Proactive innovation for incontinence-associated dermatitis (IAD) for admitted patients in an acute rehabilitation hospital

Purpose:To determine if aggressive bowel management by a multi-disciplinarily team can prevent incontinence-associated dermatitis (IAD) and reduce PrU risk factors in acute rehabilitation hospital patients.  

Method/Results:Retrospective medical record data of patients admitted to an acute rehabilitation hospital from April to June and received interventions for bowel problems during their hospital stay will be gathered for a 3 month period to establish a sample patient group, using an original patient demographic form. The acute rehab facility implemented a daily multi-disciplinarily group huddle, “Poop-in-a-Group” (CWOCN, MD, NP, nursing supervisors, Pharmacist, and RD) for early detection of patient’s with GI problems, including diarrhea, distended abdomen, constipation, inadequate intake, and bowel incontinence. Timely team interventions were implemented, thus improving patients’ nutrition and bowel health to prevent and/or heal skin breakdown. Descriptive and graphic analysis of various interventions and outcomes are provided.

Discussion:Incontinence-associated dermatitis (IAD) develops in 36% of critically ill patients typically with fecal incontinence and does not resolve by the time most patients are discharge from the Critical Care Unit (Bliss, et al., 2011). Presence of IAD increases the vulnerability of skin integrity and is frequently associated with pressure ulcers (PrUs), affecting the sacral area or the buttocks (Ersser, et al., 2005). As part of the hospital’s PrU prevention and treatment strategy as recommended by Gray, M., et al, 2012, the hospital implemented a more proactive approach suited for acute rehabilitation setting to maximize patient mobility and reduce loss therapy time.   

Conclusion:Management of bowel continence is critical in preventing IAD and reduces risk factors for PrU. Serial discussions among our multi-disciplinarily team were needed for the sample population with neurogenic bowel and tube feeding. Description of the mechanism of diarrhea in these patients and interventions to restore bowel health will be suggested.