Improving Skin Assessments in Darkly Pigmented Skin and Incontinence-Associated Dermatitis in the Acute Care Setting: A Quality Improvement Project

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Improving Skin Assessments in Darkly Pigmented Skin and IncontinenceAssociated Dermatitis in the Acute Care Setting Tracey Ly, BSN, RN, S-AGACNP Kylie Bytendorp, BSN, RN; Katherine Doyon, PhD., M.Ed., RN, CHPN Key Take Away: Work is still needed to improve bedside nurses’ knowledge of skin assessments in darkly pigmented skin. . Challenges to skin integrity should be treated as comorbidity—-not just a hygienic challenge. Background • Challenges with detecting erythema/ compromised skin integrity in darkly pigmented skin • Current literature/education rely on visual cues based on white skin • Most nurses lack the training to identify early skin breakdown in darkly pigmented skin. • Incontinence-associated dermatitis (IAD) occurs in approximately 18% of hospitalized patients. Methods • Improve assessment/treatment of skin breakdown in darkly pigmented skin • Questionnaire assessed baseline knowledge of skin assessments/postincontinent treatment • Skin assessment tool identifying erythema on different skin tones • Education session for skin assessment/ prevention/treatment post-incontinence • Unit supply room flowcharts guide appropriate supplies for IAD prevention/treatment • Post-intervention questionnaire evaluated knowledge change; chart review evaluated documentation change Differentiating different skin breakdown complications Results • Rates of documenting incontinence-associated dermatitis: 2 occurrences of hospitalized patients were documented to have IAD pre-intervention. 4 occurrences of hospitalized patients were documented to have IAD post-intervention. • Feasibility: 61% of staff reported increased knowledge in skin assessments and postincontinence treatment. • Usability: 71% found toolkit to be useful and the education session to have changed their practice for post-incontinence care/prevention of IAD. • Satisfaction: 81.3% of nursing staff were “very” or “somewhat” satisfied with the education session and toolkit. • Knowledge Assessment: scores improved from 67.96% correct to 70.88% correct (p value 0.0134) Conclusions • Bedside nurses unaware of differences in skin tone assessments • Potential for use in hospital yearly education • Highlights knowledge gaps in medical education of skin assessments • Encourages further work for education of treatment of patients with darkly pigmented skin @uofunursing @utnurseresearch