Changing Our Methods of Adult Incontinence Management to Decrease Skin Breakdown and Improve Patient Satisfaction

Purpose:

Improve the management of adult urine and fecal incontinence to decrease skin breakdown and improve patient satisfaction.

Background:

In our acute care community hospital, adult urine and fecal incontinence was managed with diapers and a thin chux pad under the patient. We were seeing a significant number of Stage 1 and 2 pressure ulcers, along with incontinence associated dermatitis.  On doing a literature review, we found that our protocols and some products did not follow current evidence based practice.

Objectives:

1. Decrease our number of inpatient Stage 1 and 2 pressure ulcers

2. Update our management of adult incontinence to reflect current evidence based guidelines and practice

Methods:

Based on a literature review, we identified products and methods to make our practice in line with current recommendations.  We selected several products and performed trials and evaluations.  Nurses perceptions and feedback were collected both verbally and written.  We also obtained verbal feedback from patients about their comfort and satisfaction with the plan of care. Based on the information collected, products were chosen, protocols updated, the staff was educated, and a revised plan of care was implemented.

Outcomes:

In a data comparison for a selected period prior to implementation in 2008 and after implementation in 2009, the number of consults for incontinence was similar: 59 in 2008, 62 in 2009.  However there was a significant decrease in Stage 1 pressure ulcers: 49 in 2008, 37 in 2009; and Stage 2 pressure ulcers: 205 in 2008, 130 in 2009.

Conclusion:

The revised plan of care decreased the incidence of Stage 1 and 2 pressure ulcers and was positively received by staff and patients.