evidence & practice / outer tissue

WOUNDS

Prevention and management

of skin tears in older people
McInulty L (2017) Prevention and management of skin tears in older people. Emergency Nurse. 25, 3, 32-39.
Date of submission: 1 January 2017; date of acceptance: 21 February 2017. doi: 10.7748/en.2017.e1687

Lorna McInulty Abstract

Senior lecturer in emergency Skin tears are frequently encountered in emergency and unscheduled care, and are prevalent
and unscheduled care, in older people. Patients may present soon after an acute skin tear, or at a later stage when the
University of Central wound presentation is different and there are complications. This article describes evidence-based
Lancashire School of Health recommendations and strategies for the prevention, assessment and management of skin tears,
Sciences, Preston, England discusses risk factors and explains when to refer patients for specialist management.

Correspondence Keywords
[email protected]; emergency nurse, pretibial lacerations, skin tears, wounds, wound dressings
[email protected]

Conflict of interest
None declared Aims and intended learning outcomes risk of these injuries because of general
The aim of this article is to describe the frailty, difficulty mobilising and falls. Skin
Peer review nature and management of skin tears, and tears in older people occur in the lower
This article has been subject outline best practice. After reading the article, limbs, particularly in the pretibial region,
to external double-blind and completing the time outs, you should the forearms and hands (Battersby 2009,
peer review and checked be able to: Clothier 2014). Other groups at risk of skin
for plagiarism using »» Describe the predisposing factors for skin tears. tears include people who are critically ill or
automated software »» Summarise prevention strategies. clinically compromised (NHS Education for
»» Describe the anatomy, physiology and Scotland (NES) 2015). These patients might
functions of the skin. also be older as increases in co-morbidities
»» Summarise the process of wound healing. and complex health problems are common
»» Understand potential complications in this population.
associated with skin tears. A range of co-morbidities increases the risk
»» Explain which dressings are appropriate for of skin tears, including chronic cardiovascular
managing skin tears. and renal disease (Stephen-Haynes and Carville
2011), and poor nutrition and hydration
Prevalence of skin tears (Clothier 2014), while chronic pulmonary
A skin tear is defined as ‘a wound caused by disorders (LeBlanc et al 2008) and suppressed
shear, friction and/or blunt forces, resulting immunity (NES 2015) are risk factors in all
in separation of skin layers’ (LeBlanc and patient groups.
Baranoski 2011). In emergency and urgent Accurate figures for prevalence of skin
care settings, skin tears are usually associated tears in the UK are not readily available, but
with older people, but they are not uncommon some researchers claim that many skin tears
in neonates and infants who have immature go unreported (Clothier 2014, All Wales
skin, and when the epidermis and dermis are Tissue Viability Forum 2015, Stephen-Haynes
not fully cohesive (Bianchi 2012). and Deeth 2016). It is reasonable to assume
Premature babies, neonates and infants that prevalence in the UK is comparable to
who require hospital care are particularly at similarly developed nations with growing
risk of skin trauma caused by invasive devices populations of older people, such as Australia
and the dressings and tapes used to secure and the US. One Australian study found a skin
them. These devices are generally placed tear prevalence of 8% to 11% in patients in
in and around the head and face, or in the public hospitals (Mulligan et al 2009), while
extremities. Therefore, these are the areas US figures, although more than ten years old
where skin tears are seen in this age group. (Baranoski 2005), suggest that 1.5 million
Paediatric risk factors differ from those older people a year sustain skin tears in care
associated with older people, who are at facilities for older people.

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Revalidation
Find out more at:
rcni.com/revalidation

