to occur while allowing for a second, more experience professional opinion to occur when possible. The only disadvantage I believe in would be the financial strain in providing additional hours to RNs and managers to enact such a project.
1. Discuss the research question or main problem discussed in the study? The main problem discussed in this study is incontinence-associated dermatitis in hospitals and how often times it is overlooked and misdiagnosed. The study also discusses how IAD can cause a physical, social, and emotional impact on the patients. The study aims to evaluate ways to intervene and prevent the occurrence of incontinence-associated dermatitis. The intervention concentrated on assessment and management, education to patients and their families, and proper skin care in order to prevent the occurrence of IAD. 2. Discuss the sample size used in the study. The sample size of the study was conducted across six hospitals located across Australia. In this study a total of 1897 patients participated in the study, from which 964 were assessed pre-intervention and 933 post- intervention. From the total participants, 343 were incontinent.
Describe the method used by the author of the study
The study used a quasi-experimental conducted in Australia pre-and post-intervention design to evaluate the effectiveness of a multifaceted intervention on incontinence-associated dermatitis (IAD) in hospital settings conducted in Australia.The intervention used several steps: including assessing and managing patients`s incontinence needs and teaching caregivers and family members to increase awareness about IAD.The skin care regimen used in the study did amazing
Describe the method used by the author of the study? - this study is a quasi-experimental pre and psot study conducted in 18 wards whihc was part of a larger implementation sceince study on incontinence associated dermatitis.
Discuss the research question or main problem discussed in the study? - 343 of the 964 individuals evaluated during the study's pre-intervention phase were found to be incontinent. 351 of the 933 individuals evaluated during the post-intervention phase were found to be incontinent. Hospital-acquired incontinence-associated dermatitis (IAD) was shown to be 36.3% less common in the post-intervention group than in the pre-intervention group, with a prevalence of 4.27%.
Describe the method used by the author of the study? - this study is a quasi-experimental pre and poststudy conducted in 18 wards which was part of a larger implementation science study on incontinence associated dermatitis. skin an incontinences assessments were conducted on patients during February and march 2020 and July and august 2021. the intervention comprised continence assessment and management, an education brochure for patients and families on IAD, the aghent global IAD categorization tool and skincare regimen
Describe the method used by the author of the study
The design was the use of the Imbed Study which is described as a quasi-experimental, pre and post transitional research study to determine, primarily the prevalence of IAD, using an implementation science approach, which is the (PARIHS) promoting action on research implementation in Health Services framework. The study was performed across 6 hospitals in five health districts across New South Wales in Australia. A total of 426 hospital beds in different medical specialties with the exception of long term care participated. The study used intervention which included an intervention component of education of staff, incontinent assessment and management, education of patients and family and caregivers, practice guidelines and categorization and patient skin protection. Data were collected using two data collection tools during clinical audits, an IAD and incontinence and skin and a baseline Data collection from which determines basic patient health and demographic data.
How does this research article compare to our practice, policy and/or procedure?
The article is very similar to our policy and/or procedure in such ways that. We also conduct a research/audit in the form of the SWAT, in which the team does skin/wound prevalence audit, and gather data for incidence of pressure injuries. We also have a standard of care/best practice guidelines similar to the intervention in the study for IAD/pressure injury prevention such as skin protectant, appropriate bed, use of absorbent layers under the patient . Incontinent assessment of patients is part of nursing daily assessment and documentation.
1. Discuss the sample size used in the study During the study's evaluation of incontinence and hospital-acquired incontinence-associated dermatitis (IAD), there were 2 phases: Pre-intervention phase: 343 of 964 individuals evaluated were found to be incontinent. Post-intervention phase: 351 of 933 individuals evaluated were found to be incontinent. Key findings included that IAD prevalence was reduced by 36.3% in the post-intervention group compared to the pre-intervention group, with a final prevalence of 4.27%. Despite the increased patient acuity and additional challenges caused by the COVID-19 pandemic, this significant reduction in IAD rates demonstrates the effectiveness of the intervention, underscoring improvements in patient care practices.
2. The research question in the study was: "How effective is a multisite intervention designed to prevent and treat incontinence-associated dermatitis (IAD) in hospital settings?" The study aimed to determine the effectiveness of EBP bundle: whether implementing an evidence-based practice bundle would result in a reduction in both the prevalence and severity of IAD. Also, the comparison of pre- and post-intervention conditions: evaluating and comparing the pre-intervention and post-intervention conditions to measure the impact of the intervention on IAD outcomes. By focusing on these aspects, the study sought to assess the practical benefits of the intervention in improving patient care and reducing the incidence of IAD in hospital settings.
A) What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital? ADVANTAGES 1. **Awareness and Focus on Care**: - The high prevalence of IAD in hospitals has led to increased awareness and focus on preventing and managing this condition. This can result in improved overall skin care practices and the development of better protocols. 2. **Innovation in Products and Treatments**: - The prevalence of IAD drives innovation in products designed to prevent and treat the condition. This includes the development of advanced barrier creams, more effective absorbent products, and new skincare technologies. 3. **Enhanced Training and Education**: - Healthcare providers receive specialized training and education on how to manage IAD, which can lead to better patient care and more comprehensive approaches to skin health. DISADVANTAGES 1. **Increased Healthcare Costs**: - Managing IAD can be costly due to the need for specialized products, additional nursing care, and potentially longer hospital stays. This adds financial strain on healthcare systems and institutions. 2. **Patient Discomfort and Reduced Quality of Life**: - IAD can cause significant discomfort, pain, and embarrassment for patients, impacting their overall quality of life and emotional well-being. 3. **Risk of Infection**: - IAD can increase the risk of secondary infections, such as fungal or bacterial infections, which complicates the patient’s condition and extends recovery time.
B) Discuss the limitations of the article: limited sample size, design flaws, and/or author bias When examining the impact of incontinence-associated dermatitis (IAD) prevalence in hospital patients, several potential flaws or limitations in understanding and addressing this issue can arise: 1. **Underreporting and Diagnosis Issues** - **Flaw**: IAD may be underreported or misdiagnosed due to lack of awareness or standardized diagnostic criteria. - **Impact**: This leads to an incomplete understanding of the true prevalence and severity of IAD, potentially causing underestimation of its impact on patient care and outcomes. 2. **Inconsistent Care Practices** - **Flaw**: There might be variability in how different healthcare providers or institutions manage IAD, leading to inconsistent care practices. - **Impact**: This inconsistency can result in uneven patient outcomes and complicates efforts to develop universal guidelines or protocols for prevention and treatment. 3. **Focus on Immediate Symptoms Rather than Long-term Solutions** - **Flaw**: The focus may be primarily on addressing immediate symptoms rather than implementing long-term prevention strategies. - **Impact**: This can lead to recurrent issues and a lack of progress in reducing the overall incidence of IAD.
Six hospitals in one state in Australia, This is quasi- experimental pre and post study. A total of 1897 were assessed pre intervention = 964 and post intervention = 933. A total of 343 pre intervention patients 351 post intervention had a incontinence .This incontinence associated skin damage prevalence decreased by 36.3% from the pre intervention 6.71 % to the post intervention period despite higher acuity and the COVID-19 pandemic in the post intervention period.
Discuss the research question or main problem discussed in the study? The study aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence associated dermatitis in hospital settings and often overlooked and misdiagnosed resulting in delayed and costly treatment while causing significant patient discomfort. The study also discussed the IMBED intervention included using of barrier cream cloths, minimisation of bed protection layers, use of appropriate continence aid and continence assessment and management tools. It also discussed in this study that IAD causes physical, social and emotional impact on the patient.
The study used a total of six different hospitals (ranging from the metropolitan area to rural hospitals) to select their participants. From each of the hospitals three different floors were used for a total of 426 beds. Each unit selected for the study comprised of a specialty including: subacute and rehabilitation, acute geriatrics, palliative care, respiratory and GI, general medical-surgical, and intensive care unit.
Describe the method used by the author of the study.
