At a glance…
Long-term care providers must ensure that their skin tear procedures and practices reflect the current literature and clinical practice guideline recommendations. This article outlines the latest clinical information.
In the United States alone there are more than 1.5 million skin tears per year in institutionalized adults.
1 Eighty percent occur on the arms and hands. Over the past 20 years, clinicians, researchers, and regulators have focused their attention on the problem of skin tears, especially in older adults. The result is a better understanding of the problem with excellent demographic data and understandings of underlying etiologies. Long-term care providers must ensure that their skin tear procedures and practices reflect the current literature and clinical practice guideline recommendations.
Classification, risk assessment, demographics, etiologies
In 1993, Payne and Martin published their definitive work on skin tears, formally defining “skin tears” and introducing a three-category system that remains the gold standard today.2 In 1994, White, Karam, and Cowell introduced a Skin Tear Risk Assessment Tool.3 Following two decades of research it is now clearly recognized that skin tears in the elderly occur due, in part, to physiologic changes in the skin as we age and to certain medications that thin the skin (e.g., corticosteroids). Research shows that the major causative etiologies for skin tears are:
Wheelchair injuries 25%
Bumping into objects 25%
Skin tears are often associated with falls and fall events5 and with low-quality lotions and bathing products (lotions and soaps).6,7,8,9 This is where good prevention and treatment strategies come into play.
Clinical practice guidelines
To help direct clinical practice, a number of tools and clinical practice guidelines for skin tears have been developed in recent years. In 2004, the Patient Safety Authority of the Commonwealth of Pennsylvania began a statewide skin tear initiative. Their data and skin tear toolkit can be downloaded from the Patient Safety Authority of the Commonwealth of Pennsylvania Web site at http://www.patientsafetyauthority.org.5
Many of the clinical practice guidelines that have been developed can be downloaded from the Internet via search engines. These documents can help you update your facility's skin tear procedures and practices (see sidebar, pg. 32).
Identify individuals at high-risk for skin tears. Just as pressure ulcer risk assessment may reduce the prevalence of pressure ulcers, identifying those individuals at high risk for skin tears and instituting prevention strategies may reduce the risk of skin tears. One skin tear risk assessment tool has been published.
3 Many facilities use their own admission skin assessment forms for this purpose. Once a high-risk resident is identified, an individualized skin tear prevention plan of care should be developed, implemented, and documented.
Maintain a safe environment. Tactics include preventing falls and bumps, providing good lighting, ensuring an uncluttered environment, and upholstering or covering sharp edges of furniture. Educating patients, caregivers, and staff on preventive strategies and transfer techniques is critical.
Identify individuals at high-risk for skin tears
Maintain a safe environment
Use soaps and lotions with emollients
Use protective clothing and devices
Use soaps and lotions with emollients. Use of moisturizers or emollients on a daily basis reduces skin tear risk, lowers the incidence of skin tears, and is cost-effective. Avoid the use of aggressive adhesives-such as tapes and certain dressings. Thousands of dollars can be saved annually per facility.9
Use protective clothing and devices. Long-sleeved shirts, stockings, and clothing modifications are effective strategies for preventing skin tears. Skin sleeves and leg protectors are useful preventive devices, especially for individuals who experience recurring skin tears.