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Oral Abstracts (Session 5 of 5)
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(Presentation 36.1) Skin care protocols for pressure ulcers and incontinence in long-term care: a quasi-experimental study Patricia Thompson, MS, RN; Diane Langemo, PhD, RN, FAAN; Julie Anderson, PhD, RN; Darlene Hanson, MS, RN; Susan Hunter, MSN, RN, UND College of Nursing, Grand Forks, ND Objective: The objective of this study was to evaluate the effect on pressure ulcer prevalence, incidence, and healing time by incorporating the use of a specific body wash and a skin protectant into skin care protocols that are based on guidelines from the Agency for Health Care Policy and Research. Design: The authors performed a quasi-experimental intervention study. Setting: The study was conducted in 2 rural long-term care facilities. Participants: The authors selected a convenience sample of 136 residents at 2 rural long-term care facilities during a 3-month preintervention and a 3-month postintervention period. Interventions: A 3-month preintervention observation period (baseline) was followed by a staff in-service session in which the use of a body wash and a skin protectant was introduced into skin care protocols and a 3-month postintervention observation period. The skin care protocols included skin assessment techniques, prevention and treatment strategies for Stage I and Stage II pressure ulcers, and management of incontinence. Results: Stage I and Stage II pressure ulcers significantly decreased from 35 preintervention to 14 postintervention (t = 19.48, df = 47, P = 0.05). The prevalence of pressure ulcers preintervention was 11.3% compared with 4.8% postintervention (t = 2.47, df = 1.0, P = 0.24), The change in the incidence of pressure ulcers was significant (t = 8.48, df = -2.0, P = 0.01) with 32.7% preintervention and 8.9% postintervention. Healing time for pressure ulcers ranged from 4 to 70 days preintervention (mean [M] = 22.72 ± 18.25) to 6- to 49- days postintervention (M = 16.0 ± 12.93). The decrease in pressure ulcer healing time preintervention to postintervention was statistically significant (Chi2 = 14.9, P = 0.001). The presence of fecal and urinary incontinence was significantly associated with the development of Stage I and Stage II pressure ulcers (Chi2 = 44.8, P = 0.000). Conclusions: Implementation of skin care protocols that included use of a body wash and a skin protectant reduced the incidence of Stage I and Stage II pressure ulcers and decreased healing time. References Frantz RA, Xakellis GC Jr, Harvey PC, Lewis AR. Implementing an incontinence management protocol in long-term care clinical outcomes and costs. J Gerontol Nurs 2003;29(8):46–53. Cuddigan J, Ayello I, Sussman C, Baranowski S. Pressure Ulcers in America: Prevalence, Incidence, and Implications for the Future. Reston, VA: National Pressure Ulcer Advisory Panel; 2001. Panel on the Prediction and Prevention of Pressure Ulcers in Adults. Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline, No. 3. AHCPR Publication No. 92–0047. Rockville, MD: Agency for Health Care Policy and Research; May 1992. Lyder CH, Shannon R, Empleo-Frazier O, McGeHee D, White C. A comprehensive program to prevent pressure ulcers in long-term care: exploring costs and outcomes. Ostomy Wound Manage 2002;48(4):52–62. Brandeis GH, Morris JN, Nash DJ, Lipsitz LA. The epidemiology and natural history of pressure ulcers in elderly nursing home residents. JAMA 1990; 264:2905–9. Gray M. Preventing and managing perineal dermatitis: a shared goal for wound and continence care. J Wound Ostomy Continence Nurs 2004;31(1 suppl):2–9. Warshaw E, Nix D, Kula J, Markon CE. Clinical and cost effectiveness of a cleanser protectant lotion for treatment of perineal skin breakdown in low-risk patients with incontinence. Ostomy Wound Manage 2002:48(6):44–51. Xakellis GC Jr, Frantz RA, Lewis A, Harvey P. Cost-effectiveness of an intensive pressure ulcer prevention protocol in long-term care. Adv Wound Care 1998;11(1),22–9. Nix D. An analysis of 66 perineal skin care protocols from 32 states: use of skin protectants is lacking in protocols and application (poster). Phoenix, AZ: 19th Annual Clinical Symposium on Advances in Skin & Wound Care; October 1–3, 2004. Hunter S, Anderson J, Hanson D, Thompson P, Langemo D, Klug MG. Clinical trial of a prevention and treatment protocol for skin breakdown in two nursing homes. J Wound Ostomy Continence Nurs 2003;30:250–8. |
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