The study that was completed was a quasi-experimental and pre- and post- transitional research study. The beginning of the study was a 12-month pre intervention period, followed by the implementation of the IMBED multifaceted initiative and completed with a 15-month post-intervention period. During the implementation period the they were using an evidence-based healthcare bundle to prevent and manage incontinence associated dermatitis.
1 Discuss the sample size used in the study? The sample size of this study included 18 wards across six hospitals in Australia. The exact number of patients assessed was not specified in the study The study did mention some hospital were from regional and rural areas.The study did not include the long term facilities.The units included were GI, general medicine surgical and intensive care
1.what are the advantages and disadvantages to the proposed recommendations in the article? In this article, they talked about the impact for prevalence for incontinent associated dermatitis (IAD). Some of the advantages were the outcomes of the study with decreased cases of IAD throughout 6 major hospitals located in Australia. Another advantage was the involvement between the staff and managers, educators all collaborating for the bigger purpose of keeping patient skin integrity safe. One of the disadvantages I saw was that part of the bundle to reduce these numbers was to also provide education to the patient caregiver and family members. To me this is a disadvantage, especially once patient leaves the facility because they cant ensure that the measures such as creams, appropriate supplies, and appropriate amounts of linens be used like in a hospital setting. I can imagine there can also be a financial disadvantage for these families once they leave the hospital or acute facility.
2. what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital? On my unit specifically, some advantages would be decreasing IAD. The majority of the patient population that come to my unit are very limited in mobility, have history of incontinence, and a lot are given medications to diurese which can also cause incontinent episodes. Making sure we use adequate amounts of supplies can help with the quick consumption of supplies such as the pads we use, or using the right creams. Some disadvantages would be actually getting staff to follow the recommendations. We have some staff that may need a little reminding since they are used to a certain method for so many years. My unit has had a relatively low number of HAPIs but I do see a lot of moisture related skin injuries.
1. How does this research article compare to our practice, policy and/or procedure?
The methods and procedures in this article are very similar to our practice, policy and procedures because we perform the same interventions to prevent and treat IAD. For example, in incontinent patients we always assess the skin, perform turns every two hours and as needed and have skin rounds weekly. Also, we use barriers creams, appropriate continent aids such as external catheters (condom catheters and purewicks), incontinence pads and never leave a patient sitting on a soiled pad. In ICU, we also implement an early mobility protocol which would allow a patient mobility to be able to use the bathroom appropriately if they are continent.
2. Describe the method used by the author of the study.
The method used for this study was a quasi-experimental, research study to determine the prevalence of IAD using an implementation science approach. There was a pre-intervention period which lasted from October 2019 to September 2020 and a post-intervention period of 15 months, from May 2021 to July 2022. The implementation was affected by the Covid-19 pandemic which was declared a national emergency on March 2020. The study was undertaken across six hospitals in five health districts.
1) Describe the method used by the author of the study.
The author used a quasi-experimental, pre- and post-translational research study to determine, primarily, the prevalence of incontinence-associated dermatitis (IAD) using the implementation science approach. This approach is called the Promoting Action on Research Implementation in the Health Science (PARIHS) framework. Due to the COVID-19 pandemic, the study consisted of a pre-intervention period of 12 months from October 2019 to September 2020 and a post-intervention period of 15 months from May 2021 to July 2022. The study was reported according to the modified Consolidated Standards of Reporting Trials (CONSORT) statement and the Template of Interventional Description and Replication (TiDieR) intervention checklist.
2) Discuss the sample size used in the study.
The sample size used was 964 patients who participated in the pre-intervention audit and had their skin and continence status assessed. The post-intervention audit had 933 patients whose skin and continence status had been assessed. The study was undertaken across six hospitals in five health districts across New South Wales, Australia. Eighteen wards participated, consisting of 328-bed wards from four metropolitan hospitals and three 15-bed boards from two regional hospitals specializing in acute and rehabilitation medicine, acute geriatrics, palliative care, respiratory and gastroenterology, general medical, surgical, and intensive care. No long-term facilities, such as nursing homes, were included in the study.
Impact of an evidence-based bundle on incontinence associated dermatitis prevalence in hospital patients:
Discuss the sample size used in the study
The sample size of this study consisted of 964 subjects with 343 of them incontinent for the preintervention audit. The post intervention audit consisted of 933 subjects isolating 351 incontinent participants. Within this study the subjects were further categorized within the pre-intervention 23 out of the 343 developed incontinent associated dermatitis (IAD) as hospital acquired and the post-intervention showed 15/351 were observed to have reduced incidences of 36.3%.
Describe the method used by the author of the study.
The method used for this study was the quasi-experimental design. Six hospitals consisting of 18 units were utilized for data collection of incontinent associated dermatitis in Australia. Assessments initially began in 2020 from February to March with reassessments occurring in July to August of 2021. Interventions used included the Ghent Global IAD Categorization tool. The GLOBIAD was created in 2018 giving rise to an international consensus to characteristics of IAD evolvement along with an agreed documentation incorporated into patient care and analysis. (Beeckman D. et al., 2017).
References Beeckman D., Van den Bussche K., Alves P., Beele H., Ciprandi G., Coyer F., de Groot T., De Meyer D., Dunk A.M., Fourie A., García-Molina P., Gray M., Iblasi A., Jelnes R., Johansen E., Karadağ A., LeBlanc K., Kis Dadara Z., Long M.A., Meaume S., Pokorna A., Romanelli M., Ruppert S., Schoonhoven L., Smet S., Smith C., Steininger A., Stockmayr M., Van Damme N., Voegeli D., Van Hecke A., Verhaeghe S., Woo K. and Kottner J. The Ghent Global IAD Categorisation Tool (GLOBIAD). Skin Integrity Research Group - Ghent University 2017. Available to download from www.UCVVGent.be
Describe the method used by the author of the study.
The IMBED study was a quasi-experimental, pre- and a post-translational research study to determine, primarily, the prevalence of IAD, using an implementation science approach—the Promoting Action on Research Implementation in Health Services (PARIHS) framework .21 Owing to the COVID-19 pandemic, this study consisted of a pre-intervention period of 12 months (October 2019 to September 2020) and a post-intervention period of 15 months (May 2021–July 2022), separated by the implementation of the IMBED multifaceted initiative.
Discuss the sample size used in the study.
The study was undertaken across six hospitals (four major referral hospitals, one regional and one rural hospital) in five health districts (three metropolitan, two rural) across New South Wales (NSW), Australia. Eighteen wards participated (three per hospital), comprising three 28-bed wards from the four metropolitan hospitals and three 15-bed wards from the two regional hospitals (426 beds in total), specialising in subacute and rehabilitation medicine, acute geriatrics, palliative care, respiratory and gastroenterology, general medical, surgical and intensive care. No long-term care facilities such as nursing homes were included in the study.
Describe the method used by the author of the study.
This quasi-experimental, pre/post-translational research study was undertaken across six hospitals in five health districts across New South Wales, Australia. Eighteen wards participated, comprising three 28-bed wards and three 15-bed wards specializing in subacute and rehabilitation medicine, acute geriatrics, palliative care, respiratory and gastroenterology, general medical. The intervention was multifaceted and comprised of clinician and patient facing approaches.
Discuss the research question or main problem discussed in the study? The study was aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence-associated dermatitis in six hospitals in one state in Australia. IAD is a painful skin condition linked to hospital-acquired pressure injuries. It is often overlooked and misdiagnosed while causing significant patient discomfort.
Describe the method used by the author of the study -There was pre – intervention period of 12 months and post for 15 months in 6 hospitals in Austrailia. Included no long term care facilities. They used an audit tool to gather data – which included frequency/quality of stools, mobility status, incontinence products used, and whether they had other injuries. They had a local investigator on site working with the staff members.
Discuss the sample size used in the study.
-Total of 964 patients participated in pre intervention audit. In the post intervention, 933 patients had their skin assessed. This was done across 6 hospital settings. No long term care facilities were used.
-what are the advantages and disadvantages to the proposed recommendations in the article? The research did not specify what were the exact interventions/products used. The conclusion was that any interventions used would be more beneficial than not using a skin protectant. The disadvantages would be that some patients did experience worsening of the IAD post intervention and the difficulties monitoring these patients over long periods of time to determine appropriate treatments.
