Incontinence Associated Skin Damage (IASD): Tracking Prevalence & Severity

Background:  300+ bed community hospital conducted Incontinence Associated Dermatitis Severity Instrument (IADSI) validation study in 2014.  The researchers evaluated IADSI instrument for inter-rater and intra-rater reliability.  The data collected revealed a 0.96 Intra-Class Correlation Co-efficient when comparing simultaneously scored assessments of 20 registered nurses, with those of CWOCN Specialist.

Incontinence Associated Skin Damage (IASD) is a precursor to pressure ulcer development.  Currently, there is no existing National, Regional, or local data base of IASD prevalence collected, shared or reflected in an established benchmark.  A National benchmark would be beneficial in identification of problem of IASD and drive clinical practice changes to prevent and treat IASD. 

Question:  What is the prevalence of IASD in the acute care in-patient setting, specific to parameters of IASD present on admission, IASD hospital acquired, and IADSI score. 

Methods:  A specially trained team of Registered Nurses, Comfort Care Providers (CCP), and Patient Care Associates (PCA) conduct data collection during monthly point prevalence study.  Each team consists of Team Leader, RN, and CCP or PCA, 10 teams total.  Team responsibilities include, completing head-to-toe skin assessment, room safety check and concurrent chart review for each patient.  In addition, patients with incontinence are assessed and scored with IADSI instrument, which is completed by team RN.   Monthly data is collected, analyzed and trended, providing relevant clinical insight to IASD Prevalence, IADSI score, and differentiation of POA or Hospital acquired.

Outcomes:  Preliminary data utilizing 6 months of monthly point prevalence metrics reveals 12% prevalence of IASD during monthly point prevalence studies.  The severity of injury ranged from 0-43 utilizing the IADSI assessment tool.  Hospital acquired IASD was 8.0%. 

Conclusion:  System and process development to accurately collect data related to prevalence of IASD will help establish a National benchmark which will contribute to improvements in patient skin safety.