Skin Tears Preventable With a Gentle Approach: A Case Series.

Skin tears are a major problem for patients and the health care professionals who treat them. Although opinions on their prevalence differ, it is estimated that they are encountered more frequently than pressure sores but are overlooked. Recommendations based on strong evidence were presented for the prevention and treatment of skin tears as classified by the International Skin Tear Advisory Panel. This case series includes the clinical status of 3 patients who developed skin tears while receiving care in the hospital, and the corrective and preventive practices related to skin tears. This article will contribute to raising the awareness of health care professionals in predicting, preventing, evaluating, and treating skin tears.

Desgarros cutáneos: su incorporación al marco conceptual de las lesiones cutáneas relacionadas con la dependencia / Skin tears: their incorporation into the conceptual framework of dependency-related skin injuries

Los desgarros cutáneos son lesiones prevalentes en adultos mayores y están fuertemente relacionados con la presencia de dermatoporosis. Se trata de lesiones poco conocidas, infradiagnosticadas y mal abordadas a las que se les ha restado importancia a lo largo de los años. Recientemente, el GNEAUPP ha considerado incluirlos en el marco conceptual de las lesiones cutáneas relacionadas con la dependencia, dado el cumplimiento de esa vulnerabilidad y la necesidad de cuidados de los pacientes que pueden o están en riesgo de padecerlos. Se presenta el caso clínico de una paciente crónica compleja con dermatoporosis que sufre un desgarro cutáneo. Se detalla el mecanismo de producción, características clínicas y categorización de esta lesión, así como las medidas basadas en la evidencia actual adaptadas a la situación de la paciente. Con ello se pretende destacar la importancia del cuidado de la piel y el conocimiento, prevención y abordaje de estas lesiones por parte de los profesionales sanitarios (AU)

Skin tears are prevalent lesions in older adults, strongly related to the presence of dermatoporosis. These are little-known, underdiagnosed and poorly managed injuries that have been played down over the years. The GNEAUPP has recently considered including them in the conceptual framework of dependence-related skin lesions, given the fulfillment of that vulnerability and need for care of patients who may or are at risk of suffering from them. We present a clinical case of a complex chronic patient with dermatoporosis who suffered a skin tear. The mechanism of production, clinical characteristics and categorization of this lesion are detailed, as well as the measures based on current evidence adapted to the patient’s situation. This article pretend to highlight the importance of skin care and knowledge, prevention and management to these injuries by health professionals (AU)

[Cross-sectional study on skin tears in fragile, aging skin: nursing deficits in a common problem in Germany]. / Querschnittstudie zu Skin Tears in fragiler Altershaut.

Cross-sectional study on skin tears in fragile, aging skin: nursing deficits in a common problem in Germany Abstract. Background: Skin tears are internationally classified as a common phenomenon in elderly people. Methods of prevention, early detection, classification, and specific treatment of skin tears are internationally established. Up to now skin tears have received little attention in Germany, and the present state of studies is insufficient. Aim: The aim of this study was to reveal for the first time the nurses' perspective in Germany concerning skin tears. Methods: A cross-sectional design was conducted in an online survey to ask general and geriatric nurses about frequency, classification systems, terminology, risk factors, prevention, and treatment methods concerning skin tears. Results: With 137 completely answered questionnaires, persons from various nursing disciplines and regions were reached. The incidence of skin tears was rated by 83.2 % of the respondents as common or very common, whereas 37 different terms for skin tears had been used. Numerous risk factors and methods of prevention were named; however, classification systems are hardly known. Knowledge about dressings is partially inadequate. Conclusions: An explicit and standard terminology for the phenomenon "skin tear" as well as the utilization of international classification systems are urgently needed in Germany. Evidence-based treatment and prevention should become standard in Germany. Beginning in nursing school and nursing college, specific education and counselling must be established for nurses as well as for patients and their caregivers.

Skin tears: prevention and management.

