Posts Tagged ‘skin tears’

Essential Steps for Skin Tear Prevention

Thursday, February 11th, 2016

Skin tears are a common condition for the patients we care for, which is why it’s so important for clinicians to know who is at risk, and what can be done to minimize them. 

Skin Tear Prevention

Painful. Disfiguring. Traumatic. Skin tears are all of these things, plus they can lead to further complications and serious infections. Unfortunately, they also happen to be a very common condition for the patients we care for. In fact, an estimated 1.5 million skin tears occur each year – and that’s just among institutionalized adults.

In addition to causing pain and discomfort, skin tears can be difficult to treat, and are a direct reflection of the quality of care delivered at our facilities. This is why it is imperative for clinicians to know who is at risk for skin tears, and what we can do to prevent them from happening.

Who is at risk?

Although skin tears can occur among all ages, the youngest and oldest patients are at the highest risk. This is due to the structure of both immature and aging skin. In addition, those who are dependent on caregivers for daily activities are particularly vulnerable, since they are regularly positioned and transferred for such things as bathing and dressing. Others who are higher at risk include:

  • Older adults who ambulate independently
  • Those who are critically ill or have multiple risk factors
  • People with a history of skin tears
  • Anyone with impaired mobility
  • Those with sensory or cognitive deficits
  • Patients with visible changes in the skin such as edema, dry skin or purpura
  • Patients on four or more regularly prescribed medications
  • Patients on specific types of medications, including analgesics, antidepressants, anticoagulants, and steroids
  • People who are agitated and combative – they are more likely to bump into objects
  • Those with cardiac, pulmonary or vascular disorders

Skin tear prevention

The truth is that skin tears are not completely preventable. Since part of our job is to support our patients’ independence and improve their quality of life, at some point or another, skins tears will occur. The good news is that, as caregivers, there are things we can do to keep them at a minimum.

Improve patient environments

A patient’s environment can be modified in simple ways that can make a big difference when it comes to skin tear prevention. For instance, you can make sure there is adequate lighting in your patient’s room or living space. Seniors, for example, typically need more light in order to see clearly and avoid accidents. Next, pad furniture corners and other objects that may cause blunt force trauma when bumped, and remove throw rugs that may buckle or slip.  In addition, ensure that the patient is not wearing rings or other jewelry that can snag the skin.

Care for skin properly

Proper skin care can can go a long way in preventing tears. Skin is better able to resist tearing when it’s well-nourished and hydrated, which means nutrition plays a key role. Therefore, consult with a dietitian about the patient’s diet, and make sure they are receiving adequate fluids.

Frequent baths can dry out the skin, which increases the likelihood of skin tears. This can be a problem when facility regulations mandate that patients must have daily or weekly full baths.  If you find that frequent bathing is contributing to dry skin, adjust the full-bath schedule to twice a week, with spot baths in between.  Also, it’s important that when administering a bath, you:

  • Use lukewarm water (not hot)
  • Use soapless, pH-balanced solutions with no rinse or emollient soap
  • Pat the skin dry – do not rub

To keep the skin hydrated following a bath, apply a moisturizing agent. The stratum corneum – or outermost layer of the skin – needs at least 10% moisture. Moisturizers should be applied while the skin is still damp (not completely dry and not soaking wet) to trap that moisture.

There are three types of moisturizers:

  • Humectants promote the retention of moisture, replacing the oils in the skin
  • Occlusives provide a layer of oil on the skin surface, slowing water loss
  • Emollients soften and spread easily on the skin.

A humectant will pull the moisture up from the dermis into the epidermis to help keep skin intact (it’ll even pull moisture out of the air in the room). But humectants need to be coupled with an occlusive product to trap the moisture. In other words, you need to add a layer of oil on the skin’s surface to slow down evaporation.

Meanwhile, we want our skin to be able to slide, right? And that’s the role of emollients. They make the stratum corneum smooth and less susceptible to friction, which can create that skin tear.

More strategies for prevention are to cover fragile skin with long sleeves, pants and knee-high socks, or products such as DermaSaver® or Posey® SkinSleeves™.  If something rubs up against the patient, the clothing or the device will move and hopefully not tear the epidermis from the dermis.

