Date of Graduation

Summer 8-12-2022

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

MSN project

Abstract

Problem: Moisture-associated skin damage (MASD) has always been a problem, regardless of the setting is an I.C.U., Med-Surg, or long-term care. Evidence suggests prevalence rates can range from 5.2% to 46%, depending on the facility. The highest rates of incontinence-associated damage (IAD) occurred in long-term acute settings (Kayser et al., 2019).

Context: The veterans of the Community Living Center (CLC) have an increased risk for skin breakdown. Currently, of the fifteen residents, six residents (40%) have MASD, two of which have chronic MASD (13%). MASD can be a common occurrence for adults with limited mobility or cognitive diseases. MASD may cause burning sensations and pain around the wound, especially when additional urine or feces touches the wound (Woo et al., 2017). These adults may not be able to clean themselves or know to tell staff members when they need to be cleaned.

Intervention: To mitigate this problem and enhance the quality of life for veterans, a structured skin care regimen (SSCR) will be implemented and include an initial skin assessment and biweekly skin checks by RNs caring for veterans in the CLC. The SSCR will be implemented through staff in-services and will consist of the following: skin cleansing and drying of the peri area during ADL care with Sage wipes twice a shift and as needed after every bowel and incontinent event; use of skin barrier cream; and use of only one breathable disposable underpad (BDU) while in bed.

Measures: Data on MASD was obtained from a chart review of RN skin assessment for initial skin assessment, post-in-services biweekly skin assessments, and a final skin assessment at three months post-in-services with the goal to decrease MASD rates to below 6%. Specific data such as the Braden scale, skin temperature, skin turgor, skin color, and skin integrity will be monitored on the CLC admits. Pre- and post-questionnaires for staff in-services and MASD rates will also be part of the measured outcomes.

Result: At the end of month two, MASD rates fell below 6%, and all residents had their MASD healed. There was one case of reoccurrence with a patient that had chronic MASD. Towards the end of month three, staff shortage became an issue, and the unit had to be closed. The residents and staff were absorbed into other units until adequate staffing was available.

Conclusion: Implementation of SSCR and skin monitoring practices met the expected outcome by decreasing MASD to below 6%. Due to interventions becoming part of daily routine, the quality improvement project will maintain sustainability in this unit.

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