Heartbeat: Poo emoji cupcakes highlight skin damage in critical care patients

March 6, 2020

During early December (2019), critical care colleagues across the multi-disciplinary team were surprised with the offer of poo emoji cupcakes and a cake of the Bristol stool chart..

The tongue ‘n cheek treats were all in aid of an initiative to raise awareness of the breakdown of skin among patients in critical care. “Critical care patients are at increased risk of developing diarrhoea and this can result in skin breakdown,” Practice Development Practitioner, Pegeen Fisher told Heartbeat.

Data from incident reports indicates that the skin damage seen in critical care is most often caused by moisture or medical devices. The team launched various initiatives with the aim to reduce risks in those two areas.

“We used this initiative to launch several measures to address this issue,” added Pegeen. For example, the acute faecal incontinence with diarrhoea (AFID) protocol which is a regimen that patients will follow – hence the use of the Bristol stool chart cake and poo emoji cupcakes!

“We also introduced a resource that identifies measures that can be undertaken to reduce medical device related skin damage. For example, when non-invasive ventilation masks are used – the aim would be to ensure that the appropriate size is used and that the patient’s skin is assessed on a regular basis.

“Colleagues are also being urged to use barrier film applicators on moist skin in skin folds and trachy sites. We have also worked closely with the procurement team to ensure we are using appropriate incontinence products.”

All of these measures have been developed in response to a review of our clinical incidents around skin damage and targeting areas where potentially, patient care can be improved.

Pegeen said: “Wider literature suggests that our data is consistent with other critical care units, but we are still keen to reduce incidences of preventable harm where we can. Critical care patients are naturally very high risk of skin breakdown due to the nature of their acute illness, reduced perfusion, immobility and increased chance that they will develop diarrhoea.

“As critical care nurses this means we need to be extra vigilant around our preventative measures and identification of early signs of skin damage. Ongoing training is being cascaded across the critical care nursing team to provide updates around these initiatives, which have been introduced to support colleagues to reduce risks in these areas.”