Be gentle, learn more

It goes without saying that we should be extra gentle when lifting, repositioning or transferring patients. By taking your time and softening your touch when caring for those at higher risk of skin tears, the frequency of such occurrences can be decreased.

Educating ourselves and our patients is also an important part of preventing skin tears. We need to understand the risk factors, keep the skin as nourished and moisturized as possible, avoid dangerous edges and surfaces in the environment, and treat patients gently.Skin Tear Webinar Coupon Code

For even more details on the prevention, staging and treatment of skin tears, view this free one-hour webinar recorded at the 2015 Wild On Wounds (WOW) National Conference. For access, click here and use the code SKINTEARS.

What do you think?

Were you already aware of who is most at risk for skin tears, and does this affect how you treat patients? And are there any preventative measures you regularly put in place that seem to help? If you have additional ideas, or any stories to share, please leave them below!

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

 

 

Ouch! Let’s Talk About Skin Tears

Wednesday, December 2nd, 2015

This WCEI free webinar will help wound care professionals understand more about skin tears, including how to treat and prevent them (and help patients heal).

Skin Tears - Prevention and Management

If you’ve ever suffered a significant skin tear, then you know how painful they can be. The inevitable bleeding (and sometimes even disfigurement) during the healing process can take a toll, both physically and emotionally. So you can imagine how awful it would be to experience this same cycle of pain, over and over again.

Unfortunately, skin tears are a common occurrence with institutionalized patients (particularly in older adults), and often lead to further complications. In fact, a reported 1.5 million skin tears occur in this population each year, and that doesn’t even include unreported incidents occurring at home.

But we’re here to help, thanks to our own WCEI Clinical Instructor Gail Hebert, and her presentation at the 2015 Wild on Wounds National Conference in Las Vegas, “How To: Skin Tears – Prevention and Management.” In this free webinar (see access code below), you can listen to her recorded session and arm yourself with the latest information about skin tear treatment, prevention and management. You can also help to bring the number of annual skin tears down while protecting patients and helping support the facilities in which you work.

 

Gail Hebert, RN, BS, MS, CWCN, WCC, DWC, OMS, WCEI Clinical Instructor

Gail Hebert, RN, BS, MS, CWCN, WCC, DWC, OMS, WCEI Clinical Instructor

Ready to learn?

So what exactly is a skin tear? As Hebert explains in the webinar, it’s a traumatic wound caused by shear, friction and/or blunt force trauma that results in either a partial or full thickness injury. And while skin tears certainly occur, to think they are inevitable is short-sighted.

“Our role is to make sure we’ve done everything we can to minimize their occurrences,” says Hebert. “Not just by accepting that skin tears happen and move on, but to work hard at all the variables that can be controlled, so skin tears can be the exception rather than the rule.”

Through Hebert’s webinar, you will learn so much more about skin tears, including:

  • How to identify risks for skin tears and skin tear category classifications.
  • Current evidence-based recommendations for accurate skin tear assessment, prediction, treatment and prevention strategies.
  • Forms and tools you can put to use immediately.

“Skin tears are considered to be negative patient outcomes,” adds Hebert. “So in terms of your facility’s reputation, you don’t want to be known as a place where an excessive number of skin tears take place.” In other words, if people wonder if your facility is doing everything it can to prevent them, you want to be able to respond with a resounding, “Yes!”

 

What people have to say

Those who were able to attend Hebert’s session in person last summer at the WOW Conference had plenty of feedback to share. Here’s a sample:

 

 “Who knew there was enough on this subject matter to actually speak on it for one whole hour? It was great!”

“Excellent speaker, and was happy to hear that I was caring for skin tears in the right manner! Now I can go back to my facilities and students, and pass this information on! Thank you so much! Very engaging speaker!”

“This was a great review for me. I used last year’s skin tear outline to help build our skin tear policy, so I truly appreciate the updated outlines provided with this lecture.”

 

Go ahead, take the skin-tear plunge!

Are you ready to learn more about skin tears and put into practice your newfound knowledge?  Click here and use the code SKINTEARS to access this 60-minute recording, which qualifies for an education credit.

 

 

Tell us your stories

Have you made improvements in your own facility when it comes to skin-tear prevention? What were they, and what results have you noticed? Do you have any other suggestions for skin-tear treatment, prevention or assessment? Leave your comments below.

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.