Nambucca Valley Care’s Successful Skin Tear Initiative

Nambucca Valley Care (NVC) - Autumn Lodge has successfully integrated proactive systems and reduced the amount and complexity of skin tears over the past year by 59% and achieved a 66% reduction in skin tears over the quarter alone. This initiative was implemented at Autumn Lodge from an organisation perspective and following the success at Autumn Lodge was rolled out to NVC’s other three homes.

Figure 1: Skin Tears (General) - Yearly Trend Graph

It is well documented and known that skin in the aged is thinner, frailer, dryer and when damaged takes longer to heal. Skin integrity at Nambucca Valley Care (NVC) Autumn Lodge is no different and poses a significant reduction to resident’s quality of life. Without good skin integrity being maintained there is an increased risk of pressure ulcers, skin tears, infections associated with pain, reduced mobility and increased health care costs such as admission to hospital and wound dressings. Maintaining skin integrity and preventing skin tears was highlighted as a priority area for NVC Autumn Lodge High care as a pilot site to be rolled out to our other three homes.

A multifaceted approach was developed at Autumn Lodge to reduce skin tears over the short, medium and longer term to ensure the new established practices and improvements are embedded into every day practice. The first step was to highlight the current issue by gauging the current resident population’s skin integrity. This was done by assessing each resident individually within a very short time frame to ensure we had accurate baseline data so that we could identify any improvements upon reassessment. A multidisciplinary team approach was used with the formation of a skin care action group, who meet monthly to develop and implement strategies.

Any resident highlighted as at risk who had existing skin conditions, nutrition, swallowing, balance or mobility problems were referred to the appropriate interdisciplinary expertise. For example, podiatry, nutrition, nursing, speech, medical, physiotherapy for immediate intervention and a management plan.

The team education session

For the medium term several strategies were utilised such as development of posters, education was given in small groups, individually via face to face and eLearning. All Registered Nurses and Enrolled Nurses were directed as part of mandatory training to complete six wound management modules through eLearning. These modules provided online interactive training consisting of the fundamentals of skin and wound anatomy including assessments, through to pressure injuries, skin tears, and leg and foot ulcers. Additional to this a large number of staff attended a Medicare Local education presentation at Coffs Harbour and Kempsey, this included education and advice of what type of moisturiser is most effective and why.

The next step was reviewing the current products - including wound dressings, soaps and moisturisers. This enabled NVC to ensure we were using the best soaps and moisturisers for maintaining optimal skin integrity for the aged including pH balanced skin products. A moisturiser trial of two new products was undertaken for a three month period. The first product used caused some residents to have skin reactions, so this product was ceased. The next trial was focused on the residents who had previous skin irritation to ensure this did not reoccur. After the trial period skin assessments were redone and the results reviewed at the action group.

The decision was made to introduce the new moisturiser for all rooms within Autumn Lodge to ensure staff had good access to the moisturiser to encourage usage. More education was given at staff meetings highlighting the benefits and ensuring moisterisers were used as a twice a day minimum.

An equipment review was also undertaken where additional items used specifically for pressure relieving were purchased such as more air mattresses, Roho cushions and new gel chairs. Our Occupational Therapist and Physiotherapist took on the portfolio of being responsible of distribution, monitoring usage and educating of staff on correct usage of the equipment.  To ensure this reduction of skin tears is embedded into daily practice skin tears are continually monitored, accessed and reduced, the improvements made have now been integrated into the three other homes at NVC. 

Reviewing the current products to ensure optimal skin integrity

Skin integrity is the primary barrier for all people to reduce the risk of skin tears, wounds and infections; it is imperative Aged Care Organisations give good skin care to frail and aged skin. This requires having an evidenced based set of procedures and systems embedded into daily practice. To reduce skin tears a holistic approach was taken by NVC to maintain good skin integrity. Nambucca Valley Care focused on reducing skin tears by using a multidisciplinary team, educating staff, utilising appropriate equipment and trialing new products to achieve optimal results. As shown by our reduction in skin tears this approach has enhanced our practices and systems, and improved our resident’s quality of life.

Andrew Bailey, Facility Manager; Autumn Lodge Village