Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Chan YK(1), Chan NH(1), Yuen WH(1), Chan CH(1), Lam MS(2), Ada C(3), Chung WY(1), Wong MY(1), Li YS(4)
Affiliation :
(1) Department of Medicine and Geriatrics, POH,(2)Nursing Services Division, NTWC, (3)Quality and Safety Division, NTWC, (4)Wound Team, NTWC
Introduction :
Skin tears in elderly patients with fragile skin is a potential risk in M&G wards. It is a wound caused by shear, friction, and/or blunt force resulting in separation of skin layers. Skin tears were occasionally reported in POH M&G wards but often went overlooked or under-reported. Staff knowledge gaps regarding prevention and management of skin tears were noted. Without proper care, skin tears can worsen into chronic wounds causing pain, infection, and delayed healing, diminishing patient quality of life. This also increases medical costs and hospital stays. To promote a comprehensive management on skin tears, a “Skin tears prevention and management program” was developed in POH M&G department.
Objectives :
The program aims to standardize skin tear prevention and management, as well as enhance staff awareness and knowledge about skin tear risk assessment, preventive measures, and post-injury management.
Methodology :
The program had been implemented in eight M&G wards of POH in October 2021. A multidisciplinary team was assembled, comprising doctors, nurses, physiotherapists, occupational therapists, and dietitians. A working group was formed to develop the "Workflow of skin tears Prevention and Management" outlining admission screening criteria to identify high risk patients, preventive measures, immediate wound care, and post injury management. Patients who have had a skin tear within the last 90 days or age ≥ 80 years old, have fragile skin/ exhibit aggressive behavior/require physical restraint will be eligible for the program. Preventive measures would be implemented in accordance with the workflow such as alert signage, moisturizer use, gentle handling, restraint avoidance, use of non-adhesive tape etc. A “skin tear first aid kit” and "cue card" were designed to help nurses treat skin tears in proper and effective ways. Training sessions for both nurses and supporting staff in 8 M&G wards were organized to enhance their knowledge and skill on handling of such condition.
Result & Outcome :
A total of 2,979 patients across the 8 M&G wards were enrolled in the skin tear prevention program between 2022 and 2023. The reported incidence of skin tears decreased by 40%. No skin tears were reported as a result of staff and environmental factors such as the use of adhesive tape and restraints, as well as procedure-related causes including turning and transfer in 2023. 68% of reported skin tears were attributed to uncontrollable patient factors such as underlying fragile skin conditions, which included edema and dry itchy skin. Staff were reinforced to adhere to the workflow. Over 60% of skin tear wounds fully healed during hospitalization. Remaining 40% were appropriately referred for community follow-up according to the workflow. A staff survey of 100 nurses and 50 supporting staff with positive feedback were received. They expressed enhanced alertness to high-risk patients and confidence in the identification and management of skin tears. The program improved skin tear prevention and management in our clinical practice. Timely wound management significantly reduced complications and accelerated healing, which benefits the patient. By following the program, staff awareness and knowledge of skin tear management were enhanced. Ongoing implementation and monitoring of the program continue within POH M&G department.
