Harries F J, Begg P A
University Hospitals Birmingham NHS Foundation Trust.
Professor and Honorary Research Fellow, The Royal Orthopaedic Hospital Birmingham NHS Foundation Trust.
J Wound Care. 2016 May;25(5):268-76. doi: 10.12968/jowc.2016.25.5.268.
The use of non-rinse skin cleansers in the care of patients who are at risk of tissue breakdown is not new within the National Health Service (NHS). Back to the Floor Continence Care Rounds (introduced in 2012 to facilitate bedside continence care education) at University Hospitals Birmingham had identified that in the current climate of austerity and efficiency savings, the use of non-rinse cleanser was being randomly rationed. Our objective was to determine whether the introduction of a smaller tube of non-rinse cleanser with targeted education would improve usage and ultimately improve the skin of incontinent patients.
There were five clinical areas randomised into two groups. In group 1 three clinical areas were provided with targeted education and new sizes of tubes of non-rinse skin cleanser. In group 2, the two remaining clinical areas acted as control groups, one receiving targeted education only and the remaining had no education or new sized tubes. The incidence of incontinence associated moisture lesions from each clinical area was monitored for 13 weeks pre and post study period.
The in-depth study undertaken at University Hospitals Birmingham, over a 6-month period, confirmed a trend in staff committing to the ethos of prudency, and in turn compromising the use of the most effective treatment and prevention of incontinence associated moisture lesions. The ability of the Trust staff to recognise and respond to a change in practice and the responsiveness of a commercial provider to the proposed new methodology has resulted in a significant reduction in incontinence associated moisture lesions across the trust. The clinical areas included in the study demonstrated a 70-76.9% reduction in moisture lesion incidence compared to an 8.3-13.6% reduction in the control groups.
The results strongly suggest that a reduction in incontinence associated moisture lesions can be achieved by a simple change in nursing regime. The combination of solid education provision, alongside a more appropriate size of product, has demonstrated significant patient benefit, greater adherence in practice and a reduction in waste. The integrity of the patients' tissue was preserved and staff were satisfied with their input and the patients' progress. The outcomes of this study will have an impact on patient benefit and on the efficiency for trusts resulting in greater patient satisfaction and a more appropriate use of limited resources.
SCA provided 20ml tubes of TENA Wash Cream free of charge and the TENA Nurse Advisor for support during the education provision element of the study.
在国民医疗服务体系（NHS）中，使用免冲洗皮肤清洁剂护理有组织损伤风险的患者并非新鲜事。伯明翰大学医院开展的“回归病房失禁护理查房”（于2012年推出以促进床边失禁护理教育）发现，在当前财政紧缩和节省开支的大环境下，免冲洗清洁剂的使用被随意限制。我们的目标是确定引入小包装免冲洗清洁剂并进行针对性教育是否会提高其使用率，并最终改善失禁患者的皮肤状况。
五个临床区域被随机分为两组。第1组的三个临床区域接受了针对性教育，并获得了新规格的免冲洗皮肤清洁剂。第2组的两个临床区域作为对照组，其中一个仅接受针对性教育，另一个既没有接受教育也没有获得新规格的清洁剂。在研究前后的13周内，监测每个临床区域失禁相关性潮湿损伤的发生率。
伯明翰大学医院在6个月期间进行的深入研究证实，工作人员存在秉持节俭理念的趋势，进而影响了对失禁相关性潮湿损伤最有效治疗和预防方法的使用。信托机构工作人员认识并应对实践变化的能力以及商业供应商对提议的新方法的响应能力，使得整个信托机构中失禁相关性潮湿损伤显著减少。与对照组8.3% - 13.6%的减少率相比，纳入研究的临床区域潮湿损伤发生率降低了70% - 76.9%。
结果有力地表明，通过简单改变护理方案即可降低失禁相关性潮湿损伤。扎实的教育与更合适规格的产品相结合，已证明对患者有显著益处，在实践中依从性更高且减少了浪费。患者组织的完整性得以保留，工作人员对自身的投入及患者的进展感到满意。本研究结果将对患者受益情况和信托机构的效率产生影响，从而提高患者满意度并更合理地利用有限资源。
SCA免费提供了20毫升装的添宁洁肤乳，并在研究的教育提供环节提供了添宁护士顾问以提供支持。
