Evidenced Based Skin Care…A Kaleidoscope of Data and Interventions

This topic is significant to wounds, continence and professional practice. Clinician knowledge and data triggers led to multi-faceted evidence-based skin integrity interventions. The purpose was to improve and standardize skin care provided for high risk, acute care patients. The practice innovations were challenged by education and buy-in of the staff, while trying to achieve tangible, positive fiscal outcomes for the organization. The objective was to impact improved skin integrity and reduce pressure injury. Developing a skin care program supporting prevention and maintenance of skin health resulted in positive outcomes and good stewardship of resources.

Interventions had a prevention focus:

• Improved identification and use of skin care products
  • Prevention through accurate standardized risk scoring.
  • Early interventions focused on nutrition of skin.
  • Implementation of pressure ulcer prevention standards.
  • “Save Our Skin!” education program with assessment identifiers.
• Reduce linen layers
  • Promotion of therapeutic microclimate with elimination of quilted pads, optimizing the ability of the mattress to redistribute pressure, and reduce moisture.
  • Added repositioning sheet based on assessment data for individual patient mobility.
• Moisture management
  • Optimized patients’ microclimate to reduce shear and maceration.
  • Decreased moisture and heat content to enhance tissue tolerance and lower sacral pressures.
  • Staff education on alternative moisture control measures, focused on critical thinking skills for sources of moisture and interventions addressing moisture content.
• Management of incontinence
  • Determine cause with focused interview and review of patient history.
  • Collaborate with other disciplines to manage moisture sources.
  • Interventions based on type of incontinence (scheduled toileting , medication review, commode, long necked urinal, and quick response to call lights)
  • Utilizing appropriate continence product based on risk assessment of moisture for individual patients.

Outcomes demonstrated overall reduction of hospital acquired pressure ulcers by 3.28 per 1000 discharges. Several individual units achieved lower incidence rates for several consecutive months.