82 Reducing Incidence Rate of IAD Beeckman, Van Lancker, Van Hecke, & Verhaeghe, % 現況分析一重症病房腹瀉病人失禁性皮膚炎發生率之現況 Cooper & Gray, 200

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1 81 降低重症病房腹瀉病人失禁性皮膚炎發生率 * 1 中護中護理 2 中護護理 3 中護中護理 4 中護護理 5 中 6 中護理摘要背景目的解決方案結果結論理 2013 年 10 月 12 月 34.72% 護理護護護護期 34.72%22% CochranePubMedCINAHINursing Reference Center 年 2000 年 2014 年 524level 2level 3 6 護 2014 年 4 月 10 月 34.72%19.8% 期護期護關鍵詞 : 護前言 %Bliss et al., doi: /jn * @ms.kmuh.org.tw 引用格式 [Lin, T. R., Hwang, M. R., Nien, H. H., Liu, C. C., Shie, P. S., & Chen, S. H. (2015). Reducing the incidence of incontinence associated dermatitis in intensive care unit diarrhea patients. The Journal of Nursing, 62(6), ] doi: /jn

2 82 Reducing Incidence Rate of IAD Beeckman, Van Lancker, Van Hecke, & Verhaeghe, % 現況分析一重症病房腹瀉病人失禁性皮膚炎發生率之現況 Cooper & Gray, incontinence associated dermatitis, IAD Bliss et al., 2011 IAD Catham & Carls, % %n = % % % % 56% 二護理人員對失禁性皮膚炎預防及照護認知 Beeckman, Woodward, & Gray, content validity index, CVI % 74.3%60% % % % % % 三護理人員執行腹瀉病人失禁性皮膚炎預防及照護正確性 Doughty et al., % 0% 0.96% 14.42% The Journal of Nursing Vol. 62, No. 6, December 2015

3 護理人員 % % 四失禁性皮膚炎相關在職教育五腹瀉病人發生失禁性皮膚炎原因 2013 IAD 目標設定 % 22% 實證文獻查證一實證文獻搜尋及評讀 PICOpatient, intervention, comparison, outcomes CochranePubMed CINAHLNursing Reference Centerfecal incontinenceskin careincontinence rate systematic review clinical trial 病人 IAD IAD 政策設備圖一重症腹瀉病人失禁性皮膚炎發生率高之特性要因圖 IAD = incontinence associated dermatitis

4 84 Reducing Incidence Rate of IAD University of Oxford 2011 Level 2 Level , IAD 表一實證文獻評讀結果 Park & Kim 2014 Samsung Medical Center IAD 38 ICU 38 CCUICU ICU The Bristol Stool ScaleIADS NPUAP 1. IADS p < %50%, p <.001 Level 2 Beeckman et al IAD Skin Condition Assessment tool IAD 8.1% 27.1%p = IAD severity 3.8/10 6.9/10p =.06 Level 2 Becckman et al PUCLAS IAD % % 53.1%p <.001 Level 2 Bale, Tebble, Jones, & Price IAD IAD + IAD IAD 1. p = IAD 25.3% 4.7% p =.021 Level 3 IAD = incontinence associated dermatitis; ICU = intensive care unit; CCU = coronary care unit; NPUAP = National Pressure Ulcer Advisory Panel; PUCLAS = pressure ulcer classification tool The Journal of Nursing Vol. 62, No. 6, December 2015

5 85 問題及解決辦法 Gray, 病人轉入加護病房評估 IAD 高危險因子 IAD PH < PH < : Gray, 圖二失禁性皮膚炎預防及照護流程 IAD = incontinence associated dermatitis

6 86 Reducing Incidence Rate of IAD 85100% Gray, 成果評量 % 19.8% 421.4%5 23.8%620.6%722.6%8 17.9%913.6% %22% % 85.1% % % 10.8% % 84.89% 表二失禁性皮膚炎預防及照護認知前後測結果 n = 82 n = 82- % 危險因子預防措施照護措施傷口判斷 2. IAD 平均正確率 IAD = incontinence associated dermatitis The Journal of Nursing Vol. 62, No. 6, December 2015

7 87 表三護理人員失禁性皮膚炎照護正確率前後測結果比較 20.05% %100% 結論 34.72% 19.8% Beeckman 2010 n = 104n = % 參考文獻 [Shiu, S. R., Hsu, M. Y., Chang, S. C., Chung, H. C., & Hsu, H. H. (2013). Prevalence and predicting factors of incontinenceassociated dermatitis among intensive care patients. Journal of Nursing and Healthcare Research, 9(3), ] doi: /jnhr (6)77 82[Chuang, P. Y., & Hwang, S. L. (2001). Incontinence dermatitis in the adult population. The Journal of Nursing, 48(6), ] doi: /jn [Chen, J. R., Lin, T. H., Shih, H. J., Chou, M. J., & Wang, W. L. (2008). Increasing nurses competence in caring for adult patients with incontinence dermatitis. Chang Gung Nursing, 19(1), ] Bale, S., Tebble, N., Jones, V., & Price, P. (2004). The benefits of

