Improved Access to Incontinence Care Products Helps Reduce Pressure Ulcers

Introduction:

The change in the Inpatient Prospective Payment System (IPPS) provides an incentive for  hospitals to take pressure ulcer prevention seriously.  As a Magnet credentialed hospital, Mercy Medical Center has consistently tracked pressure ulcer data and has benchmarked with the National Databank of Nursing Quality Indicators (NDNQI).  While our pressure ulcer data has always compared favorably, the payment ramifications of IPPS provided us with an opportunity for improvement. 

Purpose:

Staff was not complying with our current incontinence skin care protocol.  While we had a protocol that was evidenced-based, an analysis determined that staff were often too late to initiate the protocol.  Moisture related skin injury, especially secondary to urinary and fecal incontinence, is a risk factor for pressure ulcer development. 

Method:

Our analysis showed that 22% of our hospitalized patients had some degree of incontinence.  An analysis of our data and practices offered the following conclusions:

·        Too many product choices created confusion for staff

·        Products were not located for easy access

·        Current products did not support best practice for incontinence care 

While moving our incontinence products closer to the bedside seemed like an easy problem to fix on the surface, regulatory issues mandate certain products be secured on units with ambulatory patients, such as mental health, skilled nursing and long term care.  Our diverse patient population created a challenge in keeping our previous products at the bedside.

Conclusion:

Implementing a dimethicone-impregnated barrier cloth and providing bedside availability of this product have enhanced caregiver compliance of our incontinence skin care protocol while maintaining safety regulations.   We were able to achieve near zero incidence of facility acquired pressure ulcers and have been able to maintain it in a cost-effective manner.