PREVENTION OF SKIN TEARS
The early recognition of those who are at risk of skin tears is a vital part of prevention.
A full skin assessment should be undertaken on admission or at the first visit to identify the risk factors. (NHS Improvement 2018). Following on from the assessment, ongoing skin inspections should be incorporated into the management plan of care. E.g. aSSKINg (Assess Risk, Surface, Skin, Keep moving, Incontinence, Nutrition, Giving Information.)
ISTAP (LeBlanc et al, 2013, 2018) recommend a multidisciplinary team approach to the implementation of a systematic skin tear prevention programme.
This is based on three risk factor categories:
- Skin
- Mobility
- General health
(Ellis 2015)
| RISK FACTOR | PATIENT | HEALTH CARE PROFESSIONAL/ CARER |
|---|---|---|
| General health | Where appropriate educate the patient. Discuss how best to improve nutrition and hydration. |
Maintain a safe environment. Education on protecting the patient from self –harm. If there is evidence the patient being under/overweight refer to dietician. Recommend a review of any polypharmacy. |
| Mobility | Where appropriate encourage active involvement. Introduce an appropriate selection and use of assistive devices. |
Daily skin assessment and monitor for skin tears. Awareness of importance of safe patient handling. Implement a fall prevention programme, (including removal of obstacles, ensure good lighting). Pad equipment. |
| Skin | Educate awareness of any medication that can induce skin fragility. Wear clothing that will protect the skin e.g., long sleeves. Keep skin moisturised. Keep fingernails short. |
Skin hygiene - use warm/tepid water with soap-less pH-neutral cleansers and moisturise skin. Avoid strong adhesives, dressings, and tapes. Avoid sharp fingernails/jewellery. |
Adapted from ISTAP LeBlanc 2018
Emollient therapy should be seen as a vital part of skincare in patients with aged skin.
Use of emollients promotes general skin health and twice-daily application has been proven to reduce incidence of skin tears by 50% (Carville et al, 2014).
Emollient products are available as moisturisers (creams, ointments and lotions), bath oils, gels and soap substitutes (NICE, 2015). Some emollients work by ‘trapping’ moisture into the skin and reducing water loss by evaporation. Emollients that include substances known as humectants (e.g., urea) work by actively drawing water from the dermis to the epidermis and compensating for the reduced levels of natural moisturisers in the skin (Wounds UK, 2015).
Self-care, wherever possible, should be encouraged in those suitable patients, and to include emollient therapy, encouraging the patient to apply moisturisers themselves where possible. This can be incorporated into the patient’s daily routine.
Patient awareness of skin tears and general skin health can be beneficial, encouraging the patient to monitor their own skin for any changes. They can also be encouraged to be aware of potential risks and mindful of their environment, helping to avoid self-injury to fragile skin.