-what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital? The overall findings of the article suggest that treatment of the IAD caused improvement in a majority of the research population. We already use skin prevention/treatment regimen at psjmc, but the advantage shown through this research further supports our efforts. The article also gives us an example of what we would need to do if we intended on doing a skin study on our unit. It highlights the importance of needing clear criteria on how to classify the dermatitis and the need to document on all patients skin to obtain a true baseline of IAD prevalence
Discuss the sample size? The sample size included a total of 964 participants who participated in the pre-interview audit and 343 of the participants were considered incontinent. In the post-intervention, 933 had their skin assessed and 351 were considered incontinent. The findings between both groups were similar. Describe the method used. The method was a quasi-experiment that included a pre-intervention phase of 12 months and 15-month post-intervention phase. The subjects were distributed across 6 hospitals in different areas that included subacute , surgical, medical, and ICU. Long-term facilities were excluded.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
Advantages: Reduction in Incidence: Implementing an evidence-based bundle can significantly lower the prevalence of incontinence-associated dermatitis (IAD) in hospital settings, improving patient comfort and outcomes.
Standardized Care: Evidence-based bundles promote standardized care protocols, ensuring that all patients receive the same high-quality interventions, which can improve overall care consistency.
Cost-Effectiveness: Reducing IAD can lead to lower treatment costs associated with skin care, wound management, and longer hospital stays, which can benefit both patients and healthcare systems.
Improved Staff Education: These bundles often include staff training, enhancing nurses' and caregivers’ knowledge about prevention and management of IAD, which can lead to better patient care.
Increased Patient Satisfaction: By addressing skin integrity and discomfort, patient satisfaction may improve, contributing to a better overall hospital experience.
Disadvantages: Implementation Challenges: Transitioning to a new evidence-based bundle can face resistance from staff, require additional training, and necessitate changes in workflows, which might slow down initial adoption.
Resource Allocation: The need for resources (time, personnel, materials) to implement the bundle may strain hospital budgets, especially in facilities with limited funding.
Monitoring and Evaluation: Ongoing evaluation of the bundle’s effectiveness requires continuous monitoring, which can be resource-intensive and may divert attention from other critical areas of patient care.
Variability in Patient Populations: The effectiveness of the bundle may vary across different patient populations, making it less effective in certain contexts or demographics, which could lead to inequities in care.
Over-Reliance on Protocols: There’s a risk that staff may become overly reliant on protocols, potentially leading to less individualized patient care if specific patient needs are not adequately addressed.
Overall, while the recommendations from the study offer significant potential benefits for reducing IAD in hospital patients, careful consideration of the challenges and limitations is essential for successful implementation.
2. Discuss the sample size in this study.
The sample size in Barakat-Johnson et al. (2024) is substantial, involving 964 patients in the pre-intervention group and 933 in the post-intervention group across six hospitals. This diverse setting, including both metropolitan and rural areas, enhances the generalizability of the findings. The inclusion of various ward types allows for a comprehensive evaluation of the interventions' impact on IAD prevalence across different patient demographics and care environments. However, it’s important to consider whether the sample size adequately reflects the broader patient population and whether it provides sufficient statistical power to detect significant changes in IAD prevalence.
How does this research article compare to our practice, policy and/or procedure? This research article is very detailed on how to care for patients living with dementia and stating the importance of nurses’ risk assessment and finding out the major impact by age related condition change, physical or environmental changes. Also, affected by a personal physical and mental decline from arthritis, diabetes, cardiac issues, Parkinson's disease, chronic lung disease, depression, stroke, or medications (Cholinesterase inhibitors medications, diuresis, and sedatives). As a healthcare professional, I cannot assume/stereotype that dementia patients have a symptom of incontinence, and I should determine the management plan individually as a person-centered assessment by physical, mental, and emotional status. The incontinence of urinary and fecal incontinence affects patients from pressure ulcers, urinary tract infections, catheterization, fecal constipation, which increases the risk of prolonged staying, or readmission risk to the hospital. Sometimes it increases the risk of hospital mortality. In our practice, we also assess individual newly admitted patients as patient centered care. We collaborate with physical and occupational therapists to evaluate the patient’s toileting ability including safety concerns. Also, we assess new patients' skin with the assistance of two nurses, and then consult with a wound care nurse as needed.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital? The advantages of implementing the article recommendations in our unit is to offer a person-centered continence assessment to all the patients and identify the primary issue and treating/improve the cause of urinary and fecal incontinence. We assess patients' ability to implement care for bladder and bowel control with training. It is always important to respect individual patients and family then acknowledge the incontinence affecting them physically, mentally, financially. The disadvantages of implementing the article recommendations in our unit as a neurology related unit with some of our patients were diagnosed with advanced dementia or experienced repeated stroke. The new hospitalized diagnoses are altered mental status, septic, and UTI. Most are chronic mental or physical disabilities which makes it difficult for nurses to assess the impact of incontinence from the multiple complications.
- Discuss the research question or main problem discussed in the study? The research question/main problem discussed in this study is the prevalence of incontinence-associated dermatitis (IAD) in hospital settings that can result in hospital-acquired pressure injuries (HAPI) and ways to negate such issues. It is mentioned that IAD is a debilitating and painful skin condition and should be properly accepted as a step towards patient's overall wellbeing and safety. In this study, researchers have developed and tested an evidence-based healthcare bundle in hopes of preventing, as well as managing, IAD.
- Describe the method used by the author of the study The method used by the author of the study implemented the Promoting Action on Research Implementation in Health Services (PARIHS) framework. The study's method was focused on a quasi-experimental, pre- and post-translational research study that helped to determine the occurrences of incontinence-associated dermatitis (IAD). With this in mind, researchers looked at the pre-intervention timeline of 12 months and a post-intervention timeline of 15 months to see the effect of their study centering around interventions used to survey the prevalence of IAD.
1.Discuss the sample size used in the study. -The study had a total of 1897 patients. Pre-intervention consisted of 964 patients & post-intervention consisted of 933. 2.Discuss the research question or main problem discussed in the study? - The study tested the effectiveness of an evidence-based bundle on the prevalence & severity of incontinence associated dermatitis. The bundle included continence management, education & specialized skin care regimen.
How does this research article compare to our practice, policy and/or procedure?
The intervention components used in this study were similar to our interventions in my current practice. There were 5 types of interventions in this study. One was Eduction of patients, family, and caregivers which included a brochure on Incontinence-associated dermatitis which I thought was a good idea. Another intervention component was patient skin protection which included implementation of a skin care plan, in which we practice daily at work.
Discuss the research question or main problem discussed in the study?
The main problem discussed in this study is Incontinence-associated dermatitis or IAD. IAD is a skin condition that occurs when the skin is exposed to urine or stool for a prolonged period of time. It's a form of skin inflammation that can cause discomfort, itching, pain, and other symptoms. The surrounding skin may have a wet, macerated appearance in the acute phase, and dryness and peeling skin in the chronic phase. This study compares cases of IAD pre and post interventions.
Describe the method used by the author of the study.
This research study used a quasi-experimental, pre/post translational design. The Australian area of New South Wales was the focus of the study, using 6 hospitals in 5 districts. Departments specializing in subacute/rehab medicine, general medicine, respiratory and gastroenterology, palliative care, and acute geriatrics were used, totaling 18 departments. Clinician and patient facing approaches used a multifaceted intervention strategy.
Discuss the research question or main problem discussed in the study?
Incontinence associated dermatitis was studied. Mainly, interventions to reduce its prevalence and severity were focused on. The study was based in 6 hospitals in 1 state in Australia.
Describe the method used by the author of the study;
ReplyDelete- This study was a quasi-experiment using both pre-intervention period of 12 months and a post-intervention period of 15 months. The subjects were gathered across 6 hospitals in New South Wales, Australia including subacute, rehabilitation, acute geriatrics, palliative, respiratory, gastroenterology, general medical, surgical and ICU except for long-term care facilities. Pre-intervention group and post-intervention group were selected based on willingness of participation, presence of incontinence and hospital acquired IAD. Although Post-intervention group had higher rates of incontinence, double incontinence, higher acuity, and longer LOS in hospital compared with Pre-intervention group, Post-intervention group showed a lower prevalence of IAD, which means their skin implementation showed effectiveness of their intervention.
