Wound and Ostomy Journal January 2021
Skin tears: prevention and management.
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3/11/2021 Bethany Sobesto
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
One of the things this article talks about is preventing skin tears. The methods listed, to prevent skin tears, include: skin moisturizing, proper nutrition, wearing protective clothing, keeping finger nails short, avoiding tough adhesive tape, avoiding room clutter so the patient does not hit themselves on accident, controlling edema, proper transferring, and proper repositioning. We do all of these things at PSJMC. We try to be gentle when removing adhesives. We gently reposition patients if they have fragile looking skin. We order a nutrition consult for malnourished patients. We apply skin lotion to dry skin. We remove jewelry that could cut into their skin. We do what we can to protect patient's aging skin.
what are the advantages and disadvantages to the proposed recommendations in the article?
For the management of skin tears, the article recommends controlling bleeding, cleaning the wound, approximating the wound edges if possible, and applying the proper dressing. The appropriate dressing is based on the amount of wound drainage as well as whether or not the wound is infected. For example, gelling fiber would be used for a wound with moderate to heavy exudate. The advantages of using the proper dressing are good wound healing, moisture balance, antimicrobials to decrease infection, protection by cushioning the area, and approximation of wound edges. The disadvantages of using a dressing can be an allergic reaction to the dressing such as a silver dressing, the drying out of the wound bed, and further tearing of the skin from improperly removing the dressing.
How does this research article compare to our practice policy and procedure?
ReplyDeletePSJMC implements preventative measures similar to article's guidelines such as:
* Daily skin assessment and monitoring
* Safe patient handling techniques
* Initial fall assessments and prevention
* Moisturizer applications. Avoidance of strong adhesives/tapes
* Involvement of other healthcare team such as the PT to
improve mobility and safe transfer, dietician to optimize
nutrition
* Providing education to patient on skin care and skin tear
prevention.
In the presence of skin tear, PSJMC implements the following management similar to the article recommendations:
* Use of non adherent dressings such as Xeroform petrolatum dressing and gentle boarder foam dressing depending on exudates
* Avoidance of sterile strips, films and hydrocolloids to prevent further trauma on removal
* Avoidance of strong adhesive or tapes to secure dressings, instead we use kerlix kling to secure dressing for ease of removal
What are the advantages and disadvantages of implementing the article recommendations to your unit and /or hospital?
A lot of our patient population are older adults and elderly from nursing facilities who are prone for skin injuries such as skin tear.Aside from aging, other factors such as impairment on cognition and nutrition and underlying conditions make the them high risk for skin injury.Implementing preventative strategies diminish impact of skin tear to patients.Proper management in the presence of skin tears such as appropriate dressings are important to prevent further trauma , infection ,pain and suffering. Special precautions should be considered when it comes to patient's sensitivity or allergy when using some dressing products
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe article recommends the following to prevent and manage skin tears:
Daily skin assessment and monitor for skin tears
Use protective clothing/devices
Avoid strong adhesives, dressings, tapes
Moisturize skin
Avoid sharp fingernails/jewelry
We implement these same measures at PSJMC. Early identification and prevention are keys to reduce the incidence of skin tears.
2. What are the advantages and disadvantages of implementing the artice recommendations to your unit and/or hospital?
The majority of the patient population in the ICU are elderly adults who are highly susceptible to skin tears due to a myriad of factors that are not limited to age, underlying disease process, agitation, and impaired nutrition. The advantages of implementing preventative measures will help reduce trauma and increase patient comfort.
How does this reserach article compare to our paractice, polcey, and or prcedure
ReplyDeleteThis articles focused on skin tears, and used methods such as skin moisturizing, proper nutriton, wearing protective clothing, keeping finger naisl short, and avoding the uses of adhesive tape, and room clutter to the patient does not accidentally get hurt and create friction. This is something we have done consistently within our own practices, as we used adhesive removers, when removing those tough adhesives. We frequently round to remind patients, and reposition those with a braden score less than 18 who have fragile skin. We initiated this on our unit with a turn team, to protect those with fragile skin.
What are the advantages and disadvantages of implementing the article recommendations to your unit and/ or hospital?
While of course the advantages of implementing preventative measures will help reduce skin tears, trauma, and increase patient comfort, our unit disadvantage is that our population on 4N is range from acute cvas, seizures, and demented patients., They and are susceptible to skin tears from a variety of issues, such as agitation, impaired nutrition, and the inability to follow commands. While we could follow an implement these practices, our patients might accidentaly damage their skin by forcibly removing adhesives such as tegaderms on their IV sites.
-Marc Dacalos, 4N
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe article discusses skin tears and this is something we are always doing our best to prevent in the hospital. Techniques and practices such as skin moisturizing, adequate nutrition (dietician is involved with this too), gentle handling of the patient (especially those with fragile skin), removal of clutter, and daily assessments are what we do in the hospital on a daily basis. Our unit has also implemented a turning team to turn patients every 2 hours that have a Braden score less than 19, as they are high risk to develop skin tears as well as pressure injuries.
what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The advantages to implementing these are practices will include a decrease in the number of skin tears and can also help with patient satisfaction scores as they will report less pain and discomfort than if they had sustained as skin tear. As much as these practices can help, they can only do so much prevention as more agitated or confused patients can possibly injure themselves, and those that cannot follow commands will ignore teachings to help prevent injury or ignore eating an adequate nutritional intake.
How does this research article compare to our practice, policy and/or procedure?
ReplyDelete1). There are many similarities to our practice, such as providing a safe environment, daily assessments of skin, and proper transferring/repositioning. Some of the differences between the ISTAP guide and our practice is: a. the skin be moisturized BID, b. wearing of protective clothing, and c. maintain a room temperature that is not too hot.
what are the advantages and disadvantages to the proposed recommendations in the article?
2). Some of the advantages of implementing the changes proposed by the article is that moisturizing the skin BID would make it less fragile, and therefore less prone to shearing and tearing and protective clothing would cushion the skin during turning. The disadvantages to these would be that lotions would make dressings less adherent and that protective clothing would make full assessments more difficult.
How does this research article compare to our practice, policy and/or procedure.
ReplyDeleteThe research article explored various strategies and techniques for the prevention and management of skin tears, which are reflected in PSJMC's policies and practices. These include skin assessment every shift, fall prevention/assessment, dietary consultations, safe/gentle patient handling with proper equipment use, repositioning every 2 hours, providing a safe and clutter-free environment.
What are the advantages and disadvantages of implementing the article recommendations to your unit and/ or hospital?
Caregivers implementing these strategies will improve our management of skin tears and increase patient comfort and satisfaction. While the article stated that education provided to patients is an important factor in reducing skin tears, the patient population of 4N has a number of individual factors such as impaired cognition and agitation that contribute to an increased risk of skin tears. Due to these factors, it is sometimes difficult to manage these injuries.
-Maitrang Tran, 4North