A follow-up to the Australian study Prevention should start with early Online archive
(Mulligan et al 2011) suggested an overall identification of those at risk (Bianchi 2012). For related information,
visit emergencynurse.
4.3% increase in skin tears from the 2009 Many prevention strategies are simple and co.uk and search using
figures. There are more recent figures easily implemented but might be neglected the keywords
from small-scale US studies (LeBlanc and by older people. Therefore clinicians should
Baranoski 2011) and UK-based clinical audits advise them about potential hazards, including
(Stephen‑Haynes et al 2011), but these are trip hazards such as loose footwear, uneven
confined to care homes, and do not therefore carpets and scatter rugs.
illustrate the true extent of the problem. Areas of the home in which people
Skin tears are not uncommon across all age frequently move around should be clutter
groups, but development of chronic wounds free, for example the route from the living
is strongly related to increasing age (Morgan room to the kitchen and the bedroom to the
2015). Chronic wounds in this context are bathroom, and sharp-edged furniture should
loosely defined as acute wounds that fail to be padded. Clinicians must use moving and
heal within an expected timeframe. However, handling equipment properly to further
many skin tear wounds can, with appropriate protect patients.
management, be prevented or resolved. The Charities such as Age UK can visit people
rest of this article focuses on these aspects of at home to offer advice about practical falls
care in relation to older people. prevention, and some emergency departments
(EDs) have close links and easy referral systems
TIME OUT 1 to such organisations. Referral for people
Risk factors and causes of skin tears at risk can also be made to community falls
Thinking about older people, write a list of what you consider teams, which usually include an occupational
to be the risk factors and causes of skin tears. therapist and social worker who can
provide grab rails, properly fitting footwear
Risk factors and causes of skin tears and other aids.
Readily identifiable causes of skin tears There is increasing momentum in the
include traumatic removal of dressings or UK ambulance service to promote fall
surgical tape and blunt force trauma related prevention by encouraging paramedics to
to falls or wheelchair injuries (Hebert 2016). refer patients to falls teams to try to reduce
Clinicians should be aware of the need to injury and subsequent transfer to hospital
adhere to uniform policy, as long fingernails (Snooks et al 2014).
and inappropriate jewellery can also cause skin Paramedics, like district nurses, are well
tears (Stephen-Haynes and Carville 2011, All placed to risk assess patients’ homes, and in
Wales Tissue Viability Forum 2015). Not all some areas paramedics are formally included
causes are obvious. Putting on or removing in falls teams. Such falls prevention schemes
tights and stockings can put vulnerable skin help preserve patients’ independence and
at risk (Hebert 2016), and when activities dignity (Pyer et al 2015).
like these are undertaken by clinicians or
other carers, the risk is magnified. Prevention Anatomy and physiology
strategies, therefore, are important and Despite prevention strategies, skin tears still
preferable to cure. occur, and when assessing or managing these
Additional risk factors include being over 75, injuries it is important to understand the
being female, a history of previous skin tears, anatomy and physiology of the skin.
cognitive or sensory impairment including
from diabetes and dementia, visual impairment BOX 1. Skin tear prevention
(Clothier 2014), agitation, incontinence and
polypharmacy (Herbert 2016). »» Assess for risk on admission to healthcare services and whenever the patient’s condition changes.
»» Implement a systematic prevention protocol.
TIME OUT 2 »» Ensure those at risk wear long sleeves, long trousers or knee-high socks.
Prevention »» Provide shin guards/leg protectors for those who experience repeat skin tears on shins.
What can be done to prevent skin tears in community and »» Ensure safe patient handling techniques and equipment/environment.
hospital settings? »» Involve patents and families in prevention strategies.
»» Educate nursing staff and caregivers to ensure proper techniques for providing care without causing
skin tears.
Prevention »» Consult a dietician to ensure adequate nutrition and hydration.
Community and hospital healthcare »» Keep skin well lubricated by applying hypoallergenic moisturiser at least twice a day.
professionals can reduce the risk of skin tears »» Protect people at high risk of trauma from self-injury during routine care.
by taking the preventive actions listed in Box 1
(LeBlanc and Baranoski 2011)
(LeBlanc and Baranoski 2011).

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evidence & practice /outer tissue

