Hospital Skin Tear Disaster! A Thing of the Past in Surgical Services

2,495 views
1,805 views

Published on

Edel Murray, Clinical Nurse Consultant, St. Vincents Private Hospital delivered this presentation at the Reducing Avoidable Pressure Injuries Conference. For more information about this annual event, please visit: www.healthcareconferences.com.au

Published in: Health & Medicine, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
2,495
On SlideShare
0
From Embeds
0
Number of Embeds
348
Actions
Shares
0
Downloads
23
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Hospital Skin Tear Disaster! A Thing of the Past in Surgical Services

  1. 1. Hospital Skin Tear Disaster! A thing of the past in Surgical Services Edel Murray Clinical Nurse Consultant St. Vincent’s Private Hospital (SVPH) , Sydney
  2. 2. 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)
  3. 3. 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
  4. 4. Skin tear Consensus Panel (Le Blanc, Baranoski et al, 2011)
  5. 5. More prevalent with, but not limited to , the extremes of age
  6. 6. 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
  7. 7. Our experience at SVPH
  8. 8. 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)
  9. 9. 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%
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. Education, Education, Education… Oh NO! a skin tear what will I do? The guidelines are on the computer Check the flowchart on the wall
  14. 14. 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%▼
  15. 15. 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%▼
  16. 16. Skin tears at SVPH 2007-2008
  17. 17. Review ICU Surgical Services (SS)
  18. 18. Multidisciplinary focus groups: staff buy in & Education
  19. 19. 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
  20. 20. 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
  21. 21. Surgical services guidelines:
  22. 22. Skin Tear Management in SS Stock room SS Management pack
  23. 23. Weekly Multidisciplinary Vascular Radiology meeting Nurses Surgeons
  24. 24. 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
  25. 25. At risk skin tear patient alert
  26. 26. Skin tear alert in observation chart
  27. 27. Disasters a thing of the past
  28. 28. 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
  29. 29. Questions? Thank you Sculpture by the Sea 2010

×