SCIENCE, PRACTICE AND EDUCATION of the respondents (69.6%, n =695) reported prob- lems with the current methods for the assessment and documentation. Ninety percent supported develop- ing a simplified tool for assessment. 19 A systematic review of STs by Strazzieri-Pulido et al. (2015) 13 found an estimated global prevalence between 3.3% and 22% in acute care settings and 5.5% and 19.5% in home care settings. 2,13 Studies out of Brazil found a 12.2% ST prevalence, 2 with a range of 3.3–22% in hospitalised adults. 2,13 Austral- ian prevalence studies of hospitalised patients ranged from 8.1%–8.9%. 15,16 The 10-year analysis of ST prevalence by Miles et al. (2021) 16 found 60.7% of reported STs were hospital-acquired, 38.7% of pa- tients had multiple STs and 84.8% of patients with STs were 70 years of age or older. 16 The development of a ST definition by the Interna- tional Skin Tear Advisory Panel (ISTAP) has been instrumental in establishing a consensus of what actu- ally constitutes an ST. An updated definition of STs has been defined as ‘traumatic wounds caused by me- chanical forces, including [the] removal of adhesives. Severity may vary by depth (not extending through the subcutaneous layer). 20,21 This was expanded from an earlier definition of STs which read ‘…a wound caused by sheer, friction and/or blunt force trauma resulting in the separation of skin layers. A[n] ST can be partial thickness (separation of the epidermis from the dermis) or full thickness (separation of both the epidermis and the dermis from the underlying structures)’. 22 In October 2018, wound committee members (Table 1.) of an orthopaedic specialty, Magnet-designated hospital in Boston, Massachusetts discussed the is- sue of STs in their surgical orthopaedic population and the lack of standardisation in their assessment, documentation and treatment among nurses and medical staff. STs occurring on patients that were both present on admission or sustained during the hospital stay were being assessed, documented and treated in a non-standardised fashion by nursing and medical staff. There was no consistency or common language used in classifying or documenting STs. Treatments used were not evidence-based, and STs were not being routinely identified or documented. Treatment was left up to the individual nurse or li- censed independent practitioner (LIP) as to what products to use and how to manage skin repair. To establish standardisation of the above-stated issues, it was decided to create an evidence-based practice protocol. The nursing research committee had previ- ously adopted The Iowa Model Revised (see Figure 1.) as the guiding framework for projects; therefore, the wound care team chose to use this as their guid- ing model as well. Purpose/Process The purposes of this evidence-based practice (EBP) project were: 1) to find a classification tool to imple- ment standardised assessment and documentation of STs, both present on admission and those that develop during hospitalisation; 2) to review the litera- ture to find the best practices for treatment protocols; and 3) to develop and implement a treatment algo- Table 1: Wound Care Team Specialty Number of Members Administration 1 Nursing 10 Nurse Manager 1* Nurse Practitioner/Hospitalist 1 Nursing Co-ordinator 1 Nutritionist 1 Quality Control Nurse 1* * Co-Chairs. Wound Care Team Member Numbers Wound Care Certified 8 1 JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION 120
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