January 2020 Wound and Ostomy Journal
Skin integrity in older adults: pressure-prone, inaccessible areas of the body.
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Bethany Sobesto 1/21/2020
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
At PSJMC we consider factors which affect skin integrity. We do a skin assessments on our patient's and look for pressure ulcer risk factors like limited movement, neurological impairment, poor nutrition, cognitive impairment, and previous pressure ulcers. We also consider factors which can lead to skin damage such as old age, incontinence, poor hygiene, long term skin conditions, and falls. This article mentions these items so our practices at PSJMC are similar to what is mentioned in it. The only practice that I saw, that we don't follow, is the avoidance of zinc based barrier creams. The article mentions that zinc based barrier creams should be avoided because they can block the skin's pores and coat the inside of incontinence pads which reduces the absorbency of the pad. This is not what we were taught at PSJMC and we do use the zinc based creams on incontinent patients.
What are the advantages and disadvantages to the proposed recommendations in the article?
The advantages of adhering to the proposed recommendations include a reduction in the prevelency of pressure ulcers, a decrease in risk of infection, protection of fragile skin, and overall preservation of skin integrity which is important because the skin has many vital functions. As far as the disadvantages adhering to the proposed recommendations there are few that I can think of. One could be the time it takes to educate family or caregivers to properly care for the patients skin.
Melissa Bautista 2/16/20
ReplyDelete1) How does this research article compare to our practice, policy and/or procedure?
This article focuses on the aging population which is similar to our patient population at PSJMC. Many of our patients have factors that impair skin integrity mentioned in the article including urinary/fecal incontinence and chronic conditions like diabetes. The article mentions the importance of regular full skin assessment. At PSJMC our policy is to perform skin assessment upon admission, transfer, and every shift. The article also mentions a multidisciplinary approach to aid in maintaining skin integrity. At PSJMC we utilize interdisciplinary teams such as dietary services to optimize nutritional support and physical therapy for early mobility to help maintain skin integrity.
2) What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The article mentions that zinc-based barrier creams should be avoided because they can coat the inside of incontinence pads and reduce their absorbency. I think this may pertain more to ambulatory outpatients that use incontinent briefs. For inpatients that are frequently moist due to urinary and fecal incontinence zinc-based barrier creams help prevent breaks in the skin.
Stephanie Smith (09/01/2020)
ReplyDelete1. How does this research article compare to out practice, policy, procedures.
This article focuses on elderly patients, which is the majority of the patients in the hospital. Skin maintenance is addressed, for example the type of skin cleanser used. In the hospital we use fragrance free and hypoallergenic soaps, which has a gentler pH to protect skin. Specific parts of the body were highlighted that are more susceptible to compromised skin, and those are also focused on when we do our assessments (on admission, transfer, etc).
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital.
Implementing these recommendations should help us protect our patients skin, hopefully causing less damage due to ulcers, skin tears, etc. WE use cavilon skin barrier for moisture protection.
Stephanie Smith (09/01/2020)
ReplyDelete1. How does this research article compare to out practice, policy, procedures.
This article focuses on elderly patients, which is the majority of the patients in the hospital. Skin maintenance is addressed, for example the type of skin cleanser used. In the hospital we use fragrance free and hypoallergenic soaps, which has a gentler pH to protect skin. Specific parts of the body were highlighted that are more susceptible to compromised skin, and those are also focused on when we do our assessments (on admission, transfer, etc).
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital.
Implementing these recommendations should help us protect our patients skin, hopefully causing less damage due to ulcers, skin tears, etc. WE use cavilon skin barrier for moisture protection.
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ReplyDeleteThis comment has been removed by the author.
ReplyDeleteSkin integrity in older adults: pressure-prone, inaccessible areas of the body.