Discuss the limitations of the article;
- Since this study was a quasi-experiment, randomization was not used, which automatically let this article less credibility although the study showed their effective intervention resulted in lowering IAD.
Discuss the sample size used in the study
ReplyDeleteDuring the pre-intervention phase of the study, a total of 964 patients were assessed, with 343 identified as incontinent. In the post-intervention phase, 933 patients were assessed, with 351 identified as incontinent. The prevalence of hospital-acquired incontinence-associated dermatitis (IAD) decreased from 6.71% in the pre-intervention group to 4.27% in the post-intervention group, reflecting a 36.3% reduction. This reduction was achieved despite the higher acuity of patients in the post-intervention group and the additional challenges presented by the COVID-19 pandemic.
Describe the method used by the author of the study
The study employed a quasi-experimental pre-and post-study design, conducted across 18 wards in six hospitals within one Australian state. The researchers implemented a comprehensive intervention that included a continence assessment and management plan, an educational brochure for patients, families, and caregivers, the use of the Ghent Global IAD Categorisation Tool (GLOBIAD), and a skin care regimen involving three-in-one barrier cream cloths.
Data collection occurred during two phases, with pre-intervention assessments conducted between February and March 2020, and post-intervention assessments carried out between July and August 2021. The primary outcome measured was the prevalence of incontinence-associated dermatitis (IAD), with secondary outcomes including the length of hospital stay and the severity of IAD.
Describe the method used by the author of the study;
ReplyDeleteThe method used was the quasi experimental pre and post study, conducted in 18 wards, was part of a larger implementation since study incontinence associated dermatitis. Skin and incontinence assessments were conducted on patients during February and March 2020 (pre-intervention) and July and Aug 2021(post intervention). The intervention comprised continence assessment and management,an education brochure for patients, family and caregivers on IAD
Discuss the sample size used in the study
ReplyDeleteA total of 1897 patients were assessed (pre-intervention=964, post intervention=933 ) A total of343 (35.6%) pre intervention patients and 351 (37.6%) post intervention patients had incontinence. The prevalence of hospital acquired IAD was 6.71% in the pre-intervention group and 4.27% in the post intervention group: a reduction of 36.3% (p=0.159) despite higher patient acuity, prevalence of double incontinece and the COVID 19 pandemic in the post intervention group compared with the pre intervention goup. Our multisite best practice IAD prevention and treatement intervention was able to reduce the prevalence and severity of hospital acquired IAD suggesting enduring effectiveness of the intervention.
1. Describe the method used by the author of the study.
ReplyDeleteA 12-month pre-intervention phase and a 15-month post-intervention period were used in this quasi-experimental investigation. With the exception of long-term care facilities, the subjects were distributed across six hospitals in New South Wales, Australia: subacute, rehabilitative, acute geriatrics, palliative, respiratory, gastrointestinal, general medical, surgical, and ICU. Based on the participants' willingness to participate, the existence of incontinence, and hospital-acquired IAD, pre- and post-intervention groups were chosen. The Post-intervention group demonstrated a lower prevalence of IAD, indicating that their skin implementation demonstrated the effectiveness of their intervention, despite having higher rates of incontinence, double incontinence, higher acuity, and longer length of stay in the hospital when compared to the Pre-intervention group.
2. Discuss the sample size used in the study.
343 of the 964 individuals evaluated during the study's pre-intervention phase were found to be incontinent. 351 of the 933 individuals evaluated during the post-intervention phase were found to be incontinent. Hospital-acquired incontinence-associated dermatitis (IAD) was shown to be 36.3% less common in the post-intervention group than in the pre-intervention group, with a prevalence of 4.27%. Notwithstanding the increased patient acuity in the post-intervention group and the extra difficulties brought on by the COVID-19 pandemic, this reduction was accomplished.
Luna Chowdhury
4 North
1. What are the advantages and disadvantages of the proposed recommendations in the article?
ReplyDeleteThe advantages of the proposed recommendations include a significant reduction in the prevalence and severity of incontinence-associated dermatitis, improved patient outcomes, and increased education and awareness among patients and caregivers. The comprehensive and evidence-based approach to IAD management showed effectiveness even under challenging conditions, suggesting enduring benefits. However, the intervention also has disadvantages, such as the complexity of implementation, which requires extensive resources, training, and time. Compliance can vary among staff and patients, potentially affecting results, and the findings may not be generalized to all settings.
2. Discuss the research question or main problem discussed in the study?
The main problem discussed in the study was the high prevalence and severity of incontinence-associated dermatitis in hospitals, which can lead to further complications if not managed properly. The research aimed to evaluate the effectiveness of an evidence-based intervention designed to reduce IAD prevalence and severity in hospitalized patients. By implementing a comprehensive care bundle that included continence management, education, and a specialized skin care regimen, the study will demonstrate that a structured approach could effectively prevent and manage IAD in a clinical setting.
Elin Danelian
3 North
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteIncontinence-associated dermitis and it's resulting complications are the main problem discussed in this article. The research is aimed to evaluate the effectiveness of an evidence-based intervention designed to reduce IAD prevalence and severity in hospitalized patients. A comprehensive care bundle that included continence management, education, and a specialized skin care regimen was implemented. The study seeks to show that a structured bundle will decrease IAD prevalence.
2. Describe the method used by the author of the study.
Using a quasi-experimental study, a 12-month pre-intervention phase and a 15-month post-intervention period were conducted. The subjects were distributed across six hospitals in New South Wales, Australia: subacute, rehabilitative, acute geriatrics, palliative, respiratory, gastrointestinal, general medical, surgical, and ICU - excluding long-term care facilities. Pre- and post-intervention groups were chosen to observe incontinence and hospital acquired IAD. As a result of skin implementation, the post-intervention group demonstrated a lower prevalence of IAD, indicating that their skin implementation demonstrated the effectiveness of their intervention, even though their risk factors were much higher then the pre-intervention group.
Natalie Bresson
ICU
Discuss the research question or main problem discussed in this study
ReplyDelete1. This study was done to evaluate an intervention (Skin bundle) on the prevalence and severity of incontinent associated dermatitis. This was a pre and post study.
2.The advantages and disadvantages or the recommendations of this article
The advantages of the recommendations of this article would be reduction in prevalence and severity of incontinence associated dermatitis, improved patient outcomes with decreased pressure injury, decreased pain and decreased cost to the hospital and the consumer. The disadvantages to the recommendations would be the time it a=takes to implement the bundle, resources to implement this bundle, time needed to train the staff, compliance of the staff/patient /caregivers.
1. Discuss the sample size used in the study.
ReplyDeleteThis initial sample size of 946 patients allowed researchers to assess the baseline skin and continence status. The 343 incontinent patients represent a subset who had issues with continence at the start of the study. After the intervention, the sample size was slightly reduced to 933 patients. The number of incontinent patients increased slightly to 351. This could be due to various factors, including changes in patient population, improved detection of incontinence, or an actual increase in cases of incontinence.
2. Discuss the research question or main problem discussed in the study?
The research question in the study aimed to evaluate the effectiveness of a multisite intervention designed to prevent and treat incontinence-associated dermatitis (IAD) in hospital settings. Specifically, the study sought to determine whether implementing an evidence-based practice bundle would reduce the prevalence and severity of IAD when comparing pre- and post-intervention conditions.
Describe the method used by the author of the study.
ReplyDeleteThe method of this research study involved using a comparison of IAD prevalence in two different settings: a pre- and and post-transitional research process at several different hospitals in Australia. The pre- intervention period lasted one year and the post- intervention period lasted fifteen months. A simple tool, titled IMBED, was introduced after the initial phase that allowed caregivers to utilize evidence-based strategies.
Discuss the sample size used in the study.
This study analyzed patients with incontinence-associated dermatitis (IAD) in six hospitals in Australia. The study was initiated in early 2020 (February and March) and analyzed 964 patients for IAD. Of those 964, 343 were identified with incontinence issues. The study concluded with a post-intervention group of 933 analyzed and 351 identified with incontinence issues. The study concluded in mid 2021 (July and August) after best practices of prevention and treatment of IAD were rolled out.
