SCIENCE, PRACTICE AND EDUCATION Figure 1: The International Skin Tear Advisory Panel’s classification system Type 1: No skin loss Type 2: Skin tear with partial flap Type 3: Skin tear with total flap loss Linear or flap tear which can be repositoned to cover the wound bed. Partial loss which cannot be repositioned to cover the wound bed. Total flap loss exposing entire wound bed. tears can occur for a number of reasons, including: getting up during the night, low lighting, not having the appropriate mobility aid, changing environment from home to care, other people causing the fall, decreased muscle tone, altered gait or decreased range of ankle motion. 2 Skin tears were once classified in stages; more recently, based on ISTAP’s classification system1, the stages have been simplified to aid in the assessment of a skin tear into three distinct types (Figure 1). Applying these types enables the care provider to categorise the skin tear correctly, in a timely manner and to apply the appropriate treatment. 2 Early assess- ment and intervention reduces the risk of infection and the potential for continuation into a complex chronic wound. 3 Early prevention and treatment Early prevention and treatment of skin tears is multi- factorial and centred around three key concepts: skin care, skin tear education for staff and skin tear wound assessment and management. 2,3 Skin care relates to decreasing the risk of skin tears, which may occur when completing tasks such as personal care needs and meal assistance. 4 Skin tear education is centred around staff members being provided education on skin care and their being able to recognise residents who may be at potential or actual risk of a skin tear. 5–7 All of these concepts should be evident in policies and procedures, particularly within an aged care facility where there is an increased risk of skin tears occurring. However, implementation of the correct assessment and management of a skin tear, in a timely manner, as reflected in these policies can be impacted by available resources, particularly the nursing workforce. Personal care attendants, more commonly referred to as ‘unregulated workers’, are now the predominant workforce in the aged care sector in Australia, where this study was conducted. This group of workers has not previously been empowered or educated either to assess or dress wounds. Instead, they are required to report to a nurse (a regulated worker), which can delay the assessment and management of wounds by hours, if not days, in some instances. A key considera- tion in skin tear management is prompt attention to reduce the chance of a skin tear becoming a chronic wound. 4 The economics of skin tears There is currently a deficit of suitable regulated staff resources to undertake the early prevention and management of skin tears; 3,4 this poses a great burden on already-stretched economic resources, particularly in the aged care sector. A study by Rando et al. 3 in 2018 estimated that the cost of managing a skin tear using a standard dressing approach of an antimicro- bial iodine gauze, non-adherent pad and adherent clear film, or a crepe bandage, was approximately $65.53 AUD (based on seven dressing changes), compared to the use of a hydro-responsive wound dressing, which was $28.21 AUD (based on four dressing changes). These costs were inclusive of both the nurses’ time and dressings required for the dura- tion of skin tear healing. 61 JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION
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