TIME OUT 3 to shearing forces and friction. The epidermis

Skin anatomy and physiology has no blood supply, so receives oxygen and
Look at Figure 1 and try to label the layers and structures nutrients through diffusion from the capillaries
of the skin. The answers are shown opposite. in the dermis (Hogan-Quigley et al 2012).
The layers of epidermis closest to the
The skin consists of three layers, the epidermis, dermis receive most nutrition and the amount
the dermis and the subcutaneous layer, or they receive reduces the nearer the layers
hypodermis. The epidermis is roughly one are to the skin surface. The outermost layer
tenth of a millimetre thick, but consists of of the epidermis is the stratum corneum,
five individual layers. The innermost layer which is made up of dead cells. These cells
is the stratum basale and is attached to the are continuously shed in a process called
dermis by a basement membrane. In youth, desquamation, and new skin cells develop
this membrane is plump and healthy, but with from the dermis and push the epidermal layers
age it becomes flattened and has less resistance upwards. This is an ongoing process with skin
turnover taking approximately four weeks
(Colbert et al 2009), although this may be
Figure 1. Skin anatomy and physiology longer as people age (Hebert 2016).
The dermis is a form of connective tissue
17 Epidermal layers that contains important structures, including
nerve endings, blood and lymphatic vessels,
hair follicles and sweat glands. It is separated
5
from the epidermis by the basement membrane
4 whose composition decreases with age
16 3 (Hebert 2016). Collagen and elastin, which
provide the skin’s strength and elasticity,
19 2 also reduce with ageing (Stephen-Haynes
and Deeth 2016). There may be diminished
7 capillary blood flow and less oil produced by
1
the sebaceous glands, resulting in drier skin
(Stephen-Haynes and Carville 2011), and
falling oestrogen levels in older women also
18
15 affect skin integrity (Farage et al 2013). A
combination of these factors make the skin
11
6 vulnerable to friction and shearing.
13 14 The subcutaneous layers of skin consist
of fat and connective tissues. As the ageing
9 dermis loses its healthy properties, so too
8 does the subcutaneous layer, which becomes
12
10
thinner and less resistant to trauma. The
looser connection between the dermis and
subcutaneous layer means that bleeding
Figure 2. Comparison of older and younger skin is more difficult to control, therefore
large haematomas can develop (Figure 2).
Ultimately, the level of trauma necessary to
injure the skin is far less than that necessary
to injure younger, healthier skin.
Epidermis
TIME OUT 4
Haematoma
Areas of skin tears
Try to recall patients you have seen with skin tears. On what
area of the body did the patients sustain the injuries?
Haematoma Dermis
The dorsal aspects of the hands age more
rapidly, partly due to greater exposure to the
Subcutaneous damaging effects of the sun, and are more
Young skin fat layer
susceptible to loss of the fatty layers, so are
vulnerable to skin tears, alongside the forearms
Older skin and pretibial areas. Hebert (2016) suggests that
70% to 80% of skin tears occur on the hands

34 / June 2017 / volume 25 number 3 emergencynurse.co.uk

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and arms, and that most are sustained between Assessment of skin tears Answers to time out 3
6am and 11am, or 3pm and 9pm, when people Wound inspection and documentation should 1. Stratum basale
generally undertake more physical activity. include the following: 2. Stratum spinosum
»» Description of the anatomical site of 3. Stratum granulosum
TIME OUT 5 the wound. 4. Stratum lucidum
»» History of the mechanism of injury and time 5. Stratum corneum
Skin functions
6. Eccrine sweat gland
List the functions of the skin and explain why it is important the injury was sustained.
7. Sebaceous gland
for the skin to remain intact. »» Wound dimensions.
8. Hair follicle
»» The degree of viable compared to non-viable
9. Cutaneous vascular plexus
Functions of the skin tissue, including flap necrosis. 10. Adipose tissue (fat)
The skin has many important functions, »» Evidence and type of exudate, for example 11. Hair follicle receptor
including protection and sensation, immunity, haemoserous fluid or blood. 12. Pacinian corpuscle
vitamin D synthesis, temperature regulation, »» Presence of haematoma. 13. Sensory nerve fibre
excretion of water and urea, and supporting »» Condition of the surrounding skin, for 14. Hypodermis (subcutaneous
movement and growth through its elastic example swelling, maceration, induration layer)
properties. Therefore, it is important that or infection. 15. Reticular layer
it remains intact and, in cases of trauma, is »» Possibility of wound edge approximation. 16. Papillary layer
appropriately managed to encourage rapid Clinicians should take a holistic approach 17. Hair shaft
healing and recovery. (Clothier 2014), so should also undertake a 18. Arrector pili muscle
pain assessment using an appropriate scale 19. Meissner’s corpuscle
Appearance of skin tears (Stephen-Haynes and Deeth 2016), and the
Skin tears have characteristic appearances result should be recorded and acted on before
(Figure 3), and patients often present with working on the wound itself. Benbow (2016)
some skin loss, an obvious skin flap, or both. recommends wound photography as ‘an adjunct
There are two grades of skin tear, partial to documentation of assessment’, and states
thickness and full thickness (Stephen-Haynes that other factors, such as smoking, ageing,
and Deeth 2016), and the former results in nutrition, mobility and stress must also be taken
separation of the epidermis from the dermis, into account during assessment. The All Wales
while the latter results in separation of the Tissue Viability Forum (2015) considers an
epidermis and dermis from the underlying assessment incomplete if attention is not given
structures, such as tendon or bone. Visual to underlying disease processes, such as diabetes
inspection helps to determine this. and peripheral vascular disease, which may have
If patients present with a dressing in contributed to the injury, and which can affect
place, it is important to try to establish the the healing process.
direction of the flap so the dressing can be There are various skin tear classification
removed in the least traumatic way. Clinicians systems and it is good practice to use one.
should either document this information, or The most well-known validated systems are the
draw an arrow on the dressing to indicate Payne-Martin Classification (Payne and Martin
the direction of the flap, and the best way 1993) and the Skin Tear Classification System
to remove the dressing. (STAR) (Carville et al 2007).

