Prevention and management of IAD

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Department of Surgery , Kwong Wah Hospital
Introduction :
SIGNIFICANCE OF THE STUDY: IAD is a preventable problem, but maintaining skin integrity for incontinence patients is still very challenging. A project for IAD prevention was done with a significant result on 2017. Referring to the previous result, a quality improvement program was set up. An algorithm was developed with 2 forms introduced: IAD Risk Assessment & Management Record and IAD reporting record. The former is used to assess the IAD risk of incontinence patients and the stage of IAD if any, appropriate treatment will be given for different patients and the latter is used to record the IAD case if any.
Objectives :
PURPOSE: The primary purpose of this project is to prevent and manage the Incontinence-Associated Dermatitis (IAD) by using an algorithm. The secondary purpose of this project is to raise the caregiver’s attention on the issue of IAD development, which can help to keep the skin integrity of incontinence patients.
Methodology :
SUBJECT AND DESIGN SETTING: The program was held at a male acute surgical ward with 56 beds in Hong Kong. Patients were usually having both medical and surgical problems. Ethical clearance was sought from department nursing management board. All incontinence patients were included, but those patients with pressure injury in the sacral region were excluded. METHODS: 3 months pilot study was started in the beginning. Patients were randomly allocated in the ward as usual. On admission, patients were assessed and categorized into 4 groups with its own nursing approach (high risk, early IAD, moderate IAD and severe IAD) which based on the algorithm. Re-assessment would conduct at least once weekly and if there is any abnormal skin condition observed. During the hospital stay, nurses monitored the skin integrity of participants continuously, assisted by HCA.
Result & Outcome :
RESULTS: In the pilot study, there was only one case was recorded on the IAD reporting record. This single case was developed before admission, and healed up quickly under the algorithm. Therefore, it means there was no patient develop IAD in the pilot study. It showed significant findings with positive impact for prevent and control IAD. LIMITATION: The status of this program is only in the pilot stage, further study with more case number is needed in the future. The number of incontinence patients are fluctuated in surgical ward. Higher compliance rate would be better, which could reflect the truth and increase the effectiveness and generalization of this program. CONCLUSIONS: Based on the pilot findings, it showed a positive result, which can prevent and control clinical IAD effectively. Prevention of IAD stands an important role in this program. It suggested that use of Vaseline and skin barrier could reduce the development of IAD. Application of skin barrier shows a significant effective change to prevent and manage IAD. The IAD algorithm is benefit for both patients and nurses.

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