Prevention and Management of Skin Tear in a Geriatric Ward Setting

Abstract Description

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Authors (including presenting author) :

Tong MY, Lo YS, Chan OL

Affiliation :

Medicine and Geriatrics, United Christian Hospital

Introduction :

Skin tear refers to the traumatic wound caused by shear, friction, or blunt force resulting in separation of skin layers. It involves in partial or full-thickness injuries. Thinning of the dermis and the epidermis in the aging process, together with the dry and fragile skin condition, made the elderly become the high-risk group that suffering from skin tears. In a geriatric ward setting, it was observed that cases with new skin tear developed during hospitalization are mostly related to the use of adhesive tape in medical / nursing procedures (e.g. blood taking, wound dressing). Without proper treatment, skin tears have high probability of becoming complex chronic wounds, causing unnecessary pain and distress, and may eventually prolong the length of hospital stay. Thus, several measures were implemented to empower ward staff on prevention and management of skin tear among the geriatric patients.

Objectives :

1. To reinforce professional knowledge of nursing staff on tissue viability and hence enhance the care provided. 2. To enhance communication among health care providers on handling high risk patients. 3. To facilitate the use of skin care products by providing handy kits.

Methodology :

For nursing staff: 1. Briefing session was given to ward nurse about the updated information about skin tear, including the international classification scale, risk assessment, prevention and management strategies. 2. Weekly nursing wound rounds were conducted to monitor wound healing progress and review current management plan. For other health care providers: Communication cards were attached on doctor and phlebotomist’s working trolleys to remind them the use of appropriate tape for certain high risk patients. For all staff: 1. Alert signage was designed and posted for identify patients with high skin tear risk. 2. A “Skin Tear Prevention Kit” was designed which aimed to minimize adhesive tape related trauma. Each kit contains skin care products including non-adhesive silicon tapes, film-forming protective barrier wipes and adhesive removers. 4 kit sets were placed on different nursing trolleys to allow easy access.

Result & Outcome :

Information session was given to ward nurse in the mid-2018 through nurse meeting. In nursing wound round, case nurses were observed with good ability on management skin tear wounds. Communication between nursing staff and other health care providers was enhanced through the alert signage and communication cards. All staff welcome the adoption of the Skin Tear Prevention Kits and agreed they were helpful in prevent skin tear in fragile patients.