Figure 3. Skin tear audit research (STAR) classification

Category 1a Category 1b Category 2a Category 2b Category 3

A skin tear where the edges can be A skin tear where the edges can be A skin tear where the edges A skin tear where the edges A skin tear where the skin flap
realigned to the normal anatomical realigned to the normal anatomical cannot be realigned to the normal cannot be realigned to the normal is completely absent.
position without undue stretching position without undue stretching anatomical position and the skin anatomical position and the
and the skin or flap colour is not and the skin or flap colour is pale, or flap colour is not pale, dusky skin or flap colour is pale, dusky
pale, dusky or darkened. dusky or darkened. or darkened. or darkened.

(Silver Chain Nursing Association and School of Nursing and Midwifery, Curtin University of Technology 2010)

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evidence & practice /outer tissue

The Payne-Martin system (Table 1) If this proves difficult, clinicians should

describes three categories of skin tear based attempt to rehydrate the skin, which makes the
on no tissue loss (category I), partial tissue flap more pliable. This can be done by placing
loss (category II), or complete tissue loss a moist, non-woven swab over the area for up
(category III), and categories I and II are to ten minutes (LeBlanc et al 2016).
subdivided. Patients with wounds assessed as full-
The STAR classification (Figure 3) has five thickness should be referred to a specialist
categories based on appearance. The main according to local policy, and practitioners
factors in assessment include the presence or should also consider referring patients with
absence of a flap, also known as a pedicle, significant bleeding or haematoma (Stephen-
colour of the skin and flap itself, and whether Haynes and Carville 2011).
or not the edges of the tear can be realigned.
The images in the STAR tool make this a more TIME OUT 7
practical and useful option, particularly for less Assessment tools
experienced practitioners, and it alludes to the Recall a patient with a skin tear who you have cared for.
desired outcomes for skin tears by including What, if any, assessment tool did you use and what were your
the possibility of anatomical realignment. specific treatment goals?
A more recent classification, produced
and validated by the International Skin The main aims of treatment are to preserve
Tear Advisory Panel (ISTAP) (LeBlanc et al the skin flap and protect the surrounding
2013a), appears to be a combination of the skin, promote healing and prevent infection.
main elements of the Payne-Martin and Wound healing by primary intention
STAR systems, although it does not refer to progresses through four stages – haemostasis,
the colour of the skin flap. The tool aims to inflammation, proliferation and maturation –
‘establish a simple and common language which are not necessarily sequential, but often
for describing and documenting (skin tears)’ overlap (Rogers and Jones 2016). This process
(LeBlanc et al 2016). Developed by experts occurs in simple wounds that do not involve
and researchers, this tool could, and perhaps tissue loss, but the process is different in
should, supersede the older ones. wounds with tissue loss, which heal by
secondary intention (Brown 2015). This article
Initial wound management does not expand further on wound healing.
The general principles of wound management
are the same as for other wounds, and include Wound management and
haemorrhage control, cleansing, gentle removal dressing choice
of haematoma and tetanus prophylaxis if Wound dressings should be appropriate for
required (Table 2). wound environments, and should promote the
healing process. Due to the fragility of the skin
TIME OUT 6 in this injury, sutures or surgical staples are
Tetanus generally precluded (LeBlanc and Baranoski
Which patients do you think would require tetanus 2011). Instead, an atraumatic wound dressing
vaccination and why? should be applied and left undisturbed for as
long as is practicable or desirable, based on the
It is important to approximate a skin tear and wound assessment and presence of exudate.
return it as closely as possible to its normal Dressings should be chosen for their ability
anatomical position. This can be achieved to maintain a moist environment and to
using a gloved finger, or a non-traumatic tool protect the surrounding skin (LeBlanc and
such as a cotton bud dampened in water or Baranoski 2016), but patient preference,
saline to prevent fragments of cotton adhering comfort and ease of removal are also
to the wound. important factors (Morgan 2015).