Skin tears commonly occur at the extremes of age and are associated with skin changes in ageing skin. They are considered to be acute wounds caused by mechanical forces, such as blunt trauma. While the true prevalence and incidence of skin tears is unknown, the available evidence suggests that these wounds occur in all healthcare settings. Importantly, skin tears are preventable with the implementation of a risk-reduction programme, which includes twice-daily skin moisturisation. Where these injuries do occur, it is important to categorise the extent of damage as well as to choose the most appropriate dressing to avoid adding any risks for further trauma.

Prevention and management of skin tears in older people.

Skin tears are frequently encountered in emergency and unscheduled care, and are prevalent in older people. Patients may present soon after an acute skin tear, or at a later stage when the wound presentation is different and there are complications. This article describes evidence-based recommendations and strategies for the prevention, assessment and management of skin tears, discusses risk factors and explains when to refer patients for specialist management.

Assessment, prevention and management of skin tears.

Skin tears are common in older people. They are acute wounds that are at high risk of becoming complex, chronic wounds due to the interplay between the physiological changes in the skin and trauma from the external environment. Skin tears have been reported to have prevalence rates equal to, or greater than, those for pressure ulcers. A comprehensive risk assessment should include assessment of the individual's general health (chronic/critical disease, polypharmacy and cognitive, sensory and nutritional status); mobility (history of falls, impaired mobility, dependent activities of daily living, and mechanical trauma); and skin (extremes of age, fragile skin and previous skin tears). A recognised classification system should be used to identify and document skin tears and guide treatment decisions in line with local wound management protocols. Nurses and carers are in a prime position to prevent, assess and manage skin tears.

'Hands on' or 'hands off'.

This is a new standard series to supplement our Cochrane Corner and Research Unwrapped evidence series. The aim of Guideline commentary is to support you to critique and utilise newly published guidelines enabling translation of appropriate recommendations to practice. The objective is to scrutinise recent guidelines to encourage an understanding of the key issues, recommendations and midwifery practice implications.

A review of patient and skin characteristics associated with skin tears.

OBJECTIVE: Skin tears are the most common wound among the elderly and have the potential to cause infection, form chronic wounds, reduce quality of life and increase health-care costs. Our aim was to identify studies that reviewed patient and skin characteristics associated with skin tears. METHOD: A review of skin tear studies reported in the English literature between 1980 and 2013 was undertaken using the following electronic databases: PubMed, Medline, CINAHL, Embase, Scopus, Evidence Based and Medicine Reviews (EBM). Search terms included aged, skin, tears or lacerations, skin tearing, geri tear, epidermal tear and prevalence. RESULTS: There were 343 articles found with using the search terms. After abstract review nine were found to be relevant to the search. The principle findings from these eight published articles and one unpublished study revealed that the most common patient characteristics were a history of skin tears, impaired mobility and impaired cognition. Skin characteristics associated with skin tears included senile purpura, ecchymosis and oedema. CONCLUSION: This review provides an overview of identified patient and skin characteristics that predispose the elderly to skin tears and exposes the lack of research within this domain. DECLARATION OF INTEREST: R. Rayner is a recipient of a 2013 Australian Postgraduate Award, Curtin University Postgraduate Scholarship and a Wound Management Cooperative Research Centre (CRC) PhD stipend. The School of Nursing, Midwifery and Paramedicine, Curtin University and the Silver Chain Group, Western Australia are participants in the Wound Management Innovation CRC. No conflict of interest exists among the authors.

Perineal protection.

Perineal tearing in childbirth is common and can have a considerable impact on women. There are various hands-on techniques that midwives use routinely to protect the perineum but not all of them are evidence based. Despite this, midwives often feel that they are the determining factor in whether a woman tears or not. Furthermore, women are rarely asked permission before hands-on techniques are used. This article explores some of the techniques used to prevent perineal tears, looks at the evidence base and invites the reader to reflect on their own practice and thinking around perineal protection.

