Evidence based approach to the management and prevention of skin tears within an aged care setting: a best practice implementation project

Abstract

Background: Skin is an important organ that serves to protect against infections, therefore any damage to the skin increases the risk of infection. The elderly are more susceptible to skin tears due to reduced mobility, dexterity, cognition and sensory awareness. Multiple medications and poor nutrition may also contribute to vulnerable skin. As those over 65 years of age are at a greater risk and our ageing population is increasing, the implementation of evidence –based guidelines for prevention and management of skin tears is imperative to reduce the incidence and improve outcomes. Objectives: The aim of this project was to promote best practice in the management, ongoing treatment and prevention of skin tears to improve outcomes for the elderly within a Hall & Prior aged care setting. Methods: The project used the Joanna Briggs Institute’s Practical Application of Clinical Evidence System and Getting Research into Practice audit tool based on best practice. A baseline audit was conducted then strategies for implementing best practices were identified and commenced. This included the commencement of a project link team, education and availability of appropriate materials as recommended by best practices, as well as implementing a more appropriate skin tear care plan. A follow up post implementation audit was then undertaken. Results: Overall, an improvement in compliance of all criteria was achieved. The baseline audit indicated two areas that were 100% compliant, but all other areas were less than 10% compliant. The results from the follow-up showed a significant change in the management of skin tears, as well as improved knowledge and plans for the prevention of skin tears. Generating a plan of care improved from 0% to 73% compliance which related to documentation of a plan for the prevention of skin tears; implementing a standardized dressing for skin tears greatly increased non adherent dressing use from 7% compliance to 93% compliance. Conclusions: Effective communication, and improved practices through ongoing training and education improved management of skin tears. Improved awareness into the importance of skin integrity is critical in future prevention of skin tears among those at risk. Future strategies such as ongoing education for skin tear prevention will be implemented to ensure ongoing best practice is maintained, particularly in the prevention of skin tears.