Construction And Application Of Prospective Management Strategy For ICU Patients With Fecal Incontinence-related Dermatitis

Objective 1.To explore the current situation and risk factors of fecal incontinence-related dermatitis in ICU patients,and to provide a basis for the construction of management strategies.2.To construct prospective management strategies by applying failure mode and effect analysis combined with root cause analysis to improve the nursing process of ICU patients with fecal incontinence-related dermatitis.3.To implement the improved management strategies in clinical settings and to test their application effects.Methods 1.Retrospective analysis: A self-designed questionnaire was used to retrospectively analyze the medical records of 220 patients with fecal incontinence who occurring in the ICU of a Grade A hospital in Anhui Province from April 2019 to December 2019.The incidence and severity of fecal incontinence-related dermatitis in ICU patients were statistically analyzed,and the risk factors were analyzed by Logistic regression analysis.2.According to the results of current investigation,the subject was determined,the fecal incontinence management group was established,the flow chart of fecal incontinence management was listed,the potential failure modes in risk management were found and identified by brainstorming method,the risk priority index was calculated,the root cause analysis was used to discuss the root causes of failure modes,and the high-risk links in the fecal incontinence management process in ICU were screened.Problems needed to be a priority for the measures for improvement,and formulate the corresponding management strategy.3.Application of prospective management strategies: 160 patients with fecal incontinence in ICU ward of a Grade A hospital in Anhui Province were selected and divided into control group(81 patients from January to June 2020)and experimental group(79 patients from July to December2020)according to time period.The control group was treated with conventional care methods for fecal incontinence,while experimental group was implemented with the prospective management strategies constructed by the failure mode and effect analysis method combined with the root cause analysis method.The incidence and severity of IAD and RPN before and after intervention were compared between the two groups.Results 1.By retrospectively analyzing the case data of 220 patients with fecal incontinence in ICU during April 2019-December 2019.The results showed that there were 220 patients with fecal incontinence in ICU,of which 88 patients had IAD,and the incidence of IAD was 40%,including 35 cases(39.8%)of grade 1 IAD;53 cases(60.2%)of grade 2 IAD.Logisitic regression analysis showed that Braden score(OR=1.358),number of days of incontinence(OR=0.206)and fecal traits(OR=4.296)were independent risk factors for the occurrence of fecal incontinence-related dermatitis(P<0.05).2.Based on the failure mode and effect analysis,the fecal incontinence in the ICU nursing process is decomposed into four main process(assessment,prevention and control of protection,monitoring and management,education and guidance)and 15 subprocesses.The failure modes were analysed,and the 13 high-risk failure modes requiring intervention were selected by ranking the RPN scores,and the causes of failure were analysed by combining root cause analysis and corresponding measures to improve the management strategies.3.After the implementation of the management strategies,the incidence of IAD in the experimental group was lower than that in the control group,and the severity of IAD was less than that in the control group,the difference was statistically significant(P<0.05).When the RPN scores of the two groups were compared,and 11 failure modes in the RPN scores were significantly decreased after intervention,with statistical significance(P<0.05).Conclusions 1.ICU fecal incontinence related dermatitis has a high incidence,among which,the high risk pressure ulcer,long days of incontinence,and dilute watery stools having a greater risk of fecal incontinence-associated dermatitis.Medical staff should properly understand the risk factors of ICU fecal incontinence-related dermatitis,and take targeted and anticipatory nursing measures to reduce its incidence and improve the quality of care.2.Using failure mode and effect analysis combined with root cause analysis in the management of patients with fecal incontinence,we can accurately analyze potential failure modes and risk causes,formulate targeted preventive measures and management strategies,and improve the management process of fecal incontinence..3.The prospective management strategy based on failure mode and effect analysis combined with root cause analysis can effectively reduce the incidence and severity of ICU fecal incontinence-related dermatitis and improve the quality of skin care management.