Most Proposed Topic :
Healthcare Advances, Research and Innovations (new projects / technology)
Authors: (including presenting author): :
C. Fung(1), K.Y. Chan(1), W.M. Yu(1), C.M. Hui(1), W.Y. Chung(1)
Affiliation: :
(1) Intensive Care Unit, United Christian Hospital
Introduction: :
Pressure injuries (PIs) are one of the nursing sensitive indicators which indicate the quality of nursing care in hospital. An upward trend in stage two or above PIs at the coccyx and sacrum, often associated with incontinence-associated dermatitis (IAD), was observed in the ICU of United Christian Hospital (UCH). An evidence-based skin care enhancement program with SSKIN (Skin inspection, Surface, Keep moving, Incontinence and Nutrition) bundle was implemented to address this issue.
Objectives: :
(1)To reduce the PI incident of IAD-associated coccyx and sacrum.
(2)To prevent the development of stage two or above PIs through the prophylactic application of foam dressings.
Methodology: :
There were 6 identical briefing sessions including SSKIN bundle implementation and use of data collection sheet were provided. The program was conducted in two phases. Phase one (June to October 2021) focused on the prevention of IAD. Initial skin assessment was performed on admission to identify high risk patients. Initial skin assessments were conducted on admission for 43 high-risk patients, characterized by bowel movements exceeding three times per day. A non-rinse, pH-balanced cleanser, which avoid friction caused by rubbing with wet cotton pads, and a durable barrier cream were used for skin protection, and diapers were checked and changed bi-hourly when soiled. Skin care products were individualized to prevent cross infection among patients.
Phase two (November to December 2022) targeted on reducing friction and shear in the coccyx and sacrum area. 76 patients were included. Exclusions were made for those with macerated or broken skin and those capable of independent mobilization. Prophylactic foam dressing was applied, monitored every 8 hours, and changed every three days or when soiled. Nurses were reminded to relief the pressure point after patient was repositioned at 3-hours interval. Early mobilization and nutrition management were emphasized in coordination with physiotherapists and dietitians.
Result & Outcome: :
The introduction of the SSKIN bundle led to a 75% reduction in coccyx and sacrum PIs among high-risk patients, compared retrospectively with the previous quarter’s data as prevalence rate.
