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A Skin Tear Pathway and Evaluation

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In my experience skin tears are an area of practice that have historically been poorly assessed, documented and treated in the UK.

Whilst an international consensus exists 1 practice remains inconsistent throughout the UK despite excellent local regional guidelines on practice 2,3

Skin tears are defined as “A wound caused by shear, friction and/or blunt force resulting in separation of skin layers…” 1,4They are common in neonates and the elderly. Prevalence figures in the UK are currently unknown.

Treatment of these wounds can be variable due to differing knowledge and widespread ritualistic practice that can increase dressing change frequency.

Skin tears can often occur in Elderly Mental Health Units where, due to patient’s age and dementia, they are at increased risk of injury due to equipment or handling issues.

Management of these patients can be challenging as they interfere with and remove the dressings after only a day, this potentially increases costs and potential for infection.

In Hertfordshire Trust 2014 Residential homes and the Elderly Mental Health Units were recording increasing levels of skin tears.

 

The Tissue viability team decided to evaluate a clear acrylic dressing *. The dressing allows constant visualisation of the wound and consequently has no upper wear time limit .

 If this evaluation proved successful it would form part of a clinical pathway for skin tears. This would be a wound decision guide that gave a step by step approach to managing skin tears and helped nurses manage this condition in a clinically rationalised manner

The evaluation was conducted across 6 of the 9 Elderly Mental Health Units over a 4 week period. September 2015

The evaluation forms were to be completed by the mental health staff.

Evaluation criteria included: wound dimensions, evidence of maceration wear time, conformability, comfort and ease of application and removal.

Each patient received a clear acrylic dressing which was changed dependent on exudate level, infection or dressing failure.

In addition a case series was conducted on the same patients by the Tissue Viability Support Nurse.

 

16 patients took part in the evaluation. No forms were completed correctly by the evaluating nurses.

The case series, however, showed that 16 patients took part and only 1 was discontinued due to clinical infection.

The dressing stayed in place for up to a maximum of 21 days wear time.

 

12 patients healed within the trial period with the remaining 3 healing after 4 weeks.

The maximum number of dressings that was used per patient during the month long evaluation was 3

No dressings were removed by patients during the evaluation

The evaluation convinced the formulary committee to add this product to the formulary and include in the Skin tear pathway.

 

Nurses on the units were unfamiliar with data collection this would need to be addressed for future evaluations.

The fact that the patients could not see to remove the dressing was a real benefit in mental health though not so important in other areas, it allows constant visualisation without dressing change, although this could be off putting to certain patients.

Nursing education on application and removal and leaving the dressing in situ for longer was a key component to success

 

The dressing proved an effective treatment on skin tears and will be the dressing of choice on the skin tear pathway.

This pathway is to be rolled out across the Trust November 2016 and used by all Community staff.

Education of staff regarding the tool and the need to leave the dressing in place will be key success factors.

Evaluation of the use of the skin tear first responder tool will be carried out in 2017

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