Patient Safety Topics
:
Skin Tears
Overview

Skin tears are a painful but preventable problem for older patients. When the dermis separates from the epidermis, a partial thickness wound occurs, often causing a flap above the exposed dermis. In the first 12 months of mandatory reporting through the Pennsylvania Patient Safety Reporting System, skin tears accounted for 2% of all reports from hospitals.

These skin traumas are not serious enough to extend the hospital stay but are painful, unsightly injuries for the patient. Skin tear dressing changes are time consuming and painful. If skin tear dressing changes are done poorly, the fragile wound bed may sustain further injury.

Key Data and Statistics

During the first 12 months of mandatory reporting, skin tears were reported 2,807 times through the Pennsylvania Patient Safety Reporting System.

Skin tears can be sizeable and, in some cases, require more than the selection of the correct dressing as the following cases indicate:

While transferring the patient from the bed to the chair with a total assist, the left leg was lifted and a 10 cm x 10 cm skin tear resulted. The physician ordered Vaseline gauze and a dressing. Further discussion with the attending resulted in suturing and stapling the area.

Patient was found on floor after staff member heard bed alarm and thud. Skin tear assessed and treated, requiring suturing to left forearm.

Use of equipment, patient transfers or falls, treatments and procedures all place the patient at risk of incurring a skin tear, as these cases illustrate:

When taking off the EKG lead the skin ripped off the patient (8 cm x 3 cm).

When removed from the bedpan a 2 cm x 1 cm skin tear occurred. Wound was dressed with a dry sterile dressing and tape.

Reported events demonstrate that the risk of skin tears increases with age, as shown in Figure 1.

Figure 1. Reports of Skin Tears per 100,000 Patient Days by Gender and Age Cohort (Jul 2004-Jun 2005)

Figure 1. Reports of Skin Tears per 100,000 Patient Days by Gender and Age Cohort (Jul 2004-Jun 2005)

Skin tears are most frequently reported from general Med/Surg units, which account for 33.2% of reported cases (Figure 2).

Figure 2. Reports of Skin Tears by Department or Unit

Figure 2. Reports of Skin Tears by Department or Unit

 

Excerpted from: Skin tears: the clinical challenge. PA PSRS Patient Saf Advis 2006 Sep. http://patientsafety.pa.gov/ADVISORIES/Pages/200609_01b.aspx.

Educational Tools

The Challenge of Skin Tears
This poster illustrates different categories of skin tears and discusses prevention strategies and treatment.

Sample Policy on Skin Tear Management
This sample policy can be adapted by facilities to provide for comprehensive management of skin tear trauma.

Sample Policy on Skin Tear Prevention
This sample policy can be adapted by facilities to provide for comprehensive, preventative skin care to patients, especially those susceptible to skin tear trauma.

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