Authors (including presenting author) :
Li CK(1)
Fu CW(1)
Affiliation :
(1)Intensive Care Unit, North District Hospital
Introduction :
IAD is defined as a type of contact dermatitis due to constant skin exposure to stool and/or urine, causing inflammation of the skin. ICU patients are often managed with sedation, multiple antibiotics therapy, and enteral feeding. All these treatment modalities predispose patients to have fecal incontinence and diarrhea, which may cause skin damage. IAD is a common skin injury among critically ill patients with diarrhea and/or fecal incontinence. Several studies have shown that one-third of critically ill patients had fecal incontinence, and an average IAD incidence rate up to 40%.
Currently, the cluster-based IAD management protocol focuses on doubly incontinence patients. An evidence-based structured skin care protocol, with pictorial guidance and simplified wordings, is designed to reduce IAD occurrence among fecal incontinence with diarrhea patients in ICU.
Objectives :
1. To develop an evidence-based skin care protocol for patients with fecal incontinence and diarrhea in the ICU setting.
2. To evaluate the effectiveness of the skin care protocol in terms of the IAD severity.
Methodology :
The “plan, do, check, act” cycle is used for continuous practice improvement in this project.
The “Plan” phase (1/10/2021 - 1/11/2021) focuses on the development of IAD protocol, intervention materials and education materials. Afterwards, the “Do” phase (1/11/2021-31/5/2022) consists of staff education and implementation of the protocol. Subsequently, in the “Check” phase (1/6/2022-30/6/2022), data will be analyzed and effectiveness of the protocol will be evaluated. Finally, in the “Act” phase (1/7/2022-31/7/2022), practice will be standardized if the protocol is effective. Future project on IAD will be planned for further improvement.
Result & Outcome :
98% nursing staff completed the education session. Most staff expressed that the protocol is user-friendly with clear pictorial description. 63 ICU patients admitted from 1/12/2021 to 31/12/2021 have been recruited and 4 of them implemented the IAD protocol. The protocol compliance is 100% in terms of identifying the IAD severity correctly and applying the intervention materials accordingly as evidenced by the clinical photos and documentations in the “shift-assessment forms”.
If the protocol is effective, it can be used in ICU to promote better health outcomes for critically ill patients, with the ultimate goal of improving their quality of care and reducing the burden on the already overstretched healthcare system.
