IMPLEMENTING EVIDENCE-BASED PRACTICE TO IMPROVE OUTCOMES FOR PATIENTS WITH INCONTINENCE-ASSOCIATED DERMATITIS

IMPLEMENTING EVIDENCE-BASED PRACTICE TO IMPROVE OUTCOMES FOR PATIENTS WITH INCONTINENCE-ASSOCIATED DERMATITIS

Abstract
Background & Problem: Incontinence-associated dermatitis (IAD) is a skin condition originating from the harmful effects of prolonged exposure to urine and fecal fluids. The inconsistency in clinical assessment of IAD is a primary concern since IAD is considered a precursor of pressure injuries (PI). PIs and IAD coexist, and the presentation may be similar, resulting in misidentification, thus increasing costs of treatment. The 140-bed skilled nursing facility (SNF) where the evidence-based practice (EBP) change project occurred had 136 (97%) incontinent patients, 7% (n=10) had IAD and 4% (n=5) patients had PIs. The factors identified as an opportunity for development directed at the nursing staff in the facility included 1) Lack of knowledge of IAD among nursing staff, 2) Incorrect identification and treatment of IAD, 3) Lack of knowledge of barrier products for management of IAD, 4) Inappropriate use of absorptive products.
Purpose: The purpose of the EBP change project was to develop an EBP structured protocol for perineal care in the 140-bed SNF.
Methods: The intervention was educating the nursing staff of registered nurses (RNs, n=13), licensed practical nurses (LPNs, n=39), and certified nursing assistants (CNAs, n=86) on prevention, identification, and treatment of IAD. The nursing staff was given a pre-test to determine their baseline knowledge then educated on IAD prevention, identification management and absorptive/barrier products. A post-test was given after the education. The post-test results showed a significant increase in knowledge.
Results: Pre-test/post-test mean scores; RNs, 74%/91%, LPNs 76%/90% and CNAs 54%/87%.
Conclusion: The implementation of the EBP change project effectively increased continuity of perineal care and increased the nursing staff’s knowledge on identification, prevention, and treatment, consequently improving patient outcomes.

Keywords:
Incontinence-associated dermatitis (IAD), Fecal incontinence, Urinary incontinence, Perineal skin care, Pressure Injury