Case study simplifying the treatment of skin tears
Simplifying the Treatment of Skin Tears in Long Term Care: A Case Series Kimberly LeBlanc BScN RN ET MN(c) & Dawn Christensen BScN RN ET MScN, Clinicians and Educators with KDS Professional Consulting, Ottawa, ON Bernadette Culhane RN Longfields Manor Ottawa, Ontario Registered Staff Longfields Manor, Long Term Care Ottawa OntarioAbstract PopulationThere is little published information available concern the management of skin tears. Five elderly patients, three males and two females ranging in age from 84 to 93 years of age. Each skin tearSkin tears in the elderly are common and treatment is costly. Skin tears are the result of had occurred less than 4 hours before treatment and was classified as Category I ,II and III Skin Tear using Mr JB, 90 year old male, Category II skin tearshearing, friction and/or blunt injury. Malone et al, 1991 found the incidence skin tears of Payne-Martin classification (O’Regan 2002). The skin tear was treated by covering it with an absorbant Day 0 Day 3 Removal Day 24the institutionalized elderly to be .92 per patient per year. Given this high incidence of clear acrylic transparent dressing following the protocol below.skin tears, an evidence based approach to identification, prevention and management of Classification System used:skin tears in the elderly population is needed. Payne & Martin Skin Tear Classification (O’Regan, 2002):Payne & Martin (1993) developed a validated classification system which can be used to Category I: Skin tears without tissue lossconsistently assess skin tears. However, limited published information exists on the Linear type (full thickness): epidermis and dermis are pulled in one layer from supporting structures. Woundprevention and management of these challenging and costly wounds. is incision like in appearance.This poster will demonstrate an approach used at one Long Term Care facility to reduce Flap type (partial thickness): epidermis and dermis are separated. Flap can be completely approximated orpain, increase healing time and decrease costs associated with the management of skin approximated to expose no more than 1mm of the dermis. Mrs T 87 year old female, Category III skin teartears. Through case study format, this poster will review one treatment option available Category II: Skin tears with partial tissue loss Day 0 Day 3 Removal Day 14for the treatment of skin tears. The use of an absorbent clear acrylic dressing in the care Scant tissue loss type: 25% or less of the epidermis flap is lost.of five (5) elderly patients living in a Long Term Care facility will be shown pictorially. Moderate to large tissue loss type: more than 25% of the epidermal flap is lost.These case studies will include initial and final assessments of the wounds including Category III: Skin tears with complete tissue lossphotos, treatment plan, problems encountered, and patient outcomes. The epidermal flap is absent.Introduction Protocol: Clean skin tear (within 4 hours after initial trauma) with normal saline and control bleeding.Skin tears are a common occurrence for patients residing in Long Term Care facilities. Approximate wound edges.While often seen as minor wounds, skin tears affect patient quality of life and are costly Take initial digital photo (after written consent form has been signed).to the health care system. In the United States it is estimated that 1.5 million skin tears Apply absorbent clear acrylic dressing. Mr P 93 year old male, Category III skin tearoccur each year (Kennedy-Evans, 2004). They are traumatic wounds which are often the Take second digital photo of wound. Day 0 Day 3 Removal Day 24result of friction alone or a combination of friction and shearing. Skin tears can be painful Fill in data sheet.and include minimal to complete tissue loss (Brillhart, 2005). The elderly are especially Take additional photos at day 3 and after removal of clear acrylic transparent dressing.at risk for skin tears. This is due in part to the physiological skin changes associated withaging, including decreased subcutaneous tissue, and dehydration and atrophy of the Results::skin. In addition, impaired vision, stiffness, sensory loss, bruising and immobility are all Complete closure in 5 out of 5 wounds in less than one month with one to two dressing changes required.risk factors (Brillhart, 2005, Kennedy-Evans, 2004). Baranoski (2000) reported that skintears are often associated with wheel chair injures (25%), bumps into objects (25%), Patients denied any pain with application.transfers (18%), and falls (12.4%). Skin tears occur most often on the arms and legs, There were no signs and symptoms of infection at any of the wound sites.however they can occur anywhere on the body. Skin tears located over the buttock areaare often mistaken for stage II pressure ulcers (McGough-Csarny & Kopac, 1998). Registered staff reported no problems encountered with the application of the dressing and reported decrease nursing time required for wound care and increased patient comfort. Mrs W 84 year old female, Category I skin tearPrevention of skin tears is challenging. Assessment tools to identify those at high risk Day 0 Day 3 Removal Day 14take into account all the factors that might influence skin health, such as: mental Cost per application was estimated to be $8.62/dressing based on unit price.status/sensory perception; mobility status; moisture, bowel, and bladder status; skin Family members, staff and patients reported to be happy with the ease of use, healing time and decreasedintegrity and friction tear; activity status; nutritional fluid status; and predisposing medical pain associated with the dressing.problems/influencing health factors. Risk assessment in combination with an appropriateskin care regime can prevent many wounds from occurring (Norman, 2003). Prevention Staff liked the ability to observe the wound through the dressing.however, is not always possible. There were no problems encountered with removal of the product.There are many wound care treatment options documented, but there is limited literature Staff did report that dressing was not conformable to all areas and smaller sizes would have beenconcerning the treatment of skin tears. There is not a gold standard for the treatment of beneficial.skin tears. This poster will address one treatment option which minimizes patient pain, Mr S 92 year old male, Category I skin tearfacilitates wound healing, protects the wound from further trauma, and is cost effective. Conclusion: Day 0 Day 3 Removal Day 22Five patients from one Long Term Care facility with partial to full thickness skin tears Skin tears are a common and costly problem frustrating health care professionals working with the elderlywere treated with an absorbent clear acrylic dressing. population. There is little published information available concerning the management of skin tears. Given this high incidence there is a need for an evidence based approach to identification, prevention and management of skin tears in the elderly population. In recent literature there has been an increase in the attention given to these wounds, however no gold standard has been developed for the management of these wounds. This poster has demonstrated one approach used at a Long Term Care facility to reduce pain, increase healing time and decrease costs associated with the management of skin tears. The results demonstrated the need for further study into the wound healing benefits of absorbent clear acrylic dressing in the treatment of skin tears and it’s cost effectiveness. References Baranoski, S. (2000). Skin Tears. The enemy of frail skin. Advances in Skin and Wound Care, 13, 123-126. Brillhart, B. (2005). Pressure sore and skin tear prevention and treatment during a ten month program. Rehabilitation Nursing, 30(3), 85-91. Acknowledgements: The authors would like to Kennedy-Evans, K.L. (2004). Addressing the pain: An innovative solution for skin tears: A case study. Ostomy/Wound Management, 50(2), 9-10. thank 3M Wound Management for their supportProfessional Consulting McGough-Csarny, J., & Kopac, C.A. (1998). Skin tears in institutionalized elderly: An epidemiological study. Ostomy/Wound Management, 44, 14S-25S. Norman, R. A. (2003). Caring for aging skin: a geriatric dermatologists expert advice on skin care for LTC residents. Nursing Homes, 4(1). O’Regan, A. 2002. Skin Tears: A review of the Literature. World Council of Enterostomal Therapists Journal. 22(2). 26-31. in the development of this poster. Payne, RL., Martin, MC. (1993). Defining and classifying skin tears: need for a common language. Ostomy/Wound Management. 39(5). 16-26.