Hello and welcome to this video presentation on” Assessing Skin Injury Risk Levels in Incontinent Patients.” We learned earlier that skin injury is one of the complication associated with fecal incontinence. Today we are going take a closer look on how to determine you incontinent patients risk level for develop skin injury.
Assessing skin can be a daunting task even for a highly trained clinician. There are times we as clinician may think what am I looking at? What caused this skin damage and how can I determine who is a risk for developing skin injury to prevent this from happening in the first place. Properly identification of the skin damage is important for several reasons. The first is to ensure the correct course of treatment is planned and the second is for reimbursement. Recent changes in reimbursement can have an negative financial impact on a facility if a pressure ulcer develops while in the healthcare facilityFortunately, there are several evidence based tools to help clinician's predict risk levels and identify skin damage. In this presentation we will be taking closer look at two of them.
The first tool we are looking at is the Braden Scale. This Braden Score s an summated tool for predicting pressure ulcers. This tool is commonly used to assess patients risk level upon admission and at regular intervals in an effort to determine there risk level of developing a pressure ulcer.
So what is a Pressure Ulcer? Just like it sounds, a Pressure Ulcer is defined as “localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure or pressure in combination with a shear.
The Braden Scale predicts Pressure Ulcers by evaluating six indicators. These indicators are: Sensory Perception, Moisture, Activity, Mobility, Nutrition and Friction & Shear.
The score or risk level is determined by the summation of the scores from each of the six indicator using a 1-3 or 1-4 numeric score. For the Moisture indicator the degree to which skin is exposed to moisture is what is important. Incontinence can lead to increased exposure to moisture thereby, putting the incontinent patient at a greater risk of developing a pressure ulcer.
The second tool we are utilizing to determine skin injury risk level is the Incontinence Associated Dermatitis Intervention Tool (also known as IAD-IT). The IAD-IT was developed as a simple format for improving the identification and treatment of IAD This tool also evaluate a patients exposure to moisture, specially urinary and fecal incontinence. You can use both photos and the definition to determine your incontinent patients IAD risk level.
Todetermine the risk level for IAD simply read the definition on the tool and use the associated photo to help assess your incontinent patients skin. As you would expect a fungal appearing rash can be present at any IAD risk level due to increase moisture associated with fecal and urinary incontinence.
Although both Pressure Ulcers and IAD skin injuries can appear as partial thickness skin injuries an key factor to remember is location, location, location.Even though both Pressure Ulcers and IAD are associated with moisture, only Pressure Ulcers occur over a bony prominence..
Through proper identification and on-going assessment you can determine your patients skin injury risk level and provide appropriate preventative care and treatment. Please join us again next week when we talk about, Managing Fecal Incontinence in the Acute Care Setting. Until then, stay healthy.
Assessing Skin Injury Risk Level in Incontinent Patients By Lori Lamb, BSN, RN, WOC/ETN
References• Junkin J, Selekof JL. Prevalence of incontinence and associated skin injury in the acute care patient. J Wound Ostomy Continence Nurs. 2007;34:260-269• Braden Scale for Preventing Pressure Sore Risk. Prevention Plus. 2001 Available at: http://www.bradenscale.com/bradenscale.htm. Accessed February 8, 2011.• European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Treatment of pressure ulcers: Quick Reference Guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009.