A Novel Approach to Treating Moderate to Severe Incontinence-Associated Dermatitis and Intertriginous Dermatitis: A Case Series.

BACKGROUND: Patients with moderate to severe incontinence-associated dermatitis (IAD) and intertriginous dermatitis (ITD) often experience pain that negatively affects activities of daily living. While traditional treatments, such as skin protectants including ointment or cream-based products, cyanoacrylate-based monomers, and wicking agents, help some patients, those with moderate to severe cases require more aggressive treatments to accelerate healing. CASE SERIES: This article describes a series of 4 hospitalized patients who presented with moderate to severe IAD and/or ITD with and without fungal infections. These patients were treated with therapies that went beyond routine skin care regimens, which included treatment with a combination of 0.25% acetic acid, a topical steroid agent, or a topical antifungal when necessary. The patients included a 74-year-old woman admitted with hypovolemic shock, an 82-year-old obese woman with pulmonary hypertension and heart failure, an 80-year-old woman with medically complicated obesity, and a 54-year-old morbidly obese woman admitted with sepsis. CONCLUSION: The outcome achieved using this novel approach was successful in treating moderate to severe IAD and ITD in these cases.

Enhancing patient education through clinical nurse specialist collaboration.

PURPOSE: The purpose of this article was to describe a collaborative clinical nurse specialist (CNS) project to enhance the patient education provided by registered nurses across 7 medical nursing units in an acute care hospital. BACKGROUND: Electronic data reviews assisted the medical CNSs with identifying a deficit in using appropriate education plans and documentation of patient education. DESCRIPTION OF THE PROJECT: The interventions implemented included the creation of new patient education brochures, updating the electronic system to enhance nurses' ability to provide patient education materials and to simplify documentation, creating a video-on-demand education channel, and ensuring that patient education materials were easily accessible. OUTCOME: Postassessment results showed that nurses' reported use of disease-specific education plan increased 33%. The staff's perception of the importance of documenting patient education provided also increased 9%. CONCLUSION: This project demonstrates CNSs' ability to design, develop, and implement a systematic and structured process to promote a consistent way for medical nurses to utilize the best disease-specific patient education resources. IMPLICATIONS: : With hospital stays being shorter and patients more acutely ill, partnering with the patients in learning how to manage their care as they transition from the hospital to home is key to help prevent hospital readmissions.

In-room display of day and time patient is anticipated to leave hospital: a "discharge appointment".

BACKGROUND: We learned from a focus group that many patients find discharge to be one of the least satisfying elements of the hospital experience. Patients cited insufficient communication about the day and time of the impending discharge as a cause of dissatisfaction. OBJECTIVE: In partnership with the Institute for Healthcare Improvement, Improvement Action Network collaborative, we tested the practicality of an in-room "discharge appointment" (DA) display. SETTING AND PATIENTS: Eight inpatient care units in 2 hospitals at an academic medical center (Mayo Clinic, Rochester, MN). INTERVENTION: DA displayed on a specially designed bedside dry-erase board. MEASUREMENTS: The primary outcome was the proportion of discharged patients who had been given a DA, including same-day DAs. Secondary outcomes were (1) the proportion of DAs scheduled before the actual dismissal day and (2) the timeliness of the actual departure compared with the DA. RESULTS: During the 4-month period, 2046 patients were discharged. Of those, 1256 patients (61%) were given a posted DA, of which 576 (46%) were scheduled at least a day in advance and 752 (60%) departed from the care unit within 30 minutes of the appointed time. CONCLUSIONS: With a program for in-room display of a DA in various hospital units, more than half the patients had a DA set, and most of the DA patients departed on time. Further investigation is needed to determine the effect of DAs on patient and provider satisfaction.

3D: a tool for medication discharge education.

BACKGROUND: At the time of transition from hospital to home, many patients are challenged by multi-drug regimens. The authors' standard patient education tool is a personalised Medication Discharge Worksheet (MDW) that includes a list of medications and administration times. Nonetheless, patient understanding, satisfaction, and safety remain suboptimal. Therefore, the authors designed a new tool: Durable Display at Discharge (3D). Unlike MDW, 3D features (1) space in which a tablet or pill is to be affixed and displayed, (2) trade name (if apt), (3) unit strength, (4) number (and/or fraction) of units to be taken, (5) purpose (indication), (6) comment/caution, (7) larger font, (8) card stock durability and (9) a reconciliation feature. METHODS: The authors conducted an exploratory, randomised trial (n = 138) to determine whether 3D, relative to MDW, improves patient satisfaction, improves patient understanding and reduces self-reported medication errors. Trained survey research personnel, blinded to hypotheses, interviewed patients by telephone 7-14 days after discharge. RESULTS: Both tools were similarly associated with high satisfaction and few self-reported errors. However, 3D subjects demonstrated greater understanding of their medications. CONCLUSIONS: Although both tools are associated with similarly high levels of patient satisfaction and low rates of self-reported medication error, 3D appears to promote patient understanding of the medications, and warrants further study.