Abstract: Incontinence Associated Dermatitis: Changing practice using an implementation research approach to reduce hospital-acquired pressure injuries across an Australian health district (50th Annual Conference)

Michelle Barakat-Johnson, RN GDipPain MN (Res) PhD Candidate, Patient Safety and Quality, Sydney Local Health District and Univeristy of Sydney, Sydney, Australia, Michelle Lai, BA (Psych) MRes (Phil), CRNU, Univeristy of Sydney, Sydney, Australia, Timothy Wand, RN NP MN(Hons) PhD, Emergency Department, The University of Sydney and Sydney Local Health District, Sydney, Australia and Kathryn White, RN MN PhD, Cancer Research Nursing Unit, The University of Sydney and Sydney Local Health District, Sydney, Australia

PURPOSE: This two-stage study examined incontinence practice, incontinence associated dermatitis (IAD) and pressure injuries (PIs) to identify underlying factors in the increase of hospital-acquired pressure injuries (HAPIs) in one Australian health district. METHODS: Between November 2015 and August 2017 a prospective audit of IAD, PIs, incontinence management and nurses’ perspectives on incontinence practice was conducted. PARTICIPANTS: In twelve wards across four hospitals, 250 patients were audited. Six nurse focus groups (n = 31) consisted of nurses working on wards at the time of the study. STAGE ONE RESULTS: Nearly half of the patient sample had incontinence (n = 111), 20.3% of incontinent patients had IAD and 4.5% had HAPIs. There was a significant association between incontinence and mobility (P < .0001) and IAD and HAPIs (p < 0.0294). Some patients without incontinence were wearing incontinence pads (22.2%). Nurses’ identified that incontinence management was inconsistent with best practice. PART TWO RESULTS: Following the implementation of initiatives to address incontinence management and prevent IAD, nurse focus groups revealed that; barrier cloths were convenient for time-poor nurses, minimized multiple steps in incontinence management, were useful for patients with incontinence and excoriation, and absorbed smells. Many nurses preferred barrier cloths over barrier creams as they could clean, moisturize and provide a barrier all in one cloth. Additionally, the cloth did not leave any visible product on the patient, enabling them to see the patient’s skin. In terms of PI prevention, nurses were confused about the appropriate use of plastic sheets and underpads, where and how to report PIs, and indicated a lack of time to document PI care properly. CONCLUSION: Inconsistent and inappropriate interventions hinder optimal care for patients, increasing costs of care and predisposing patients to risk of skin injury. Incontinence management must be incorporated in education campaigns and guidelines to prevent PIs.

R06 Incontinence Associated Dermatitis: Changing practice using an implementation research approach to reduce hospital-acquired pressure injuries across an Australian health district