"Bottoms Out"-An Initiative for Skin Care Improvement in Incontinent Patients in an Acute Care Setting

“Bottoms Out”-An Initiative for Skin Care Improvement in Incontinent Patients in an Acute Care Setting.

Perineal dermatitis is a prevalent problem for hospitalized patients from incontinence which has been documented to affect 8-20% of the patients on a medical unit, with skin alteration in 20 to 74% of those patients. The Skin Care Committee at this acute care facility realized the opportunity to impact patient care. They used the data as a quality initiative, using the PLAN, DO, STUDY, and ACT model, to determine the difference in skin integrity among patients managed with briefs and reusable cloth under pads vs. the elimination of brief use and use of disposable absorbent under pads.  Initial baseline data over a month involved looking at 293 admissions to determine overall incidence rates of alteration in skin integrity (including perineal rashes, incontinence associated dermatitis and pressure breakdown) and cost of products (briefs and disposable absorbent under pads). A reduction in the incidence of perineal rashes, incontinence associated dermatitis and pressure breakdown was demonstrated in 310 admissions following education by CWON and practice change. The findings demonstrated improvement in patient outcomes as evidenced by a 77% rate of reduction in skin integrity alteration.  Furthermore, an additional cost savings of 58% was realized with the change in practice and products.