INCONTINENCE BUNDLE: ADHERENCE, SUSTAINABILITY, AND EFFECT ON PRESSURE INJURY RATES

Introduction:

Incontinence is present in 20-54% of hospitalized patients, and increases the likelihood of hospital acquired pressure injury (HAPI). HAPI has a significant impact on health care outcomes, hospital reimbursement, and patients. An evidence-based Incontinence Bundle was instituted in March 2017, at a Midwest teaching hospital. A quality improvement project was designed to determine whether the 10-item Bundle was effectively implemented and sustained after six months, and whether it reduced incidence of HAPI.

Methods:

All adult inpatient units were included. Patients with incontinence and Braden Risk Assessment Score^© indicating risk for pressure injury were identified, and a random sample was studied. Adherence to the Incontinence Bundle was determined by nurse interview, augmented with direct observation. Audits were conducted in September 2017 and again six months later.

Results:

Sixty-eight patients were selected by random sampling: 33 for baseline assessment, and 35 for the six-month follow up. There was no significant difference between baseline and six month follow up samples with regard to risk factors. At baseline, 3% had nine or more bundle interventions in place, which improved to 20% at six months (p=.03). Implementation of nine or more bundle interventions was significantly associated with no HAPI (p=.01, OR 2.2, 95% CI [1.6-2.9]).    

Conclusions:

Though incontinence bundle implementation improved over six months, it stayed below acceptable levels. When nine or more bundle interventions were instituted, HAPI risk was significantly reduced, suggesting Bundle efficacy. Challenges to full Incontinence Bundle adherence included the number of interventions included, lack of clarity on which patients are appropriate for the Bundle, and a manufacturer recall of the dimethicone-based body wipes used in the Bundle. The hospital Skin Care Team has made changes in the Incontinence Bundle based on these findings. Future evaluation will show whether the changes result in improved outcomes.