The feasibility of integrating an evidence-based clinical guideline and the nursing information system for incontinence associated dermatitis patients in ICUs

Abstract

Background: Incontinence associated dermatitis (IAD) occurs when urine or stool comes into contact with perineal or perigenital skin. IAD is a challenge for ICU nurses. There are several IAD care guidelines in the literature, but still remained in the paper stage. Objective: The aim of this study was to pilot test the feasibility of implementing the IAD clinical guidelines into the nursing information system (NIS) to improve prevention and care of IAD for ICU patients. Methods: A three stage designed research was conducted, in the first stage a systematic review was performed in accordance with the PRISMA and PICO guidelines to develop an evidence-based clinical guideline for IAD patients in ICU. Seven electronic databases were searched for clinical studies and guidelines, and the quality of included study was assessed using the Joanna Briggs Institutes’ appraisal tools. In the second stage, the research and nursing informatics team was formed and a computerized nursing record system was designed to integrate the guideline knowledge and NIS. In the third stage, evaluate the feasibility of the computerized nursing record system using a self-developed questionnaires based on the technology acceptance model for evaluating the nurses’ perception of the system, content validity was examined, and the reliability of the instrument was tested, and patients’ IAD prevalence rates was monitored. The participants in this stage were 4 adult ICU patients and nurses. Results: In stage one, 35 articles were reviewed by two independent reviewers, 12 articles met the inclusion criteria; 2 clinical guidelines, 4 randomized controlled trials, and 6 systematic reviews, data was extracted and synthesized by a research team. Based on the evidence combined with 2 stoma care experts’ opinions the draft recommendations and accompanying guideline was proposed. The draft document was reviewed and confirmed at 3 consensus meetings attended by 21 senior nurses from 4 ICUs. In this guideline included 4 domains that provided information about general information, assessment tools, severity, preventive and treatment strategies for IAD. In stage two, the system requirement analysis and design the IAD care flow based on the 5 steps of nursing process mainly included: (1) Perineal Risk Assessment Tool was used in the assessment stage (2) Incontinence Associated Dermatitis Severity (IADS) was used to analyse the IAD severity. (3) The linkage of severity stage in accordance with nursing care plan. (4) The preventive and treatment interventions in IAD nursing care plan were classified based on severity stages. (5) The outcome was evaluated using IADS. In stage three, after IRB approved, 63 ICU patients were recruited in this study, the prevalence rate was 17.4%. The nurses’ perception of the system was evaluated in 3 directions: (1) 79% nurses’ perceived the system were ease of use. (2) 85% nurses’ perceived the system were useful. (3) 88% nurses’ perceived the system were fit the task. Discussion/Conclusion: According to the results of this study, implementing the IAD clinical guidelines into (NIS) was practical to simplifying clinic working procedure and effective in communicating and documenting IAD nursing care information.