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Sarah Sage, Melbourne Health - Preventing Incontinence Associated Dermatitis- A Collaborative Approach
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Sarah Sage, Melbourne Health - Preventing Incontinence Associated Dermatitis- A Collaborative Approach


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Sarah Sage, Coordinator: Chronic Wound Service & Coordinator: Clinical Nurse Consultants-Wound Management, Melbourne Health delivered the presentation at 2013 Reducing Avoidable Pressure Injuries …

Sarah Sage, Coordinator: Chronic Wound Service & Coordinator: Clinical Nurse Consultants-Wound Management, Melbourne Health delivered the presentation at 2013 Reducing Avoidable Pressure Injuries Conference.

The 2013 Reducing Avoidable Pressure Injuries Conference featured a comprehensive case study led program covering topics such as prevention of pressure injuries during the surgical patient journey and in people with Spinal Cord Injuries, meeting Standard 8, translating research into clinical practice and more.

For more information about the event, please visit:

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  • 1. Sarah Sage Clinical Nurse Consultant-Wound Management Susan Leenaars Clinical Nurse Consultant-Continence Management Royal Melbourne Hospital *
  • 2. *
  • 3. * *Seen in infants (usually with cloth nappies) *Type of contact dermatitis
  • 4. * *Mentioned in the EPUAP definitions: *Often confused with a stage 2 pressure injury *Proper diagnosis is to remove/manage the moisture of the skin, if the break is still there- consider moisture lesions. *Can appear in skin folds NOT just perineum
  • 5. * Incontinence Associated Dermatitis (IAD) is “skin inflammation manifested as redness with or without blistering, erosion, or the loss of skin barrier function that occurs as a consequence of chronic or repeated exposure of the skin to urine or fecal matter” (Grey 2007)
  • 6. * *Is a break in integrity *Is part of the body’s response to continuing insults *Is a type of contact dermatitis *Best treated with topical anti-inflammatory and removal/control of injuring substance
  • 7. *
  • 8. * Works to help people with incontinence overcome the incontinence * Provide people with the tools to maintain social continence * This includes but is not limited to: medication, diet, exercises, counselling etc * Works to provide optimal healing environment for wounded tissue. * E.g.. Overcome biofilm, improve nutritition, manage oedema etc * This includes but is not limited to: compression, diet, medication, dressings, exercises, counselling etc *
  • 9. * *Shared quality project MH and Hartmann’s support *Pre-learning *Pre-event knowledge and collaboration survey *1 day event to have open discussion about Victorian CNC (wound and continence) regarding expert opinion on IAD *Objective to discover current practices and understanding of IAD
  • 10. * *What were other CNCs doing in Victoria? *What was considered best practice? *Decided to run a 1 day scoping event *For senior wound and continence CNVs in Victoria in tertiary referral centres *Hoped to play match-maker
  • 11. * *4 articles *Mainly from WCON literature *Minimal literature in wound or continence circles e.g. CFA brochure was approx. 10 years old
  • 12. * *Identified gaps: *40% identified that they referred to their counterparts, (60% less than 5 times) *Clinicians indentified that IAD was a factor in pressure injury development, but did not have confidence in ward staff management *Most clinicians felt confident in their won understanding of IAD *Not targeted education on IAD prevention
  • 13. * *Brief theory to set the tone of the day *Hands-on practice with both wound and continence products (clinicians are encouraged to ‘play’ *Workshop in small groups re: policy *Clinicians not to sit with their ‘friends’
  • 14. * *Many of the participating clinicians realised that they have policies pertaining to skin management of people with incontinence *Policies were usually embedded inn aged care/continence polices *Not part of everyday practice or acute hospital knowledge
  • 15. *
  • 16. * *50% of residents in care are incontinent *80% of immobile are incontinent *1/3 0f patients admitted to Royal Park are known to be continent on admission (excludes the hidden majority) *Expectation that incontinence is a normal part of aging (its not)
  • 17. * *Summary of what policy is: *Key points are: *pH appropriate skin care (4.5-5.5) *Active toileting *Promoting continence (NOT managing incontinence) *Barrier cream for all (with pads) *Skin checks *Skin Hygiene
  • 18. *
  • 19. * *Urine is composed of 95% H2O 5% organic solutes, primary urea. *Normal skin has a pH of 5.4 to 5.9 (acid environment) this has an antibacterial effect limiting pathogenic organisms. *Urinary urea decomposes on the skin to form ammonium hydroxide which is an alkaline substance and raises the skins pH, which favours bacterial proliferation. Faeces contains enzymes including: *Proteases (Any of various enzymes that bring about the breakdown of proteins into peptides or amino acids) *Lipases (Any of a class of enzymes that break down fats, produced by the liver, pancreas, and other digestive organs or by certain plants) *50% made up of microorganisms Faeces degrade the skin barrier function
  • 20. * *Continence and skin care is seen a something that ward nurses can own *Responsibility is being taken *However, concern that each speciality is adding layers of complexity to the ward nurses role and increasing the list of tasks that have to be done *IAD, skin care and continence is on the executive agenda
  • 21. * *Nurse Rounding *Advancement of technology (e.g.. Cloth vs. disposable pads, visible vs. invisible barrier creams) *Evolution of own practice and understanding of concepts *Looking to have follow-up day on IAD *Looking to other professional groups for engagement (WOCN)
  • 22. * *Decision to take nursing education ‘back to basics’ *Improve all nursing care, then continence, and skin care will improve, reduces falls *Empower patients and carers to be involved and speak up about care and nursing needs *Nurse rounding is a philosophy NOT a task, and Susan is working to engage nurses to embrace this nursing concept
  • 23. *When Rounding? Positioning Making sure the patient is comfortable and assessing the risk of pressure ulcers Personal needs Scheduling trips to the bathroom to avoid risk of falls Pain Asking patients to describe pain level on a scale of 0 - 10 Placement Making sure the items a patient needs are within easy reach Four Ps Intentional rounding key elements
  • 24. *The Evidence *Decrease buzzer usage 40-50% *Patient falls reduced by 33% *Hospital-acquired pressure ulcer cases reduced by 56% *Overall patient satisfaction has increased by 71 percentile points Best Practise: Sacred Heart Hospital Pensacola, Florida (2007 Studer Group)
  • 25. *
  • 26. *Apply a barrier cream (article) *Don’t wait for redness or signs of incontinence associated dermatitis *Think of it like sunscreen-you wouldn’t expose skin to the sun on a hot day without protection *Don’t expose skin to urine or faeces without protection!
  • 27. * *List participants
  • 28. * *Continence Foundation of Australia *Australian Wound Management Association of Australia *Wound, Ostomy and Continence association