TABLE 1. Payne-Martin skin tear classification system

Category I: No tissue loss Ia) Linear type

Ib) Flap type

Category II: Partial tissue loss IIa) Scant tissue loss less than 25%
IIb) Moderate to large tissue loss over 25%

Category III: Skin tear with complete tissue loss

36 / June 2017 / volume 25 number 3 emergencynurse.co.uk

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Exudate can be heavier if the limb is TIME OUT 8 FURTHER RESOURCES
already oedematous, for example in patients Choosing appropriate dressings Edwards et al’s (2013)
with chronic heart failure, and a holistic Wound Dressing Guide
Think about the range of dressings available in your can be accessed at
assessment should determine whether workplace. Do you know their properties and how to select cms.qut.edu.
underlying disease processes are sufficiently an appropriate dressing? If possible, go online and consult au/__data/assets/
well controlled. Dusky or darkened skin Edwards et al’s (2013) comprehensive Wound Dressing pdf_file/0003/451767/
flaps suggest possible vascular compromise, Guide to extend your knowledge. Much of the information Book2-wound-dressing-
therefore a dressing change and reassessment about dressings described in this article is derived guide.pdf
should take place within 24 to 48 hours from this useful guide.
(Wounds UK 2012).
In terms of treatment options, an Alginate
international consensus statement, presented Alginate dressings, such as Kaltostat, are
by LeBlanc and Baranoski (2011) on behalf of manufactured from seaweed and contain
the ISTAP, suggests that research on adhesive properties that absorb significant amounts
strips, such as Steristrips, is outdated and is no of fluid through hydrophilic gel formation.
longer the treatment of choice. They are dry when applied to a wound and
The panel suggests using surgical glue for expand, becoming more gel-like as they draw
some minor skin tears, but emphasises that fluids in. This helps to clear out wounds,
all dressing choices are based on a thorough maintain a moist environment and, to an
wound assessment, and state that ‘best practice extent, protect them from bacteria, reducing
supports… the use of hydrogel, alginate, the risk of infection (Edwards et al 2013).
lipido-colloid-based mesh and foam dressings, These dressings are useful for exuding
soft silicone, foam, or non-adherent dressings, wounds, but not for dry or necrotic wounds.
applied depending on wound characteristics’. In addition, alginates usually possess
This is repeated in the most recent consensus haemostatic properties, because of the
work (LeBlanc et al 2016). calcium contained in the dressing, which
Other recent literature (Hebert 2016) helps blood coagulation (Joint Formulary
agrees with the range of dressings described Committee 2017).
above, but continues to advocate adhesive Edwards et al (2013) recommend using
strips, petroleum-based ointments and gauze alginates in infected wounds when antibiotic
as treatment options. While Hebert (2016) cover is in place. However, a secondary
provides a rationale for using most of the dressing might be required to hold the alginate
dressings she describes, there is no rationale in place and to absorb excess exudate. Foam
for the latter treatment options, which perhaps dressings, for example Lyofoam, are often
supports the consensus statement that they are used in combination with alginates because
not best practice. of their ability to absorb excess exudate,
Another recent UK report by experts provide additional protection to the injured
supports the international consensus statement area and conform to uneven body surfaces
(Stephen-Haynes and Deeth 2016). (Edwards et al 2013).

TABLE 2. Criteria for tetanus prophylaxis

Immunisation status Clean wound Tetanus-prone wound

Vaccine Human tetanus immunoglobulin

Fully immunised, ie has received a total None required Only if high risk
of five doses of vaccine at appropriate
intervals

Primary immunisation complete, None required unless next dose due soon and convenient to give now Only if high risk
boosters incomplete but up to date

Primary immunisation incomplete or A reinforcing dose of vaccine and further doses as required to complete the Yes: one dose of human tetanus
boosters not up to date recommended schedule to ensure future immunity immunoglobulin in a different site

Not immunised or immunisation status An immediate dose of vaccine followed, if records confirm the need, by completion Yes: one dose of human tetanus
not known or uncertain of a full five-dose course to ensure future immunity immunoglobulin in a different site

(Public Health England 2013)

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evidence & practice /outer tissue

