Improving prevention and managing intertrigo by developing a decision support tool for clinical nursing

Abstract

Background: Intertrigo, one of four moisture associated skin damages, is an inflammation between skinfolds caused by prolonged contact to moisture with insufficient ventilation and rubbing friction. It is commonly seen in axillae, perianal, inguinal and submammary. The skin folds inflammation is wildly affecting individuals who are ageing, obese and care dependent in acute, long-term care facilities and community dwellers. Despite the high prevalence of intertrigo to individuals, care for skinfolds inflammation remains inconsistent due to inadequate guide to practice from unstandardized use of terminology and bias results on choice of products. Although consensus recommendation was made in recent years, the Finnish nursing field continues to use outdated information in managing intertrigo. Purpose and objectives: The purpose of this quality improvement project was to develop an instruction for clinical use for nurses in managing and preventing intertrigo. The objective of this project was to facilitate nurses in identifying, assessing and delivering treatment in managing intertrigo and promote awareness in preventing intertrigo by controlling risk factors through co-tailoring a decision support tool with nurses using service design. Methods: Service design was used. Three registered nurses and three practical nurses with more than oneyear experience participated in the four phases co-creation and pilot study. Results: The decision support tool was developed based on three goals raised by participants which are promote competence on identifying and assessing intertrigo, prevent making experience or personal believe-based decision while choosing product and promote regular skin assessment. The decision support tool was composed of two sections which were management guide and prevention education. Management guide was an A4 size, six step-by-step guidance from identifying risk factors of intertrigo from patient to documenting the provided care. It carries a consensus agreed, customized choice of product list of four products which were moisture-wicking textile, petroleum jelly, zinc oxide and dexpanthenol, these products were available in the unit and equivalent to products recommended by literatures for treating inflamed intertrigo and agreed to instruct nursing colleagues to make consultation from doctors for infected intertrigo. Prevention education was a QR-coded, 13 pages online interactive continuing education with detailed description of etiology, managing and prevention of intertrigo for nurses to access to information anytime they wish. Conclusion: Management guide of the decision support tool received positive feedbacks from participants on particularly facilitation of nurses’ performance in identifying, assessing and making treatment decision while prevention education did not achieve as smoothly as the development group had expected.