Describe the method used by the author of the study?
ReplyDeleteThe study used a quasi-experimental design to evaluate the impact of an evidence-based bundle on reducing the prevalence of incontinence-associated dermatitis (IAD) in hospitalized patients. Conducted in a hospital setting, the intervention involved implementing a comprehensive care bundle that included skin care protocols, staff education, regular skin assessments, appropriate use of incontinence products, and patient education. Data on IAD prevalence were collected before and after the intervention to assess its effectiveness. The results showed a significant reduction in IAD prevalence post-intervention, demonstrating that the evidence-based bundle effectively improved patient outcomes related to IAD in the clinical setting.
Discuss the limitations of the article;
The study has several limitations, including its quasi-experimental design without a control group, which makes it hard to prove that the reduction in incontinence-associated dermatitis (IAD) was solely due to the intervention. There could be selection bias in choosing which patients were included, and differences in how consistently the bundle was applied by staff could affect the results. The study’s short follow-up period also raises questions about whether the positive effects are sustainable over time. Since it was conducted in a single hospital, the findings may not apply to other settings. Additionally, there could be issues with how data was collected or with the Hawthorne effect, where staff might change their behavior because they know they are being studied.
(1)Describe the method used by the author of the study
ReplyDelete-Study Design: The study employed a quality improvement (QI) methodology to evaluate the impact of an evidence-based bundle on the management of incontinence-associated dermatitis (IAD) in an acute care setting.
-Intervention: The authors implemented an evidence-based care bundle designed to reduce the incidence and severity of IAD. This bundle typically includes a combination of practices, such as improving skin hygiene, using appropriate incontinence products, and employing barrier creams.
-Implementation: Pre- and Post-Intervention Comparison--The study used a pre- and post-intervention design to compare IAD rates before and after the implementation of the care bundle. Data on IAD incidence and severity were collected from patient records in the acute care setting. Data Collection--Relevant data were collected through chart reviews and skin assessments performed by healthcare staff. Analysis--Statistical methods were used to analyze the data and determine the impact of the care bundle on the outcomes of interest. The authors likely employed descriptive and inferential statistics to evaluate changes in IAD rates and the effectiveness of the bundle.
(2) Discuss the research question or main problem discussed in the study?
-The main research question addressed in the study is: "Does the implementation of an evidence-based care bundle reduce the incidence and severity of incontinence-associated dermatitis in an acute care setting?"
-Main Problem: The study focuses on the challenge of managing incontinence-associated dermatitis (IAD) in acute care environments. IAD is a common and distressing condition for patients with incontinence, leading to increased discomfort, risk of infection, and longer hospital stays. The research aims to address this problem by testing whether a structured, evidence-based approach can improve outcomes for patients suffering from IAD.
-The goal of the quality improvement study is to provide empirical evidence on the effectiveness of a care bundle in mitigating IAD, thus offering a potential strategy for enhancing patient care and reducing the burden of this condition in acute care settings.
1. Discuss the sample size used in the study:
ReplyDeleteAccording to Barakat-Johnson et al. (2024), a total of six hospitals in five health districts participated in this study which focused on evaluating the effects of interventions on the prevalence of incontinence associated dermatitis (IAD). The hospitals are specifically located in metropolitan and rural areas and specialize in providing acute care, subacute rehabilitative medicine, palliative care, geriatrics, general medical-surgical, and intensive care. Each of the six hospitals participated by having three wards (for a total of eighteen wards) with a total of 462 beds. After determining the number of participating hospitals, the number of patient participants in the study was also included. In the table provided by Barakat-Johnson et al. (2024), 964 patient participants were assessed in the pre-intervention group while 933 patient participants were assessed in the post intervention group.
2. Discuss the limitations of the article:
Although the study included a large sample size of patient participants across six hospitals located in various health districts, the study was limited in the choosing of the participating hospitals. Despite how Barakat-Johnson et al. (2024) stated that intervention is necessary to prevent and address IAD in acute care hospitals and long-term facilities, the study focused only on implementing the interventions in acute care hospitals rather than long-term facilities such as nursing homes. Another limitation lies in the choice of the design study. With regards to reliability, quasi-experimental studies are valid; however, they are not as reliable when compared to randomized controlled trials (RCTs).
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ReplyDeleteThis comment has been removed by the author.
ReplyDelete1) Discuss the research question or main problem in the study:
ReplyDeleteThe study was directed to assess and evaluate the interventions used on prevalence and severity of incontinence-associated dermatitis (IAD). Pre and post intervention was utilized in the study. Interventions included the assessment and management, educate for patients and family/caregiver on IAD, the GLOBIAD tool, and skin care regimen.
2) Discuss the sample size:
Sample size consisted of 1897 patients: 964 pre-intervention and 933 post intervention. They were conducted during Feb/March 2020 for those pre-intervention patients and during July/August 2021 post intervention. A total of six hospitals in five health districts participated in this study.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe evidence-based bundle for managing incontinence-associated dermatitis (IAD) showed benefits, including a reduction in IAD prevalence and improved patient comfort. It also enhances care consistency and could be cost-effective. However, the reduction was not statistically significant, and implementing the bundle requires significant resources and effort. Additionally, the specific context of the study may limit the generalizability of the results, and new protocols could disrupt existing care routines.
2. Discuss the research question or main problem discussed in the study?
The main problem discussed in the study is the prevalence and management of incontinence-associated dermatitis (IAD) in hospital patients. Specifically, the research question investigates whether implementing an evidence-based healthcare bundle can effectively reduce the prevalence of IAD compared to standard care practices.
IAD is a painful skin condition often linked to incontinence and hospital-acquired pressure injuries. It is frequently overlooked, misdiagnosed, or underreported, which leads to delayed treatment and increased patient discomfort. The study aims to address these issues by evaluating the impact of a multifaceted intervention bundle designed to improve the prevention and management of IAD in hospital settings. The bundle includes strategies such as enhanced skin care protocols, better incontinence management, and staff education. The central research question, therefore, is whether the implementation of this evidence-based bundle leads to a significant reduction in the prevalence of IAD among hospital patients compared to the baseline rates observed before the intervention.
Describe the method used by the author of the study.
ReplyDeleteThe study was a quasi-experimental pre and post translational research study to determine the prevalence of IAD using Promoting Action on Research Implementation in Health Services (PARIHS) framework. The study was conducted from October 2019 to September 2020 for pre-intervention then May 2021 to July 2022 for post intervention. This study took place across six hospitals across New South Wales. A total of 1897 patients were assessed.
Discuss the research question or main problem discussed in the study?
The main problem of the study was to evaluate the effect of an intervention on the prevalence and severity of IAD across six hospitals. The intervention used were as follows: barrier cream cloths, minimize bed protection layer, use of appropriate continence aid, use of continence assessment tools, staff education and patient education resources. The study suggested effectiveness of the interventions despite having higher prevalence of incontinence, it exhibited lower rates of IAD from 6.71% pre-intervention to 4.27% in post-intervention group, a reduction rate of 36.3%.
1. Discuss the sample size used in the study.
ReplyDeleteThe study looked at incontinence-associated dermatitis (IAD) interventions. The sample size was conducted in Australia across 18 wards. The sample size consisted of a pre and post intervention group for a total of 1897 patients: 964 pre-intervention and 933 post-intervention. However, since not all patients had incontinence, only a total of 343 pre-intervention and 351 post-intervention patients were relevant to the study. IAD rates were 6.71% in the pre-intervention group and 4.27% in the post-intervention group which calculates to a 36.3% reduction in the post group with the study’s suggested intervention bundle.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Some advantages include correctly identifying high-risk patients and implementing evidence-based interventions in a timely manner to prevent further skin deterioration. Correctly identifying IAD will help the patient recover faster and provide relief over short and long-term treatment while in the hospital setting. Timely interventions will help to ensure there are no gaps in treatment. For example, if the RN is not comfortable relying information to the MD/NP as to what they are assessing, they may just let the specialized wound team know about it and they have “done their job.” Being able to identify and recommend treatment to the primary team will allow a correct, ongoing treatment to occur while allowing for a second, more experience professional opinion to occur when possible. The only disadvantage I believe in would be the financial strain in providing additional hours to RNs and managers to enact such a project.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem discussed in this study is incontinence-associated dermatitis in hospitals and how often times it is overlooked and misdiagnosed. The study also discusses how IAD can cause a physical, social, and emotional impact on the patients. The study aims to evaluate ways to intervene and prevent the occurrence of incontinence-associated dermatitis. The intervention concentrated on assessment and management, education to patients and their families, and proper skin care in order to prevent the occurrence of IAD.
