Wound management: Skin Tear Pack Study

The original concept for the skin tear pack came through the collaboration of the Sentry Medical Team with Key Opinion Leaders in aged care and wound management:

• Chloe Jansz (Nurse Practitioner from Healthcare United)
• Annette Ross (Executive Director Quality of Royal Freemasons)
• Prof Sonja Cleary from RMIT.
   

There are various products in place at present in the aged care sector to manage skin tears. Currently, these options require the skilled nurse to use an aseptic technique and a combination of various products, as well as a dressing pack to address the complexity of the aging skin.

This research project evaluated the introduction of a Skin Tear Wound Management Pack (STWMP) which included all key elements for skin tear wound management within its content, previously found separate in practice. Each STWMP had two sides to its packaging, one side to advise the “user” registered/enrolled nurse (not specialised in wound care) or non-regulated worker the steps on how to use the content. The other side is a pictorial diagram of the International Skin Tear Advisory Panel (ISTAP) classification, so the “user” can look at the skin tear in front of them and determine if it is an appropriate skin tear to dress as a first response or alternatively escalate concern to a registered nurse or wound care specialist.

The correct dressing choice is required that addresses coagulation status, infection risk, wound product wastage, pain and quality of life management for the resident. Sussman and Ryan’s (2019, p.11) statement to the Royal Commission into Aged Care Quality and Safety Royal Commission on behalf Wounds Australia (2019) identified “The major risks of the use of inappropriate dressings are delayed healing, wound deterioration, potential infection, pain and stress to the consumer. The impact on cost of treatment of using inappropriate products is significant.”

The primary aim of the eight-week project across four sites was to evaluate implementation of a STWMP in which any healthcare worker could apply the correct regime, decreasing the risk of progression of a skin tear to a chronic or complex wound.

The results showed a reduction in skin tear healing time, reduction in staff time and a more accurate classification of the correct type of wound. In addition it highlighted some design features and the impact of pre education and socialisation of the STWMP in practice.

The overall outcome of the study demonstrated that STWMP was used in preference to regular practice, saving nurses time, facility costs and empowering the unregulated healthcare workers to maintain residents’ safety and prevent infection. The STWMP promotes best and early practice for all residents’ skin in a multidisciplinary team that had a resident-centred approach.

Reference: Skin Tears in an Aging Population: Workforce Empowerment — evaluation of a first responder skin tear wound management pack. Authors: Jansz, C., Ross, A. & Cleary, S. January 2022

Features and Benefits

FEATURE	BENEFIT
Ideal for First response	Designed for any health care worker to apply. Ensures the correct regime can be easily followed, to decrease the risk of progression of a skin tear to a chronic or complex wound.
Suitable for all levels of knowledge	The pack is designed to guide even the most novice health care worker to provide the correct regime for classifying and treating skin tears.
Conveniently packaged	All of the essential items are available in a conveniently preassembled pack, saving time, money and ensuring compliance to the ISTAP’s best practice recommendations.
Efficient documentation	The packaging incorporates an easy to follow and comprehensive documentation check list, to ensure all of the necessary details are captured for optimal patient care.
ISTAP compliant	The pack is designed around ISTAP’s 2018 Best Practice Recommendations for The Prevention And Management Of Skin Tears In Aged Skin, which is an internationally recognised document.
Backed with scientific research	The research results showed a reduction in skin tear healing time, therefore an increased rate of healing, reduction in staff time, all creating a reduction in the burden of disease that skin tears have in the aged care sector.

Areas of use

AREA
Aged care	Specifically designed and researched within aged care, where the majority of patients who are high risk, reside. Suitable for use by any heath care worker, ensuring aged care residents can get the treatment they require without having to wait for a more senior clinician.
Primary Care/ Community care	The preassembled pack can be used in primary care facilities and the community. The convenience of the pack allows for swift and efficient treatment, without the need for finding multiple separate items. The documentation allows for comprehensive communication between health care facilities and allied health professionals regarding the injury.
Respite Facilities	A convenient preassembled pack, which can be used by any health care worker or personal care assistant. The pack will provide all of the necessary instructions to classify the wound, and provide treatment without having to wait for a more senior/ qualified health care professional to provide treatment.
Ambulance/ Patient transport	Easy to use, preassembled pack, which is space efficient and can be conveniently stored and accessed, without having to look for multiple items to treat an injury.
General medical wards	General medical wards typically contain the largest proportion of aged care patients in the hospital. The pack ensures the ISTAP guidelines for classification and management are met in a convenient and efficient manner.

FAQs

QUESTION	RESPONSE
Who was involved in the research study involving the development of the skin tear pack?	Chloe Jansz, the director of HealthCare United community nursing and Nurse Practitioner designed the pack. Royal Freemasons participated in the research trial and studies (Supported by Annette Ross Executive Director Quality) and Prof Sonja Cleary from RMIT contributed and supported the studies research and university backing. Sentry Medical provided complimentary packs for the research component of the study, but was not actively involved in the research, making this an independent body of research, without a financial conflict of interest.
What is next for the skin tear pack?	The quantitative aspect of the study is complete, but a qualitative aspect of the study is due to commence, which will take into account health care works preferences and perceptions of the pack, which will help us to further refine and understand skin tear classification, management and healing times.
Where is the skin tear pack research published?	The study is published in the European Wound Management Association’s (EWMA) Journal of Wound Management, July 2022 edition, which is a special edition focused on skin tear research, in collaboration with ISTAP.

References

1. LeBlanc K, Campbell K, Beeckman D, Dunk A, Harley C, Hevia H, et al. Best practice recommendations for the prevention and management of skin tears in aged skin. United Kingdom: Wounds International; 2018.
2. Rando T. Simplifying wound dressing selection for residential aged care. Journal of Wound Care. 2018;27(8):7.
3. Sussman G, Ryan H. EXHIBIT 6-30 - WIT.0257.0001.0001 - Witness statement of Professor Geoff Sussman and Ms Hayley Ryan. In: Royal Commission into Aged Care Quality and Safety, editor. Canberra: Commonwealth of Australia 2021; 2019. Retrieved from: https://agedcare.royalcommission.gov.au/media/11741
4. European Wound Management Association’s (EWMA) Journal of Wound Management, July 2022 edition.

Image credit: ©stock.adobe.com/au/AlexRaths