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Hospital Skin Tear Disaster! A thing
of the past in Surgical Services
Edel Murray Clinical Nurse Consultant
St. Vincent’s Private Hospital (SVPH) , Sydney
Skin Tears: What are they?
A skin tear is a
wound caused by
shear, friction,
and /or a blunt
force resulting in
separation of skin
layers.
Head
Skin tear Consensus Panel (Le Blanc, Baranoski et al, 2011)
A skin tear can be partial thickness (separation of the
epidermis from the dermis) or full thickness
(separation of both the epidermis and dermis from
underlying structures)
Head Head
Picture A Picture B
Skin tear Consensus Panel (Le Blanc, Baranoski et al, 2011)
More prevalent with, but not
limited to , the extremes of age
Individuals with impaired activity
Individuals with impaired activity,
mobility, sensation, or cognition have
increased risk of shear, friction and/or
blunt force injury related to the need for
increased assistance
Our experience at SVPH
SVPH 2004 & skin tears
It was unknown, a lot of hear say…and observational information
Two day quality audit on all hospital admissions excluding day only admissions (June)
Consent prior to all skin inspections.
Payne Martin classification system was used to classify the skin tears (Payne R &
Martin, 1993)
Ward type No. of
patients
audited
No. of
patients with
skin tears
Prevalence
Neurology, ENT 30 2 6.7%
Urology 24 1 4.1%
Vascular/Colorectal 34 2 5.88%
Cardiac 25 1 4%
Cardiac/Orthopaed
ic
19 0 0%
Orthopaedics
(2 levels)
42 2 4.7%
ICU 5 0 0%
Total 179 8 4.46%
Facts Category
1
Linear
Category 1
Flap
Category 2
<25%
epidermal
loss
Category 2
>25%
epidermal
loss
Category
3
Complete
tissue
loss
No. of tears 3 8 1 0 0
Documentation
of tears
1 2 1 0 0
Dressing
types
Nil 1 3 0 0 0
Steristrips 1 1 0 0 0
Film 1 0 0 0 0
Steristrips &
film
0 1 0 0 0
Primapore™ 0 2 0 0 0
Steristrips &
Primapore ™
0 1 1 0 0
Implementation plan
Policy and guideline developed
(multidisciplinary involvement)
Wound care products available in all
clinical areas
Education of staff
– Posters/competitions/inservices /forums
Yearly Audits
Evaluation after a year
Wound Associates (Link nurses)
Clinical Nurses interested in skin tear,
pressure injury & wound prevention and
management
1-3 Associates per clinical area
Assist with education, launch of new
products or protocols, audits, act as
resource people.
Experience assists nurses applying for
Accelerated Progression pathway (APP) &
CNS grades1,2,3
Education, Education,
Education…
Oh NO! a skin tear
what will I do?
The guidelines
are on the
computer
Check the
flowchart on
the wall
Ward type Prevalence
June 2004
Prevalence
June 2005
Prevalence
Sept 2007
Neurology, Head &
neck, ENT, BMT etc. 6.7% 3.125%▼ 2.90%▼
Urology 4.1% 10.7%▲ 3.20%▼
Vascular/
Colorectal 5.88% 12.9%▲ 0.00%▼
Cardiac 4% 13%▲ 7%▼
Cardiac/
Orthopaedic 0% 5.5%▲ 3.30%▼
Orthopaedics(2
levels) 4.7% 9.3%▲ 2.30%▼
ICU 0% 16.6%▲ 0.00%▼
No. of patients
audited 179 181▲ 204▲
Total 4.46% 9.3%▲ 3.43%▼
Ward type Prevalence
June 2004
Prevalence
June 2005
Prevalence
Sept 2007
Neurology, Head &
neck, ENT, BMT etc. 6.7% 3.125%▼ 2.90%▼
Urology 4.1% 10.7%▲ 3.20%▼
Vascular/
Colorectal 5.88% 12.9%▲ 0.00%▼
Cardiac 4% 13%▲ 7%▼
Cardiac/
Orthopaedic 0% 5.5%▲ 3.30%▼
Orthopaedics(2
levels) 4.7% 9.3%▲ 2.30%▼
ICU 0% 16.6%▲ 0.00%▼
No. of patients
audited 179 181▲ 204▲
Total 4.46% 9.3%▲ 3.43%▼
Skin tears at SVPH 2007-2008
Review
ICU
Surgical Services
(SS)
Multidisciplinary focus groups:
staff buy in
& Education
Barriers
Lack of education
Unaware of hospital process
Time
Surgical services specific guidelines
Availability of dressing
Age
Requested a risk tool of at risk patient
identifier
Project aim Improve management and reporting of
skin tears in SS
– Education
– Flow charts
– Availability of products
Identify patients at risk of skin tear
– Literature search
– Risk assessment tool
– Sticker (patient identifier)
Share project with other services
Surgical services guidelines:
Skin Tear Management in SS
Stock room SS Management pack
Weekly Multidisciplinary Vascular Radiology meeting
Nurses
Surgeons
Who are the patients most at risk?
>75 years
Visibly frail/paper thin skin
History of:
– transplant/ immunosuppression
– of steroid use
Dependent/total care patients
Assisted device user
At risk skin tear patient alert
Skin tear alert in observation chart
Disasters a thing of the past
References Le Blanc K , Baranoski S, Campbell K, Carville K, Christensen D, Edwards K ,
Gloeckner M, Holloway S, Langemo D, Madore A, Sammon M A, Williams A &
Regan M 2011, ‘Skin Tears: State of teh Science: Consensus Statement for the
Prevention , Prediction, Assessment and Treatment of Skin Tears, Advances in
Skin & Wound Care vol:24, no: 9, (Supplement1) pg. 2-15
Payne R & Martin M, 1993, ‘Defining and classifying skin tears: need for a
common language’, Ostomy Management vol:39, no:5, pg:14-32
Questions?
Thank you
Sculpture by the Sea 2010