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