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
This article discusses the vital role of skin, leading to healthy elderly. It also outlines the factors that impair skin integrity, the measures to maintain skin integrity, and to prevent pressure ulcers. Skin is our first line of defense as it provides the main protective barrier and prevents entry of organisms and substances into our body. Aging is the main factor that impairs skin integrity. Poor skin integrity should not be seen as a normal consequence of aging. Active interventions should be implemented to improve it. PSJMC's patients are mostly the elderly. Most patients admitted from the nursing facilities have impaired skin integrity, and are cognitively and physically impaired. Some are also undernourished. These are factors that impair skin integrity. Thorough integumentary assessment is the key to identify and prevent pressure injury. Nurses conduct physical assessments every shift and PRN. Once pressure injury is identified, treatment modality is applied per wound care protocol or per MD/WOC RN recommendation. To prevent IAD (Incontinent Associated Dermatitis), PUREWICK Female External Catheter is applied. It allows a simple, non-invasive urine output management in female patients. Using low pressure wall suction, the PUREWICK Female External Catheter wicks urine away from the patient and into a designated collection canister. Barrier cream is also applied to further protect the skin. For patients who need help with activities of daily living, they are referred to PT/OT before the discharge. Educational materials are also printed and given to the family upon discharge.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article specifies the practices that are useful for nurses in the community such as those involved in home health, and this may include taking a detailed health assessment, asking specific questions that will identify greater risks for impaired skin integrity, and performing physical assessments. As RNs in an acute care setting, we do physical skin assessments every shift, every 2 hours if the patient must be turned and positioned due to wounds or at increased risk for potential ones, or when doing wound care. Skin surveillance is a constant process with the goals of the prevention of skin breakdown and care of existing wounds. In a hospital setting we have immediate access to supplies such as emollient barrier creams, specialty dressings and supplies, incontinence systems such as the purewick or flexiseal, as well as dedicated wound care ostomy nurses who help to diagnose skin conditions as well as initiate appropriate treatment regimens. The article mentions ways community nurses can facilitate improvements in patient skin care and integrity via review and modification of medications that can directly or indirectly affect skin integrity, physical therapy or occupational therapy referrals, as well making improvements to temperature, living conditions, daily regimens. It is very beneficial to see the patient in their normal home environment to make the most meaningful and (hopefully) long-lasting changes. In the hospital MDs can write orders for PT/OT evaluations, social work consults if there are possible adverse home conditions affecting the patient, and for equipment that can aid mobility and self-care behavior.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Physical or occupational therapy referrals are already implemented in the hospital setting and are useful for ensuring safe mobility and better self-care at home, but the community nurse has a distinct advantage over an acute care nurse in that he/she has the ability of follow-up and frequent visits with patients to alter and optimize treatment. As for medication review, RNs in hospitals can discuss any concerns they may have with a medication with the MD, though ultimately it is the doctor's decision to change a long-term medication, and a heavy patient load or other burdens placed by the unit can greatly minimize the availability a nurse would have to go through every patient's home medications. There are advantages to having a readily available supply of different skin and wound care products for patients in a hospital in that changes in the regimen are immediate and the best plan can be determined before a patient goes home. By contrast a community nurse is limited by the supplies on hand, and ordering different supplies for home use can take time or not be optimal for the skin/wounds.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article discusses the importance of good skin integrity for the elderly patients as it acts as a barrier to microbes and toxins, sunlight and radiation. Elderly patients are more susceptible to pressure injury, and their skin takes linger time to heal.
It also discusses what can be done to maintain skin integrity and skin health and why skin integrity is important for pressure ulcer prevention. Our policy in PSJMC is to perform skin assessment upon admission, transfer, discharge and every shift.
what are the advantages and disadvantages to the proposed recommendations in the article?
The advantages of the proposed recommendations in the article includes prevention of pressure ulcers and lowering the risk of infection.
Disadvantages includes difficulty engaging patients in skin care.
What are the advantages and disadvantages to the proposed recommendations in the article.
ReplyDelete-Maintaining healthy skin in elderly patients is important since skin integrity decreases with the aging process, making them at risk for wounds and pressure injuries. Skin assessment through physical inspection, underlying factors that affect skin integrity and factors affecting self care ,educating patients in self care and referral to other health care teams such as dietician, PT, OT are important factors to promote and improve skin integrity .This holistic management provides best outcome for our elderly patients .
How does the research article compare to our practice policy and/ or procedure?
-Similarly at PSJMC, we consider the recommendations in the article. Skin assessment is done during admission and every shift. Skin integrity assessment is documented and incorporated in the Care Plan. Education regarding managing skin care are provided to patients and their families and care givers, with factors affecting self care being considered. Referral to other Dietician for nutrition and hydration, to Physical therapist for mobilization and Social Service for equipments needed at home and home safety.Use of moisturizers and skin barrier creams , use of pure wick and condom catheter for incontinence.