MAINTAINING SKIN INTEGRITY

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

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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.

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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.

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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.

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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.

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• 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.

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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.

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• 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.
• ADLs 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.

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• 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

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• 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.

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• 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
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• 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
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• 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
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THANK YOU
HAVE A GREAT DAY
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How many times did you reposition yourself?