MAINTAINING SKIN INTEGRITY

1. MAINTAINING SKIN INTEGRITY Jane Gosche Director of Nursing Klemzig Residential Care Facility

2. SKIN INTEGRITY • SKIN BY DEFINITION: • Our Skin is the largest organ of our body • The Skins functions include - Protection • Helps regulate body temperature • Produces and absorbs Vit. D • It is an excretory organ • Transmits sensation

3. SKIN INTEGRITY • INTEGRITY BY DEFINITION: • From the Macquarie Dictionary • “The state of being whole, entire or undiminished, unimpaired or perfect condition.” • In other words Whole and Complete! • Our assessment of a residents skin integrity is like putting a jigsaw puzzle together.

4. SKIN INTEGRITY • NORMAL BIOLOGICAL AGEING: • Our skin becomes thin and dry’ and is therefore at risk of tearing and bruising. • Our skin looses elasticity resulting in more skin folds.

5. OBJECTIVES • To establish risk factors. • To assess individual residents skin integrity. • To implement a process for prevention of loss of skin integrity. • Review current statistics and risk assessment interventions. • To promote optimum quality of life for residents.

6. ESTABLISH RISK FACTORS • 1) EXTERNAL RISK FACTORS: • Pressure- the constant pressure on an area of the body caused by the inability of a person to reposition them self physically. • Shearing- force of skin sliding against internal surface. • Friction- movement between the skin and contact surface. • Moisture- excessive external moisture on the skin.

7. INTERNAL RISK FACTORS: • Age, as discussed, the changes in skin integrity. • Chronic Illness, may impact on the skins ability to maintain normal functioning. • Altered cognitive status, a persons inability to be aware of repositioning. • Immobility, inability to reposition. • Diminished sensation, inability to feel pain or discomfort. • Circulatory Impairment, risk of skin break down.

8. ASSESS RESIDENT SKIN INTEGRITY • 3)On admission complete: • Initial Health Assessment and formulate a care plan- This includes a thorough skin assessment to establish a baseline. • Complete continence assessment – Assess continence pads and toileting regime. Assess for use of protective moisture barrier cream, disposable wipes and no rinse cleanser if required for incontinence.

9. Behaviour Identification – assess for potential at risk behaviours that could skin trauma, eg. Repetitious movements causing friction / shear , or non compliance with activities of daily living. • Safety - assess for safety interventions required. It is well documented that the use of restraint can cause more damage to skin integrity than no restraint. • ADL`s Meals and Drinks – assess type of diet and fluids required as well as amount of assistance and encouragement. Commence supplements if under weight, weigh weekly or monthly.

10. ADL` s Personal Hygiene – Individually assessed daily hygiene needs of a persons skin integrity, shower / sponge, Dermalux hot towel bath, or for very frail residents a shower bath is used. • no soap, residents use ph balanced shower lotion. Application of moisturiser for dry skin. • Daily inspection of skin and skin folds. • Pain assessment – type and location. • Transfer and Mobility – Links with physio assessment and a persons ability to mobilise. We promote optimum mobility therefore need to use protection on skin integrity; use of film dressing, leg, arm and hip protectors

11. Medication assessment – potential for thinning and bruising of skin. • Mini Mental – establish cognitive awareness. • Depression Scale – potential for sedentary lifestyle or self harm. • Physiotherapy – links with mobility, promotion of optimum range of movement and flexibility through an exercise program. This is conducted at hygiene time when the skin, muscles and joints are warm. • Podiatry – establish any foot abnormalities.

12. Braden Scale selected as best practise in aged care as it incorporates – Moisture, Activity, Mobility, Nutrition, Friction and Shear. • Interventions required by level of risk assessed – • Low Risk – 20 – 23 • Moderate Risk – 16 – 19 • High Risk - 11 – 15 • Very High Risk - 6 – 10 PREVENTION OF SKIN INTEGRITY IMPAIRMENT

13. Monthly Skin Tear Statistics – broken down to per resident; September 2005, 13 x skin tears on 11 residents, 4 x falls, 2 x CVA rehabilitation promoting independence, 3 x very frail skin, 3 x resident behaviours, 1 x CVA resident unaware of paralysed arm. • Monthly Incident Statistics includes time of incident, environmental design, staff actions, resident actions, fall, injury etc. • Facility audit of current mattresses, now replacing inadequate with high density foam pressure relieving mattresses monthly. • All residents to sit on egg shell foam cushions when on hard surface chair / wheelchairs. • Currently linking international nutrition scale with Braden scale. STATISTICS & RISK ASSESSMENT INTERVENTIONS

14. Assessment on admission. • Three monthly assessments to review all cares thereafter. • Review if any change to health status at any time, post hospitalisation and post surgery. • We aim to promote maximum independence, self esteem, skin integrity and quality of life in a home like environment. • As you can see the jigsaw fits together. PROMOTE QUALITY OF LIFE FOR RESIDENTS

15. THANK YOU & HAVE A GREAT DAY

16. How many times did you reposition yourself?