Hydrogel In a clinical review of these dressings,

Hydrogel dressings, such as Derma-gel, are White et al (2011) explained their
designed to moisturise wounds and promote physiological effects on wound healing, and
autolytic debridement, that is to help the supported the notion of atraumatic removal.
wound separate naturally and shed devitalised
tissue from healthy tissue (Edwards et al 2015). Hydrocolloids
The dressing encourages the body’s enzymes to Finally, hydrocolloids such as Duoderm or
carry out this process. There are different types Granuflex are no longer recommended because
of hydrogels, including tubes of gel, gel sheets their adhesive can compromise fragile skin on
and gel-impregnated dressings. Gel sheets are removal (LeBlanc et al 2016). All dressings
suitable for flat wounds, such as skin tears. should promote moist wound healing as
They should not be combined with foam this provides favourable conditions for the
dressings, however, as the foam will absorb the pathophysiological processes of wound
gel (Edwards et al 2015), so are more suitable healing, and reduces pain by keeping nerve
for drier rather than heavily exuding wounds endings moist.
(LeBlanc et al 2016). They will still often Patients can present to an ED soon after
require a secondary dressing to secure them, sustaining an acute skin tear, or at a later
and can cause maceration of the surrounding stage when presentation might be different,
healthy skin, but this can be minimised by and complications, such as infection, might
using barrier cream on the surrounding area be present, so practitioners must understand
(Stephen-Haynes and Deeth 2016). the rationale for the various treatment
options. It is also extremely important,
Silicone when referring patients for continuing care,
Silicone dressings like Mepitel are suitable to specify the treatment used, the rationale
for skin tears as they provide a wound and recommended follow up, as not all
contact layer, but are atraumatic on removal clinicians are aware of best practice.
(Meuleneire and Rücknagel 2013). However,
clinicians must be aware that some dressings TIME OUT 9
only have a silicone border, which supports Best practice
adhesion to the skin, so the central portion of Think about the management of skin tears in your clinical
the dressing could adhere to the wound itself, environment. Does it reflect best evidence and, if not, how
leading to traumatic removal. could you influence this?
Silicone dressings can be used on infected
wounds, although appropriate antibiotic cover Complications
must be in place, and there is a variety of Infection is a potential complication of skin
presentations including foams, sheets and semi- tears, and having the least chance of infection
transparent films. is an important outcome for clinicians and
Sheet-type dressings do not have to be patients (Keeton et al 2015). If there is
trimmed to wound size and can lie safely on an infection, careful consideration should
healthy skin, which makes removal easier be given to whether topical or systemic
(Edwards et al 2013). These dressings are antibiotics are required, bearing in mind
reputedly cost-prohibitive, but if used correctly that indiscriminate use of antibiotics is not
they can be cost-effective (Anuerin Bevan recommended. However, infection is likely
University Health Board 2014), specifically to delay healing time and could progress to
in terms of reduced dressing change times, cellulitis or sepsis. Other complications include
number of dressings and pain management delayed healing if patients have oedema or
costs (Meuleneire and Rücknagel 2013). peripheral vascular disease.
Patient education is vital to help prevent
Lipido-colloid complications, and should include advice
Lipido-colloid dressings are newer to the about rest and exercise, limb elevation,
market, and combine lipido-colloid particles, analgesia, nutrition and smoking cessation.
either in a non-occlusive fine mesh or within Patients with skin tears are likely to
a foam dressing, and promote healing in a experience pain and poor mobility, which
moist environnent by encouraging fibroblast can compromise their quality of life and
proliferation and collagen production (Urgo potentially lead to physical and mental distress
Medical 2015). This type of product is (LeBlanc et al 2016).
supported by the National Institute for Health The management and experience of skin tears
and Care Excellence (2016) for chronic wound is under appreciated both in the literature and
management and non-healing acute wounds. in clinical practice, according to LeBlanc et al

38 / June 2017 / volume 25 number 3 emergencynurse.co.uk

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(2016), so to address these issues they, as of the risk factors, and should use patient Write for us
part of the ISTAP, developed a tool kit for the education and appropriate referral systems For information about
writing for RCNi
prevention, assessment and management of to reduce the prevalence, enhance the healing journals, contact
skin tears (LeBlanc et al 2013b). process and prevent complications. [email protected]
It is vitally important that clinicians
Conclusion understand the nature and rationale for For author guidelines,
Skin tears are prevalent in older people dressings used in skin tear management, go to rcni.com/
writeforus
and management can be adversely affected and keep up to date with best evidence from
by co‑existing medical conditions, such as experts in the field.
diabetes, infection and peripheral vascular
disease. It is better to try to prevent, rather TIME OUT 10
than cure, skin tears, because of the potential Reflection
pain and distress they can cause patients. Now that you have completed the article, you might like
All healthcare professionals should be aware to write a reflective account as part of your revalidation.

References

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Nursing Guide to Physical Examination and History Chatswood NSW.
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(2014) Wound Healing Products: Formulary Williams, Philadelphia PA. choices costing you money? Journal of Snooks H, Carter B, Dale J et al (2014) Support
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