2. Discuss the sample size used in the study.
The sample size of the study was conducted across six hospitals located across Australia. In this study a total of 1897 patients participated in the study, from which 964 were assessed pre-intervention and 933 post- intervention. From the total participants, 343 were incontinent.
Describe the method used by the author of the study
ReplyDeleteThe study used a quasi-experimental conducted in Australia pre-and post-intervention design to evaluate the effectiveness of a multifaceted intervention on incontinence-associated dermatitis (IAD) in hospital settings conducted in Australia.The intervention used several steps: including assessing and managing patients`s incontinence needs and teaching caregivers and family members to increase awareness about IAD.The skin care regimen used in the study did amazing
Describe the method used by the author of the study?
ReplyDelete- this study is a quasi-experimental pre and psot study conducted in 18 wards whihc was part of a larger implementation sceince study on incontinence associated dermatitis.
Discuss the research question or main problem discussed in the study?
- 343 of the 964 individuals evaluated during the study's pre-intervention phase were found to be incontinent. 351 of the 933 individuals evaluated during the post-intervention phase were found to be incontinent. Hospital-acquired incontinence-associated dermatitis (IAD) was shown to be 36.3% less common in the post-intervention group than in the pre-intervention group, with a prevalence of 4.27%.
Describe the method used by the author of the study?
Delete- this study is a quasi-experimental pre and poststudy conducted in 18 wards which was part of a larger implementation science study on incontinence associated dermatitis. skin an incontinences assessments were conducted on patients during February and march 2020 and July and august 2021. the intervention comprised continence assessment and management, an education brochure for patients and families on IAD, the aghent global IAD categorization tool and skincare regimen
Describe the method used by the author of the study
ReplyDeleteThe design was the use of the Imbed Study which is described as a quasi-experimental, pre and post transitional research study to determine, primarily the prevalence of IAD, using an implementation science approach, which is the (PARIHS) promoting action on research implementation in Health Services framework.
The study was performed across 6 hospitals in five health districts across New South Wales in Australia. A total of 426 hospital beds in different medical specialties with the exception of long term care participated.
The study used intervention which included an intervention component of education of staff, incontinent assessment and management, education of patients and family and caregivers, practice guidelines and categorization and patient skin protection.
Data were collected using two data collection tools during clinical audits, an IAD and incontinence and skin and a baseline Data collection from which determines basic patient health and demographic data.
How does this research article compare to our practice, policy and/or procedure?
The article is very similar to our policy and/or procedure in such ways that. We also conduct a research/audit in the form of the SWAT, in which the team does skin/wound prevalence audit, and gather data for incidence of pressure injuries. We also have a standard of care/best practice guidelines similar to the intervention in the study for IAD/pressure injury prevention such as skin protectant, appropriate bed, use of absorbent layers under the patient . Incontinent assessment of patients is part of nursing daily assessment and documentation.
1. Discuss the sample size used in the study
ReplyDeleteDuring the study's evaluation of incontinence and hospital-acquired incontinence-associated dermatitis (IAD), there were 2 phases:
Pre-intervention phase: 343 of 964 individuals evaluated were found to be incontinent.
Post-intervention phase: 351 of 933 individuals evaluated were found to be incontinent.
Key findings included that IAD prevalence was reduced by 36.3% in the post-intervention group compared to the pre-intervention group, with a final prevalence of 4.27%. Despite the increased patient acuity and additional challenges caused by the COVID-19 pandemic, this significant reduction in IAD rates demonstrates the effectiveness of the intervention, underscoring improvements in patient care practices.
2. The research question in the study was:
"How effective is a multisite intervention designed to prevent and treat incontinence-associated dermatitis (IAD) in hospital settings?"
The study aimed to determine the effectiveness of EBP bundle: whether implementing an evidence-based practice bundle would result in a reduction in both the prevalence and severity of IAD. Also, the comparison of pre- and post-intervention conditions: evaluating and comparing the pre-intervention and post-intervention conditions to measure the impact of the intervention on IAD outcomes.
By focusing on these aspects, the study sought to assess the practical benefits of the intervention in improving patient care and reducing the incidence of IAD in hospital settings.
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ReplyDeleteA) What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
ReplyDeleteADVANTAGES
1. **Awareness and Focus on Care**:
- The high prevalence of IAD in hospitals has led to increased awareness and focus on preventing and managing this condition. This can result in improved overall skin care practices and the development of better protocols.
2. **Innovation in Products and Treatments**:
- The prevalence of IAD drives innovation in products designed to prevent and treat the condition. This includes the development of advanced barrier creams, more effective absorbent products, and new skincare technologies.
3. **Enhanced Training and Education**:
- Healthcare providers receive specialized training and education on how to manage IAD, which can lead to better patient care and more comprehensive approaches to skin health.
DISADVANTAGES
1. **Increased Healthcare Costs**:
- Managing IAD can be costly due to the need for specialized products, additional nursing care, and potentially longer hospital stays. This adds financial strain on healthcare systems and institutions.
2. **Patient Discomfort and Reduced Quality of Life**:
- IAD can cause significant discomfort, pain, and embarrassment for patients, impacting their overall quality of life and emotional well-being.
3. **Risk of Infection**:
- IAD can increase the risk of secondary infections, such as fungal or bacterial infections, which complicates the patient’s condition and extends recovery time.
B) Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
When examining the impact of incontinence-associated dermatitis (IAD) prevalence in hospital patients, several potential flaws or limitations in understanding and addressing this issue can arise:
1. **Underreporting and Diagnosis Issues**
- **Flaw**: IAD may be underreported or misdiagnosed due to lack of awareness or standardized diagnostic criteria.
- **Impact**: This leads to an incomplete understanding of the true prevalence and severity of IAD, potentially causing underestimation of its impact on patient care and outcomes.
2. **Inconsistent Care Practices**
- **Flaw**: There might be variability in how different healthcare providers or institutions manage IAD, leading to inconsistent care practices.
- **Impact**: This inconsistency can result in uneven patient outcomes and complicates efforts to develop universal guidelines or protocols for prevention and treatment.
3. **Focus on Immediate Symptoms Rather than Long-term Solutions**
- **Flaw**: The focus may be primarily on addressing immediate symptoms rather than implementing long-term prevention strategies.
- **Impact**: This can lead to recurrent issues and a lack of progress in reducing the overall incidence of IAD.
Discuss the sample size used in the study
ReplyDeleteSix hospitals in one state in Australia, This is quasi- experimental pre and post study. A total of 1897 were assessed pre intervention = 964 and post intervention = 933. A total of 343 pre intervention patients 351 post intervention had a incontinence .This incontinence associated skin damage prevalence decreased by 36.3% from the pre intervention 6.71 % to the post intervention period despite higher acuity and the COVID-19 pandemic in the post intervention period.
Discuss the research question or main problem discussed in the study?
The study aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence associated dermatitis in hospital settings and often overlooked and misdiagnosed resulting in delayed and costly treatment while causing significant patient discomfort. The study also discussed the IMBED intervention included using of barrier cream cloths, minimisation of bed protection layers, use of appropriate continence aid and continence assessment and management tools. It also discussed in this study that IAD causes physical, social and emotional impact on the patient.
Discuss the sample size used in the study.
ReplyDeleteThe study used a total of six different hospitals (ranging from the metropolitan area to rural hospitals) to select their participants. From each of the hospitals three different floors were used for a total of 426 beds. Each unit selected for the study comprised of a specialty including: subacute and rehabilitation, acute geriatrics, palliative care, respiratory and GI, general medical-surgical, and intensive care unit.
