SCIENCE, PRACTICE AND EDUCATION DOI: 10.35279/jowm2022.23.02.06 Using the Iowa Model of Evidence-Based Practice to guide development of a skin tear management protocol Christine A.F. Bell , PhD, Rn, New England Baptist Hospital, Boston, Massachusetts Authored on behalf of the Wound Care team of New England Baptist Hospital Correspondence: cabell@nebh.org · Conflict of interest: None Keywords: Clinical practice, evidence-based practice, Iowa model, International Skin Tear Advisory Panel, skin tears, standardisation ABSTRACT This paper describes the process a wound care team used to develop a protocol to standardise the care of skin tears in an orthopaedic specialty hospital. The aims of the project were to: 1) find a classi- fication tool to implement standardisation and 2) develop and implement a treatment algorithm and guidelines according to current evidence. or knee arthroplasty by 2030. 6 Total shoulder arthro- plasty (TSA) surgery continues to increase, with more than 800,000 patients currently living in the U.S. 9 Spine surgery statistics are difficult to assess, due to the number of differing surgical interventions, but by all projections will continue to increase. 10,11 Com- mon risk factors for elective orthopaedic surgeries include: advanced age, degenerative disease, limited function and female sex. 1–3,10 A protocol and algorithm were developed to deal with skin tears in a standardised format. Knowledge increased 36% after an educational intervention tar- geting skin tear aetiology and implementation of the newly developed protocol. INTRODUCTION Orthopaedic patients undergoing elective surgeries are at high risk for skin tears (ST) due to risk fac- tors such as immobility, surgical positioning, length of surgery, medical device use and anticoagulation agents that often affect the skin. 1,2 Total joint ar- throplasty (TJA) and many spinal surgeries are con- sidered to be an elective orthopaedic surgery. Trends for TJA surgery are projected to continue to rise as the population ages and the desire for continued mo- bility pushes demand. 3–8 More than 1 million TJA surgeries are performed annually in the United States (U.S.), with projected increases of up to 4 million an- nually by 2030. Within the U.S., there is a projection of 11 million citizens who will be living with a hip The literature has reported ST prevalence rates equal to or greater than pressure injuries, yet standardisa- tions of assessment, treatment and documentation are often lacking. 1 STs have been found on patients of all medical specialties and ages, but the population aged 60 years and above presented with more than those under 60 years of age. 1,12–1 4 Skin tears can become chronic issues causing debilitation, pain and decreased quality of life. 1,13–18 Background Skin tears are common and occur at least as often as pressure injuries but are not treated with the same attention. 18 An international study exploring current practices in the assessment, prevention and treatment of STs resulted in new knowledge regarding nurses’ perceptions of their challenges in caring for patients experiencing STs. Sixteen countries and 1127 health care providers (HCP) responded. Registered nurses made up 77.4% of the respondents, and advance practice nurses an additional 9.7%. Seventy percent 119 JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION
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