No Briefs About It: Preventing Incontinence Associated Skin Damage in the Acute Care Setting

BACKGROUND:  Incontinence associated dermatitis continues to be a major risk for the development of pressure ulcers. The use of briefs has been associated with poor outcomes. At our 458 bed community hospital, the routine use of incontinence briefs was discontinued in an effort to reduce the risk of incontinence associated dermatitis (IAD).

PURPOSE: Key components of the project were to reduce the incidence of moisture and incontinence associated skin damage, and to reduce the development of pressure ulcers; and to effect a cost effective, if not cost neutral change in practice by implementing 3 in 1 incontinence wipes.

METHOD: A multidisciplinary team of  ten staff,  including unit managers, CWOCN, administrative director, quality assurance and inventory control met many times to analyze current practice, formulary, best incontinence practices, implementation of wipes, barriers to implementation, and family and staff education.  An incontinence management algorithm was developed for decision making, and a letter to family was created to educate on use of briefs.

RESULTS: Audits were done to monitor the process. Reinforcement of practice continued at shift report meetings and unit manager meetings. There was 100% staff satisfaction, after three and five weeks with the incontinence wipes. Based on audits conducted to monitor the process, incontinence care compliance was 30% after three weeks, and 90% after five weeks