Describe the method used by the author of the study.
The study that was completed was a quasi-experimental and pre- and post- transitional research study. The beginning of the study was a 12-month pre intervention period, followed by the implementation of the IMBED multifaceted initiative and completed with a 15-month post-intervention period. During the implementation period the they were using an evidence-based healthcare bundle to prevent and manage incontinence associated dermatitis.
1 Discuss the sample size used in the study?
ReplyDeleteThe sample size of this study included 18 wards across six hospitals in Australia. The exact number of patients assessed was not specified in the study
The study did mention some hospital were from regional and rural areas.The study did not include the long term facilities.The units included were GI, general medicine surgical and intensive care
1.what are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteIn this article, they talked about the impact for prevalence for incontinent associated dermatitis (IAD). Some of the advantages were the outcomes of the study with decreased cases of IAD throughout 6 major hospitals located in Australia. Another advantage was the involvement between the staff and managers, educators all collaborating for the bigger purpose of keeping patient skin integrity safe. One of the disadvantages I saw was that part of the bundle to reduce these numbers was to also provide education to the patient caregiver and family members. To me this is a disadvantage, especially once patient leaves the facility because they cant ensure that the measures such as creams, appropriate supplies, and appropriate amounts of linens be used like in a hospital setting. I can imagine there can also be a financial disadvantage for these families once they leave the hospital or acute facility.
2. what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
On my unit specifically, some advantages would be decreasing IAD. The majority of the patient population that come to my unit are very limited in mobility, have history of incontinence, and a lot are given medications to diurese which can also cause incontinent episodes. Making sure we use adequate amounts of supplies can help with the quick consumption of supplies such as the pads we use, or using the right creams. Some disadvantages would be actually getting staff to follow the recommendations. We have some staff that may need a little reminding since they are used to a certain method for so many years. My unit has had a relatively low number of HAPIs but I do see a lot of moisture related skin injuries.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe methods and procedures in this article are very similar to our practice, policy and procedures because we perform the same interventions to prevent and treat IAD. For example, in incontinent patients we always assess the skin, perform turns every two hours and as needed and have skin rounds weekly. Also, we use barriers creams, appropriate continent aids such as external catheters (condom catheters and purewicks), incontinence pads and never leave a patient sitting on a soiled pad. In ICU, we also implement an early mobility protocol which would allow a patient mobility to be able to use the bathroom appropriately if they are continent.
2. Describe the method used by the author of the study.
The method used for this study was a quasi-experimental, research study to determine the prevalence of IAD using an implementation science approach. There was a pre-intervention period which lasted from October 2019 to September 2020 and a post-intervention period of 15 months, from May 2021 to July 2022. The implementation was affected by the Covid-19 pandemic which was declared a national emergency on March 2020. The study was undertaken across six hospitals in five health districts.
1) Describe the method used by the author of the study.
ReplyDeleteThe author used a quasi-experimental, pre- and post-translational research study to determine, primarily, the prevalence of incontinence-associated dermatitis (IAD) using the implementation science approach. This approach is called the Promoting Action on Research Implementation in the Health Science (PARIHS) framework. Due to the COVID-19 pandemic, the study consisted of a pre-intervention period of 12 months from October 2019 to September 2020 and a post-intervention period of 15 months from May 2021 to July 2022. The study was reported according to the modified Consolidated Standards of Reporting Trials (CONSORT) statement and the Template of Interventional Description and Replication (TiDieR) intervention checklist.
2) Discuss the sample size used in the study.
The sample size used was 964 patients who participated in the pre-intervention audit and had their skin and continence status assessed. The post-intervention audit had 933 patients whose skin and continence status had been assessed. The study was undertaken across six hospitals in five health districts across New South Wales, Australia. Eighteen wards participated, consisting of 328-bed wards from four metropolitan hospitals and three 15-bed boards from two regional hospitals specializing in acute and rehabilitation medicine, acute geriatrics, palliative care, respiratory and gastroenterology, general medical, surgical, and intensive care. No long-term facilities, such as nursing homes, were included in the study.
This comment has been removed by the author.
ReplyDeleteValarie Renaux
ReplyDeleteImpact of an evidence-based bundle on incontinence associated dermatitis prevalence in hospital patients:
Discuss the sample size used in the study
The sample size of this study consisted of 964 subjects with 343 of them incontinent for the preintervention audit. The post intervention audit consisted of 933 subjects isolating 351 incontinent participants. Within this study the subjects were further categorized within the pre-intervention 23 out of the 343 developed incontinent associated dermatitis (IAD) as hospital acquired and the post-intervention showed 15/351 were observed to have reduced incidences of 36.3%.
Describe the method used by the author of the study.
The method used for this study was the quasi-experimental design. Six hospitals consisting of 18 units were utilized for data collection of incontinent associated dermatitis in Australia. Assessments initially began in 2020 from February to March with reassessments occurring in July to August of 2021. Interventions used included the Ghent Global IAD Categorization tool. The GLOBIAD was created in 2018 giving rise to an international consensus to characteristics of IAD evolvement along with an agreed documentation incorporated into patient care and analysis. (Beeckman D. et al., 2017).
References
Beeckman D., Van den Bussche K., Alves P., Beele H., Ciprandi G., Coyer F., de Groot T., De Meyer D., Dunk A.M., Fourie A., García-Molina P., Gray M., Iblasi A., Jelnes R., Johansen E., Karadağ A., LeBlanc K., Kis Dadara Z., Long M.A., Meaume S., Pokorna A., Romanelli M., Ruppert S., Schoonhoven L., Smet S., Smith C., Steininger A., Stockmayr M., Van Damme N., Voegeli D., Van Hecke A., Verhaeghe S., Woo K. and Kottner J. The Ghent Global IAD Categorisation Tool (GLOBIAD). Skin Integrity Research Group - Ghent University 2017. Available to download from www.UCVVGent.be
Describe the method used by the author of the study.
ReplyDeleteThe IMBED study was a quasi-experimental, pre- and
a post-translational research study to determine, primarily,
the prevalence of IAD, using an implementation science
approach—the Promoting Action on Research Implementation in Health Services (PARIHS) framework .21
Owing to the COVID-19 pandemic, this study consisted
of a pre-intervention period of 12 months (October 2019
to September 2020) and a post-intervention period of
15 months (May 2021–July 2022), separated by the implementation of the IMBED multifaceted initiative.
Discuss the sample size used in the study.
The study was undertaken across six hospitals (four
major referral hospitals, one regional and one rural
hospital) in five health districts (three metropolitan,
two rural) across New South Wales (NSW), Australia.
Eighteen wards participated (three per hospital), comprising three 28-bed wards from the four metropolitan
hospitals and three 15-bed wards from the two
regional hospitals (426 beds in total), specialising in
subacute and rehabilitation medicine, acute geriatrics,
palliative care, respiratory and gastroenterology, general medical, surgical and intensive care. No long-term
care facilities such as nursing homes were included in
the study.
Describe the method used by the author of the study.
ReplyDeleteThis quasi-experimental, pre/post-translational research study was undertaken across six hospitals in five health districts across New South Wales, Australia. Eighteen wards participated, comprising three 28-bed wards and three 15-bed wards specializing in subacute and rehabilitation medicine, acute geriatrics, palliative care, respiratory and gastroenterology, general medical. The intervention was multifaceted and comprised of clinician and patient facing approaches.
Discuss the research question or main problem discussed in the study?
The study was aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence-associated dermatitis in six hospitals in one state in Australia. IAD is a painful skin condition linked to hospital-acquired pressure injuries. It is often overlooked and misdiagnosed while causing significant patient discomfort.
Describe the method used by the author of the study
ReplyDelete-There was pre – intervention period of 12 months and post for 15 months in 6 hospitals in Austrailia. Included no long term care facilities. They used an audit tool to gather data – which included frequency/quality of stools, mobility status, incontinence products used, and whether they had other injuries. They had a local investigator on site working with the staff members.
Discuss the sample size used in the study.
