Avoid Skin Tears with Proper Wound Care

Skin tears are traumatic wounds that result from a separation of the two major layers of the human skin, the epidermis and the dermis. These can become chronic wounds if they are not treated appropriately. The elderly are at a higher risk for skin tears due to the fragility of the aging skin, flattening of the basal cell layer and impaired circulation. Before initiating any treatment, the first step is to assess the wound, skin flap, or pedicle and determine the type or category of skin tear using a validated documentation system. Specialty wound EMRs can improve the accuracy and standardization of wound assessments and documentation.

Common causes of skin tears include falls, applying or removing stockings mainly over tibial areas and ankles, improper patient handling, removal of tape or dressings too often, blunt trauma, and equipment injuries. Key principles for management include assessment and documentation of the wound, wound classification using a recognized tool, management using an appropriate dressing, and thus prevention of further trauma.

The documented skin conditions help track the progress in the healing process and provide appropriate treatment. With thorough records, any practitioner picking up a patient’s notes will know when the wound was last checked, how it looked and what dressing and/or treatment was applied, ensuring continuity of care.

Initial Assessment

The initial assessment should include a comprehensive assessment of the patient and his/her wound. It is important to determine the patient’s age and medical history, any underlying co-morbidities, general health status and potential for wound healing. Nurses should also make sure to document the degree of tissue loss, skin or flap color, surrounding skin condition (swelling, discoloration or bruising), and signs and symptoms of infection.

The Right Dressing Type is Crucial

Choosing the proper dressing is the important part of wound care because it affects wound healing. The best standard dressing for a skin tear depends on the assessment outcomes and goals of care, type of tear, skin fragility, and other patient factors. An ideal dressing for skin tear application should provide a protective anti-shear barrier and optimize the physiological healing environment. While hydrogel dressings promote pain relief and a moist wound bed, antimicrobial dressings aid infection control. It is recommended to avoid tape whenever possible, as it may tear the skin on removal. An adhesive remover can be used to prevent this.

Improved Documentation with EMR

Use of an objective documentation system such as wound EMR may help alert clinicians to subtle wound changes that require aggressive treatment, thereby avoiding emergency room visits and hospital admissions. Proper documentation provides guidance for appropriate management decisions, evaluation of the healing process, and support for reimbursement claims and defense for litigation. Designed with a Nursing Module and a Physician Module with Outcome reporting, this software allows managing all levels of wound management as well as treatment based wound improvement documentation.