Abstract
Purpose: The purpose was to implement a standardized incontinence bundle for adult patients with incontinence on a medical unit. The expected outcomes were: 1. Increased nursing knowledge, 2. Adherence to the bundle, 3. Decreased incontinence associated dermatitis (IAD) rates.|Background: IAD is defined as inflammation and/or erosion of the skin secondary to urine and/or stool exposure. 45.7% of patients with incontinence have IAD, and there is a connection between IAD and morbidity, disability, and economic burdens. Insufficient nursing knowledge and atypical practice contribute to the problem.|Sample/Setting: A 28-bed adult internal medicine unit. The population included inpatients admitted to the setting in the pre- and post-bundle phases. Inclusion criteria for both phases included adults with one or more episodes of urinary and/or fecal incontinence. Those without incontinence were excluded.|Methods: The Iowa Model Revised was used to address the clinical problem. Specific interventions were derived from the literature to develop an incontinence bundle: use of disposable wipes, a skin moisturizer, a skin barrier cream, repositioning every 2 hours, use of 1 absorbent chux pad, and consideration of an external urinary and/or fecal collection device. The outcomes were measured by education delivery, an investigator-developed evaluation tool, and the electronic health record (EHR).|Results: A total of 66 patients were included (pre-bundle N = 32, post-bundle N = 32), and a total of 275 observations were documented (day shift N = 143, night shift N = 132). Bundle adherence between both shifts was 74%. Nine patients developed IAD in the pre-bundle phase, and 2 patients developed IAD in the post-bundle phase. This was a statistically significant change (p = 0.02).|Conclusion: A standardized incontinence bundle can have a significant impact on IAD rates. Medical units should consider implementing an incontinence bundle to increase nursing knowledge and decrease IAD rates.