-Total of 964 patients participated in pre intervention audit. In the post intervention, 933 patients had their skin assessed. This was done across 6 hospital settings. No long term care facilities were used.
David Kahn RN 5south
ReplyDelete-what are the advantages and disadvantages to the proposed recommendations in the article?
The research did not specify what were the exact interventions/products used. The conclusion was that any interventions used would be more beneficial than not using a skin protectant. The disadvantages would be that some patients did experience worsening of the IAD post intervention and the difficulties monitoring these patients over long periods of time to determine appropriate treatments.
-what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The overall findings of the article suggest that treatment of the IAD caused improvement in a majority of the research population. We already use skin prevention/treatment regimen at psjmc, but the advantage shown through this research further supports our efforts. The article also gives us an example of what we would need to do if we intended on doing a skin study on our unit. It highlights the importance of needing clear criteria on how to classify the dermatitis and the need to document on all patients skin to obtain a true baseline of IAD prevalence
Discuss the sample size?
ReplyDeleteThe sample size included a total of 964 participants who participated in the pre-interview audit and 343 of the participants were considered incontinent. In the post-intervention, 933 had their skin assessed and 351 were considered incontinent. The findings between both groups were similar.
Describe the method used.
The method was a quasi-experiment that included a pre-intervention phase of 12 months and 15-month post-intervention phase. The subjects were distributed across 6 hospitals in different areas that included subacute , surgical, medical, and ICU. Long-term facilities were excluded.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteAdvantages:
Reduction in Incidence: Implementing an evidence-based bundle can significantly lower the prevalence of incontinence-associated dermatitis (IAD) in hospital settings, improving patient comfort and outcomes.
Standardized Care: Evidence-based bundles promote standardized care protocols, ensuring that all patients receive the same high-quality interventions, which can improve overall care consistency.
Cost-Effectiveness: Reducing IAD can lead to lower treatment costs associated with skin care, wound management, and longer hospital stays, which can benefit both patients and healthcare systems.
Improved Staff Education: These bundles often include staff training, enhancing nurses' and caregivers’ knowledge about prevention and management of IAD, which can lead to better patient care.
Increased Patient Satisfaction: By addressing skin integrity and discomfort, patient satisfaction may improve, contributing to a better overall hospital experience.
Disadvantages:
Implementation Challenges: Transitioning to a new evidence-based bundle can face resistance from staff, require additional training, and necessitate changes in workflows, which might slow down initial adoption.
Resource Allocation: The need for resources (time, personnel, materials) to implement the bundle may strain hospital budgets, especially in facilities with limited funding.
Monitoring and Evaluation: Ongoing evaluation of the bundle’s effectiveness requires continuous monitoring, which can be resource-intensive and may divert attention from other critical areas of patient care.
Variability in Patient Populations: The effectiveness of the bundle may vary across different patient populations, making it less effective in certain contexts or demographics, which could lead to inequities in care.
Over-Reliance on Protocols: There’s a risk that staff may become overly reliant on protocols, potentially leading to less individualized patient care if specific patient needs are not adequately addressed.
Overall, while the recommendations from the study offer significant potential benefits for reducing IAD in hospital patients, careful consideration of the challenges and limitations is essential for successful implementation.
2. Discuss the sample size in this study.
The sample size in Barakat-Johnson et al. (2024) is substantial, involving 964 patients in the pre-intervention group and 933 in the post-intervention group across six hospitals. This diverse setting, including both metropolitan and rural areas, enhances the generalizability of the findings. The inclusion of various ward types allows for a comprehensive evaluation of the interventions' impact on IAD prevalence across different patient demographics and care environments. However, it’s important to consider whether the sample size adequately reflects the broader patient population and whether it provides sufficient statistical power to detect significant changes in IAD prevalence.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis research article is very detailed on how to care for patients living with dementia and stating the importance of nurses’ risk assessment and finding out the major impact by age related condition change, physical or environmental changes. Also, affected by a personal physical and mental decline from arthritis, diabetes, cardiac issues, Parkinson's disease, chronic lung disease, depression, stroke, or medications (Cholinesterase inhibitors medications, diuresis, and sedatives).
As a healthcare professional, I cannot assume/stereotype that dementia patients have a symptom of incontinence, and I should determine the management plan individually as a person-centered assessment by physical, mental, and emotional status.
The incontinence of urinary and fecal incontinence affects patients from pressure ulcers, urinary tract infections, catheterization, fecal constipation, which increases the risk of prolonged staying, or readmission risk to the hospital. Sometimes it increases the risk of hospital mortality.
In our practice, we also assess individual newly admitted patients as patient centered care. We collaborate with physical and occupational therapists to evaluate the patient’s toileting ability including safety concerns. Also, we assess new patients' skin with the assistance of two nurses, and then consult with a wound care nurse as needed.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The advantages of implementing the article recommendations in our unit is to offer a person-centered continence assessment to all the patients and identify the primary issue and treating/improve the cause of urinary and fecal incontinence. We assess patients' ability to implement care for bladder and bowel control with training. It is always important to respect individual patients and family then acknowledge the incontinence affecting them physically, mentally, financially.
The disadvantages of implementing the article recommendations in our unit as a neurology related unit with some of our patients were diagnosed with advanced dementia or experienced repeated stroke. The new hospitalized diagnoses are altered mental status, septic, and UTI. Most are chronic mental or physical disabilities which makes it difficult for nurses to assess the impact of incontinence from the multiple complications.
- Discuss the research question or main problem discussed in the study?
ReplyDeleteThe research question/main problem discussed in this study is the prevalence of incontinence-associated dermatitis (IAD) in hospital settings that can result in hospital-acquired pressure injuries (HAPI) and ways to negate such issues. It is mentioned that IAD is a debilitating and painful skin condition and should be properly accepted as a step towards patient's overall wellbeing and safety. In this study, researchers have developed and tested an evidence-based healthcare bundle in hopes of preventing, as well as managing, IAD.
- Describe the method used by the author of the study
The method used by the author of the study implemented the Promoting Action on Research Implementation in Health Services (PARIHS) framework. The study's method was focused on a quasi-experimental, pre- and post-translational research study that helped to determine the occurrences of incontinence-associated dermatitis (IAD). With this in mind, researchers looked at the pre-intervention timeline of 12 months and a post-intervention timeline of 15 months to see the effect of their study centering around interventions used to survey the prevalence of IAD.
Paolo Largoza, 3N
1.Discuss the sample size used in the study.
ReplyDelete-The study had a total of 1897 patients. Pre-intervention consisted of 964 patients & post-intervention consisted of 933.
2.Discuss the research question or main problem discussed in the study?
- The study tested the effectiveness of an evidence-based bundle on the prevalence & severity of incontinence associated dermatitis. The bundle included continence management, education & specialized skin care regimen.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe intervention components used in this study were similar to our interventions in my current practice. There were 5 types of interventions in this study. One was Eduction of patients, family, and caregivers which included a brochure on Incontinence-associated dermatitis which I thought was a good idea. Another intervention component was patient skin protection which included implementation of a skin care plan, in which we practice daily at work.
Discuss the research question or main problem discussed in the study?
The main problem discussed in this study is Incontinence-associated dermatitis or IAD. IAD is a skin condition that occurs when the skin is exposed to urine or stool for a prolonged period of time. It's a form of skin inflammation that can cause discomfort, itching, pain, and other symptoms. The surrounding skin may have a wet, macerated appearance in the acute phase, and dryness and peeling skin in the chronic phase. This study compares cases of IAD pre and post interventions.
Describe the method used by the author of the study.
ReplyDeleteThis research study used a quasi-experimental, pre/post translational design. The Australian area of New South Wales was the focus of the study, using 6 hospitals in 5 districts. Departments specializing in subacute/rehab medicine, general medicine, respiratory and gastroenterology, palliative care, and acute geriatrics were used, totaling 18 departments. Clinician and patient facing approaches used a multifaceted intervention strategy.
Discuss the research question or main problem discussed in the study?
Incontinence associated dermatitis was studied. Mainly, interventions to reduce its prevalence and severity were focused on. The study was based in 6 hospitals in 1 state in Australia.