Title : Prevention and management of medical adhesive-related skin injury: An EBP-QI project
Abstract:
Purpose: This EBP-QI project had two purposes: (1) To determine the best evidence for preventing and managing Medical Adhesive-Related Skin Injury (MARSI), using the following PICO question: For patients with medical adhesives (P), how do the best evidence-based interventions (I) compared to current practice (C) affect skin injury (O)? (2) To influence and validate clinicians' knowledge and practice of preventing and managing MARSI using a pre- and post-implementation knowledge tests.
Participants And Setting: The project was located in the western United States and provided healthcare in acute and long- term care settings. Out of the 1200 nursing staff employed by the healthcare system, we received 452 and 515 voluntary responses for the pre- and post-implementation knowledge tests respectively.
Approach: During the EBP initiative, the Fuld Institute's 7 Steps of Evidence-Based Practice model guided this project to integrate the best evidence. Our search yielded 571 articles from 4 databases. This study adhered to criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols statement, resulting in 11 significant findings. Based on the evidence, we implemented a QI initiative to identify, prevent, and manage MARSI using the sequential Plan-Do-Study-Act cycles in 2 phases.
Outcomes: The best evidence-based interventions was a 5-step prevention and management plan for MARSI, including identifying risk factors, selecting the appropriate adhesive, using proper application and removal of adhesives, and managing MARSI based on the type of skin damage. The interdisciplinary Team MARSI provided education and training as to over 450 clinicians. The post-test scores from the in-person and online education and trainings showed an improvement in knowledge acquisition in preventing and managing MARSI.
Implications For Practice: Team MARSI expanded the delivery of evidence-based medical supplies including skin barriers and adhesive removers for small and large skin injuries easily accessible to clinicians. Clinicians, not only nurses, must continue to strive to acquire tools and training to prevent MARSI. Healthcare organizations must provide evidence-based tools and education to prevent and manage avoidable healthcare- related injuries.
