Promoting diaper weaning to prevent diaper-related complications in adult inpatients: a best practice implementation project.

Abstract

Introduction: Hospitalized older adults are often routinely placed in diapers without prior assessment of continence status. This practice leads to several adverse outcomes, including skin complications.

Objectives: This evidence implementation project aimed to achieve 80% compliance among nursing staff with continence promotion strategies and a 50% reduction in the incidence of diaper-related complications.

Methods: The project was conducted over a 21-month period in four medical wards at a public university hospital in Singapore. The project used the JBI Evidence Implementation Framework, which is grounded in an audit and feedback process. JBI's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools were used to identify barriers to evidence-based recommendations and formulate strategies to address those barriers. Continence interventions included nurse-led screening, scheduled toileting every 2 hours, patient education, encouragement of fluid intake, and monitoring of skin integrity.

Results: Compliance with continence promotion strategies increased from 0% at baseline to 55.6% at follow-up audit 1, 52.4% at follow-up audit 2, and 69.4% at follow-up audit 3 (p<0.001). The incidence of skin integrity complications decreased substantially, with a reduction in incontinence-associated dermatitis from 7.0% to 2.8%. The most significant improvements were in continence screening, fluid intake, and patient education. Nursing documentation was fully compliant throughout the audit.

Conclusions: The project demonstrated that continence strategies can be effectively integrated into acute care workflows. Achieving sustained improvements necessitates ongoing leadership support, continuous staff education, and regular audit cycles. Transitioning from routine diapering to continence promotion enhances autonomy and dignity for older adults in hospital settings.

Spanish abstract: https://links.lww.com/IJEBH/A704.