8 88 Reducing Incidence Rate of IAD implementing a new skin care protocol in nursing homes. Journal of Tissue Viability, 14(2), doi: / S X(04) Beeckman, D., Schoonhoven, L., Fletcher, J., Furtado, K., Heyman, H., Paquay, L.,... Defloor, T. (2010). Pressure ulcers and incontinence-associated dermatitis: Effectiveness of the pressure ulcer classification education tool on classification by nurses. Quality and Safety in Health Care, 19(5), e3. doi: /qshc Beeckman, D., Van Lancker, A., Van Hecke, A., & Verhaeghe, S. (2014). A systematic review and meta-analysis of incontinence-associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Research in Nursing & Health, 37(3), doi: /nur Beeckman, D., Woodward, S., & Gray, M. (2011). Incontinence -associated dermatitis: Step-by-step prevention and treatment. British Journal of Community Nursing, 16(8), doi: /bjcn Bliss, D. Z., Savik, K., Thorson, M. A. L., Ehman, S. J., Lebak, K., & Beilman, G. (2011). Incontinence-associated dermatitis in critically ill adults: Time to development, severity, and risk factors. Journal of Wound Ostomy Continence and Nursing, 38(4), doi: / WON.0b013e318220b703 Catham, N., & Carls, C. (2012). How to manage incontinenceassociated dermatitis. Wound Care Advisor, 1, Cooper, P., & Gray, D. (2001). Comparison of two skin care regimes for incontinence. British Journal of Nursing, 10(6, Suppl.), S6 S20. doi: /bjon sup Doughty, D., Junkin, J., Kurz, P., Selekof, J., Gray, M., Fader, M.,... Logan, S. (2012). Incontinence-associated dermatitis: Consensus statements, evidence-based guidelines for prevention and treatment, and current challenges. Journal of Wound, Ostomy and Continence Nursing, 39(3), doi: /won.0b013e Gray, M. (2004). Preventing and managing perineal dermatitis: A shared goal for wound and continence care. Journal of Wound, Ostomy and Continence Nursing, 31(1, Suppl.), S2 S12. doi: / Park, K. H., & Kim, K. S. (2014). Effect of a structured skin care regimen on patient with fecal incontinence: A comparison chort study. Journal of Wound, Ostomy and Continence Nursing, 41(2), doi: / WON The Journal of Nursing Vol. 62, No. 6, December 2015

9 89 Reducing the Incidence of Incontinence Associated Dermatitis in Intensive Care Unit Diarrhea Patients Tsai-Rung Lin 1 Miin-Rong Hwang 2 Hui-Hsien Nien 3 Chia-Chi Liu 4 Pei-Shan Shie 5 Sue-Huei Chen 6 * 1 MSN, RN, Head Nurse, Department of Nursing and Burn Center, Kaohsiung Medical University Hospital; 2 BSN, RN, Head Nurse, Department of Nursing and Neurology Intensive Care Unit, Kaohsiung Medical University Hospital; 3 BSN, RN, Department of Nursing and Burn Center, Kaohsiung Medical University Hospital; 4 BSN, RN, Department of Nursing and Medical Intensive Care Unit, Kaohsiung Medical University Hospital; 5 MS, Administrator, Quality Management, Department of Medical Quality Control Room, Kaohsiung Medical University Hospital; 6 MSN, RN, Supervisor, Department of Nursing, Kaohsiung Medical University Hospital Abstract Background & Problems: Incontinence associated dermatitis (IAD) is a common skin disorder in critical patients who suffer from fecal incontinence. Symptoms of IAD include pain, redness, swelling, and, in some cases, secondary infections. IAD is thus a major problem faced in critical nursing care. The incidence of incontinence associated dermatitis averaged 34.72% at the intensive care unit in our hospital from October to December The factors that we identified as associated with IAD included: (1) Nurses: incorrect nursing care and insufficient IAD-related knowledge among nurses; (2) Devices: lack of skin barrier products and the use of diapers with poor air ventilation; (3) Regulations: lack of IAD care standards and lack of auditing oversight; (4) Patient problems: skin edema, incontinence, and medication use. Purpose: To decrease the incidence of IAD from 34.72% to 22%. Methods: The authors searched the Cochrane, PubMed, CINAHI, and Nursing Reference Center databases for relevant articles that were published from 2000 to Fifty studies were identified and four evidence-based references were selected for follow-up assessment. Levels of evidence were at levels 2 and 3. We designed an intervention that: (1) set a high-risk notice to increase awareness; (2) held six in-service training programs; (3) developed nursing standards and designed e-learning education lessons that specifically targeted reducing the incidence of IAD; (4) established a regular audit system. Result: The incidence of IAD decreased from 34.72% pretest to 19.8% posttest (posttest period: April - October 2014). Conclusion: This project effectively reduced the incidence of IAD in high-risk patients in our intensive care unit. The authors established evidence-based interventions that significantly improved patient outcomes. Key Words: diarrhea, incontinence associated dermatitis, skin care. Accepted for publication: July 14, 2015 *Address correspondence to: Sue-Huei Chen, No. 100, Tzyou 1st Rd., Kaohsiung City 80756, Taiwan, ROC. Tel: +886 (7) ext. 5363; @ms.kmuh.org.tw

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82 Reducing Incidence Rate of IAD Beeckman, Van Lancker, Van Hecke, & Verhaeghe, % 現況分析 一 重症病房腹瀉病人失禁性皮膚炎發生率之現況 Cooper & Gray, 200

82 Reducing Incidence Rate of IAD Beeckman, Van Lancker, Van Hecke, & Verhaeghe, % 現況分析一重症病房腹瀉病人失禁性皮膚炎發生率之現況 Cooper & Gray, 200