Wesleyhaven Village - Skin Integrity

As we age our skin becomes more fragile, thin and dry which increases our potential risk for injury. Skin tears are a common skin related injury affecting the frail elderly population with causal factors including; falls, shear, friction, bumps, knocks, manual handling, equipment and the environment. While skin tears can be minor, others can result in complex wounds and without proper treatment can lead to infection. Many skin tears can be prevented by maintaining skin integrity, following good skin care regimes and identifying and addressing the associated risk factors. It is also important for Residential Aged Care Facilities to have a comprehensive skin tear assessment process in place to monitor residents with skin tears to promote faster healing and prevent further complications.

Wesleyhaven Village has been home for over 7,000 residents since 1952 and comprises of independent living villas, respite care, rest home care and hospital level care all on the one site providing a “continuum of aged care”. Located in Naenae, Lower Hutt in the picturesque north island of New Zealand, Wesleyhaven a not for profit organisation is today home to over 120 residents. Wesleyhaven Village have participated in the QPS Benchmarking Program since 1^st of October 2006 and have recently been successful in maintaining nil skin tears in both their rest home and hospital. Colette Sweeney, Quality Coordinator Wesleyhaven has shared the skin tear prevention strategies they implemented to achieve this positive outcome.

Skin Tear Reporting Process - Open Disclosure & Staff Awareness:

Skin tears are recorded using our incident/accident reporting system which incorporates a section on cause/reason for skin tears and what we can do differently to prevent re-occurrence. All resident incidents/accidents are reported to families for open disclosure and overall responsibility. Skin tears are also discussed in our clinical meetings and if our KPI’s are not met of “no more than 0-2 skin tears per resident per month”, an action plan is developed by our clinical team.

An article on hydration and how this can aid in reducing skin tears kicked off our interest in the use of this strategy and the investigation into other skin tear preventative measures. In addition to focusing on hydration as a key strategy, we provided education around keeping nails short, wearing appropriate rings and regular moisturising of resident’s skin twice daily. These strategies were also displayed in staff rooms.

HCA Alaire Saaiman completing the daily skin care regime for Wesleyhaven Village residents. Skin hydration was a key strategy that aided in preventing skin tears and kicked off Wesleyhaven Village’s investigation into other skin tear preventative measures.

We also provided additional daily short education/discussion sessions to increase staff awareness and encourage communication in regards to skin tears and prevention strategies. These brief education sessions are incorporated into our afternoon handovers and this time has proven to offer valuable information that is making quite a difference. Our education sessions allow us time to review our skin tear statistics and strategies on a regular basis. This gives us the opportunity to constantly remind staff of our focus for the month/week or on-going.

Skin Tear Prevention Strategies:

Our focus has been on the following key strategies;

• Ensuring our residents skin is moisturised at least daily, twice daily for those who need it,
• Keeping nails short and clean,
• Our policy states that only wedding rings can be worn and we have good adherence to this,
• Slippery Sams are used to move residents when in bed and in their chair and
• A focus on being extra careful when using hoists has also added to our improvement.

Reaching our Goal & Wider Benefits:

Our Rest Home has noted a downward trend in skin tears since March 2015 and nil skin tears have been sustained by residents over the past 6 months. We have also noted similar improvements in our Hospital with skin tears decreasing since June 2015 and nil skin tears have occurred over the past quarter.

Figure 1: Skin Tears - General - Trend Graph

The above strategies have aided Wesleyhaven Village in reaching our goal of nil skin tears and these results have been shared with staff, strategies continue to be displayed in the staff rooms, discussed at team meetings and at handovers. Our focus on skin integrity has also had a positive impact on other clinical outcomes with skin infections significantly reducing over the past 2 quarters in the Rest Home, and the overall result is now performing well below the QPS Industry Benchmark. In the hospital pressure injuries have improved over a 12 month period resulting in nil pressure injuries acquired by residents this last reporting quarter.

Wesleyhaven Village’s new marketing ad “Wesleyhaven … so hot right now” illuminates the village’s fun, relaxed and friendly atmosphere.

 *Appropriate consent has been provided to publish the photographs.