Understanding Skin Tear Prevalence and Treatment: A Quality Improvement Project

Problem: Skin tears are a common acute injury to the epidermis and dermis resulting from friction or shearing due to mechanical trauma. Older adults are at increased risk of developing skin tears due to frailty and age-related changes. Recent studies identify a lack of formal training for nurses who care for this population, contributing to their reliance on ritualistic or convenient practices rather than evidence-based methods. Nurses, including those working in wound care specialty practices, have been shown to use ritualistic practices, colleague opinion, patient preferences, and situational practicalities to guide both dressing choices and treatment plans. Intervention: This project was conducted with licensed nurses working with older adults living in long-term care facilities in King County, Washington. An educational presentation was developed to address key evidence-based practice recommendations for skin tear assessment and treatment. Measures: A pre- and post-survey were developed to assess participant knowledge and confidence on the Likert scale. The educational intervention was conducted virtually. Descriptive statistics, T-tests, and analysis of variance (ANOVA) were used to analyze the data. Results: Seven respondents (n = 7) completed both pre- and post-surveys. There was no significant difference (p \u3e .05) in respondent confidence for identifying residents at risk for skin tears or accurately measuring skin tear dimensions. There was a significant difference (p \u3c .05) in respondent confidence developing a treatment plan, understanding normal skin tear healing, and using evidence-based practice, and in respondent knowledge regarding approximation of skin tear flaps, protection of periwound skin, choosing a dressing, and use of non-adherent dressings. Analysis of variance (ANOVA) comparing the pre- and post- means showed a significant difference (p \u3c 0.05) between the two groups. Implications: The initial findings suggest that a tailored educational intervention can increase nurse knowledge and confidence regarding skin tears. This project was limited due to a small sample size. It is recommended that such an intervention be utilized across larger groups of nurses caring for people at risk of developing skin tears