Staff Challenges with Differentiating IAD from a Pressure Ulcer Stage 2

When a patient is admitted in an acute care facility the bedside Registered Nurse will complete the initial assessment of the patient and document any alterations in the skin.  The staff was very aware that pressure ulcers need to be documented within 24 hours of admission in order to meet the Present on Admission criteria and that the documentation needed to be accurate. Bedside nurses have been challenged differentiating between incontinence associated dermatitis (IAD) and a Stage I or II pressure ulcer.  Unfortunately a nurse not confident in what she assesses will often times document these skin alterations more readily as a pressure ulcer rather than IAD especially if the area in question is over a bony prominence.

     Reviewing the rates of our Present on Admission Stage I and II pressure ulcers in discussion with our nursing staff, we were concerned that the rates did not match our patient population.  Not only did the nurses want more confidence in their assessment skills but we also wanted to validate appropriate interventions that could be implemented by the RN staff. The literature describes the inherent issues in determining an appropriate diagnosis and we had difficulty creating a process that would enable the bedside nurse to distinguish between the two.   This work will describe our challenges, issues, and plans in our goal to assist the bedside nurse with documenting appropriately the skin changes they note in a patient who presents with an alteration in their tissue integrity.