Achieving Optimal Outcomes by a Standardized Approach to Incontinence Care

PURPOSE:  Patients with urinary and/or fecal incontinence are at risk for skin damage due to exposure of the skin to moisture and irritants. This can lead to the formation of pressure ulcers. Education of the Nursing staff about incontinence care is a vital component to a pressure ulcer prevention plan. BACKGROUND: Our acute care facility has several skin protectant products. No standardized approach to incontinence care was in place. This created confusion over product use and if the most appropriate care was being administered. At times skin would breakdown necessitating a WOCN consult for treatment recommendations. OBJECTIVE:  A need was identified to educate the Nursing staff on the appropriate use of skin  products to achieve positive outcomes.  METHODOLOGY:  The WOCN is involved in staff education. Nursing Assistants are required to attend an annual  skills educational program. The WOCN presents at these sessions on the topic of pressure ulcer prevention. Because the Nursing Assistants primarily administer the bedside care to patients, this year's focus was on skin protectant products. The presentation gave an overview of how skin functions as a barrier, how moisture disrupts the barrier, ingredients that go into skin products and their purpose, and how the products must clean, moisturize and protect the skin. The information given was evidence- based. As a result of this program, some of the Nursing Assistants requested some type of guideline when using the skin protectants. An algorithim was developed. It divided skin conditions into 3 categories:#1--Skin not opened, no redness. #2-- Skin not opened, but red. #3-- Skin opened and red. For each of the categories the appropriate skin protectant was referenced. It was also color coded to desigante specfic Nursing Assistant and Nursing responsibilities. OUTCOME: The response has been positive. The algorithim has been reviewed by the Policy and Procedure Committee and adopted into policy at the facility.