SCIENCE, PRACTICE AND EDUCATION More recently, Rayner et al. 8 examined the healing time and dressing costs of skins tears and found that cost variations are dependent on the presence of a haematoma under a skin tear flap. The cost of dress- ings alone for skin tears with a haematoma was esti- mated at $21.19 AUD, versus $13.68 AUD without a haematoma; this estimation did not include labour costs. This is important to consider, as haematomas are a common complication of skin tears. 4 To meet the escalating demands and increasing costs in the aged care sector, there has been a move to change the skill mix of staff, favouring lower-cost unregulated healthcare workers. 13 This change has been compounded by the COVID-19 pandemic in Australia 9 The reality of these changes has had a number of consequences, including a timely first aid response when a skin tear occurs. Existing evidence suggests that, if skin tears are inappropri- ately dressed or left untreated, it can result in a chronic wound or infection. 2 Therefore, it was identified that there was an urgent need to seek a solution that empowers unregulated healthcare work- ers, as they are often the first person to encounter a skin tear, so that they may act in a ‘first response assessor’ role to initiate management within the first 72 hours of the skin tear occurring. Various products are used in the aged care sector to manage skin tears. This project is the first step in an implementation study that evaluated the in- troduction of a first responder Skin Tear Wound Management Pack (STWMP), to upskill the unregu- lated workers in the aged care sector with a view to improving healing rates. This article presents the results of the implementation of the STWMP in four aged care facilities in Australia. Aim of the study Currently, all aged care facilities within the consor- tium where the authors are based have a skin care policy in place to inform the assessment and manage- ment of skin tears. Therefore, treatment of a resident with a skin tear would routinely occur as per the facilities’ existing skin tear guidelines, which were last updated in 2020. This project introduced a first re- sponder STWMP to identify the impact on outcomes across different aged care facility sites. The primary aim of the project was to implement a unified first response skin tear wound treatment protocol that any healthcare worker could apply promptly after a skin tear occurred. The intention was to prevent infection and the progression of a skin tear into a chronic or complex wound. METHOD The theoretical methodology that underpinned this project was implementation science 11 , the framework of which is based around the clarification of pathways or the integration of new practices into a clinical set- ting. 12 Such was the case for this study, which sought to embed best practices in terms of undertaking an Figure 2a: The science of implementation phases Impact of Dissemination (Knowledge Translation) Right Audience (Knowledge Target) Timing of implementation (Knowledge Fidelity) Knowledge Uptake Knowledge Assessment Knowledge Results The steps for implementing the evidenced-based management of skin tears are depicted in Figure 2b. Figure 2b: The science of implementation phases using the STWMP Impact of Dissemination (Knowledge Translation for un- regulated Health- care Staff) Right Audience (Unregulated healthcare staff) Timing of implementation (within hours of the skin tears) Knowledge Uptake (use of STWMP and documentation in the resident’s records Knowledge Assessment (evaluate the skin tear treatment) JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION Knowledge Results (to evaluate how successful the STWMP is compared to conventional methods) 62
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