A day in the life of a specialist perineal care clinic.

The specialist perineal care clinic has been running at Rotherham NHS Foundation Trust for over three years. This article tells of a quest to further improve perineal care for women in our care and demonstrates the process from conception to birth of the clinic, as well as the journey taken in order for this service to be set up and run efficiently. Prior to this clinic most women saw different people throughout their care, which was obviously confusing for them, as conflicting advice could be on offer. This clinic has provided consistency and continuity which has improved women's experiences and, in turn, yielded improved outcomes. It has empowered the women to further play a part in their own care from antenatal methods of reducing the chance of perineal trauma to postnatal recovery after perineal breakdown and infection. Both women and staff have benefited from this service as there is always a central point of contact.

The effect of "hands on" techniques on obstetric perineal laceration: A structured review of the literature.

OBJECTIVE: The purpose of this structured review was to review current evidence of "hands on" and "hands off" techniques as it relates to rates of perineal laceration in order to provide direction for future research in this important area of midwifery practice. METHOD: A structured literature search using all identified keywords and index terms was undertaken in MEDLINE, EMBASE Joanna Briggs Institute, CINAHL, TRIP, and OVID nursing database. FINDINGS: A total of 24 papers were identified from the initial searches as potentially relevant to the review questions. Of these a total of nine papers were considered relevant for this review. These nine included one systematic review with meta-analysis, four randomised controlled trials (RCTs), one quasi-experimental study and three cohort studies. CONCLUSION: "Hands on" techniques have been traditionally used but not been well defined in the literature, therefore it is currently unclear as to whether or not "hands on" technique can reduce perineal laceration. More studies are required to test the effectiveness of a standardised "hands on" technique and also to determine what part other factors such as maternal position, visualisation and use of water might play in perineal laceration rates.

The knowledge, practice and opinion of midwives' in the UK on their training in obstetric perineal repair.

PURPOSE: To investigate the knowledge and practice of perineal repair by midwives' in the UK, as well as their perception of the adequacy of their training. METHODS: An anonymous structured questionnaire survey was conducted. Standard statistical comparative analysis was performed between groups. Significant differences were quantified by calculating odds ratios and 95% confidence intervals. P < 0.05 was considered significant. RESULTS: Analysis of 592 responses revealed that midwives who believed that they had adequate training were ten times more likely to report that they have an adequate knowledge of pelvic floor anatomy (OR 9.8, 95% CI 6.4-14.9, P < 0.001), six times more likely to be aware of recommended techniques of perineal repair (OR 6.1, 95% CI 3.8-9.7, P < 0.001) and 16 times more likely to feel competent to perform a repair (OR 16.1, 95% CI 9.3-27.2, P < 0.001). Midwives who had formal hands-on perineal repair training were four times more likely to report that they have an adequate knowledge of pelvic floor anatomy (OR 4.1, 95% CI 2.8-5.8, P < 0.001) and four times more likely to feel competent enough to perform a repair (OR 3.6 95% CI 2.4-4.9, P < 0.001). CONCLUSION: The majority of midwives in the study sample report that they were unable to identify key perineal anatomy and believed that their pre-qualification training on perineal repair was inadequate. They also believed that midwives should routinely repair simple second-degree perineal tears.

Skin tears: achieving positive clinical and financial outcomes.

Skin tears are one of the most common wounds found among frail, older individuals, and are considered to be largely preventable. Skin tears occur frequently in those with fragile skin, in neonates and the elderly; particularly those with comorbidities affecting their balance, e.g. postural hypotension, motor neurone disease, diabetes and cerebral vascular accident (CVA). Those taking oral medications including steroids and anticoagulants are also at risk of developing skin tears. The increase in the population of older people is likely to produce a concurrent rise in the number of skin tears. Health professionals and health care assistants have a significant role to play in skin tear prevention, assessment and management.