Better Outcomes for Skin Tears With New Evidence-based Dressings

Authors: Deborah Nelson BSN CWOCN, April Berry BSN CWS

Problem

A 3-layer silicone bordered foam dressing was utilized for treatment of skin tears in our facility.  WOCs noted wound maceration, pain on removal and frequent dressing changes due to lack of absorption and inability of these dressings to stay in place.

Method

A new 5-layer bordered foam dressing was evaluated.  First, staff were surveyed regarding the performance of the current dressing.  For the next 10 days, nurses continued to apply the prior 3 layer foam dressing to new skin tears. The following day, the WOC assessed the wound and applied the 5-layer dressing.  Patients were surveyed about the comfort of both dressings.   The number of dressing changes, dressing-related complications and patient comfort levels were tracked. 

Results

16 patients received the 3-layer dressing on admission and the 5-layer dressing on WOC consult.  The 3- layer dressings were lifted or falling off 94% of the patients. 1 patient’s epidermal flap was macerated. In the 5-layer dressing group, there were zero dressing complications.  The average wear time was 5+ days with 2 patients requiring a dressing change prior to discharge. All 16 patients evaluated the 5 layer dressing as more comfortable on removal.

The 22 staff that evaluated the 3-layer foam dressing rated it as: 20%- very good, 45% - good, 25% - adequate and 9% - poor.  98% of staff rated the dressing as not staying in place for the entire 3 day protocol wear-time.  15-30% of staff also evaluated it as poor in the areas of absorption and patient comfort. 

Conclusion

There were fewer dressing complications, significantly increased wear time and greater patient and staff satisfaction with the 5-layer dressing.   The new dressing that addresses all levels of wound exudate and stays in place simplified patient care and produced better outcomes.