Risk Assessments Related to Skin Integrity are Critical to Satisfactory Patient Outcomes

ICT spoke to Margaret Falconio-West, senior vice president of clinical services for Medline Industries, Inc., about imperatives related to patient skin integrity. 

Q: How critical is it for hospitals to conduct risk assessments for pressure ulcers/injuries and wound complications in at-risk patients, and what are some considerations for this process?
A: It is very critical for a hospital to assess risk of developing a pressure injury as well as the risk of infection or complications.
• All patients should be assessed for risk of skin breakdown. Think about a healthy, young athletic high schooler that is admitted through the ER/ED– the initial risk assessment says that he is not at risk. He quickly takes a turn for the worse and becomes immobile, diaphoretic, and is not eating – his risk level just soared and another Braden Scale evaluation has not yet been performed.  Understanding that the amount of pressure required to cause damage (or a pressure injury) is indirectly proportional to the amount of time that pressure is applied. 
• To me, if there is skin there is a risk. We also know that levels of risk exist. For example, those with multiple co-morbidities, poor blood flow, decrease food and water intake, as well as mobility issues are going to be at higher risk.
• Pressure injury complications can range from non-healing to infection to death.  Assessment and prevention are going to be key factors in promoting best outcomes.
• Two main things should be hard-wired into the staff mind:  risk assessment and interventions, and complication awareness. These critical concepts must be part of all training, new staff orientation, and routine refresher courses in order to bring about improved patient outcomes.

Q: What are some best practices to promote skin health in patients with wounds or pressure ulcers/injuries, or who are at risk for developing them?
A: Treatment to keep the skin healthy is a prevention best practice. When thinking about overall best practices for skin health, here are a few things facilities should consider: 
• The first step in prevention is complete and comprehensive assessment of the risk.  Know what to look for and what to do when some-thing is found. 
• The process of reversing or addressing risk factors begins once they are known. For example, it could include a special support surface for someone with immobility issues as well as dietary supplements, especially protein, for those with wounds. 
• Managing moisture, such as from incontinence, is another good practice using both appropriate containment (moisture wicking drypads or briefs) and good skin care.  Skin care in general must take into account the type of skin damage and try to correct the damage. 
• Skin care products that provide gentle cleansers, like phospholipids, should be utilized instead of harsh surfactants; dimethicone blends in-stead of occlusive barriers. Skin care that can deliver nutrients to the skin topically will help promote skin health.
Skin is the largest, most visible organ. Healthcare workers need a solution that speaks not only to prevention, but also is designed to address the treatment of varying skin breakdown. Guidelines exist but oftentimes lack context, consistency and versatility. That’s why Medline created Skintegrity, a first-of-its kind, comprehensive skin health management program centered around education, products and outcomes management to help facilities track improvements as well as identify areas that need further effort.

Q: What are some suggestions for developing and maintaining wound care/pressure ulcer/injury prevention educational programs for clinical staff?
A: Education for clinical staff:
• An effective program needs to be intuitive, simple to follow and easy to understand.  It also must include evidence-based information and the latest guidelines. Medline University offers a CE courses specific to wound care and pressure injuries that contain the latest industry trends and policies.  For example, the National Pressure Ulcer Advisory Panel(NPUAP) released the new terminology for “pressure injury” (note the change from “pressure ulcer”) as well as new definitions in April 2016.  The NPUAP held a consensus conference where these new definitions and terminology were presented.  In summary, the biggest differences include the name change (to injury), the change from Roman Numerals (I, II, III, IV) to Arabic Numbers (1,2,3,4), the removal of the word “Suspected” in Deep Tissue Pressure Injury (DTPI) and more clarification in the definitions.  Ultimately, these changes are designed to help the clinician assess and communicate better.
• It should incorporate current practices and how the new process will change.
• Importance of adult learning principles:
• Education programs must be tailored to meet their needs.  Some staff members learn by doing. Others are able to read about a process and turn around and do it, while others need to learn with both hands-on and written or oral instruction. Whatever the topic of education is, it should be available in several different formats. 
• Staff members need to understand how the new topic of their learning will help solve a problem, not just change practice for no reason.
• Having staff help develop the programs and have a say in how they are presented will help with staff buy-in and better understand staff needs.
• Motivation is a huge part of adult learning. Bring in real-life experiences, humor, involving social media, gaming, exploration, live interaction, thought provoking questions and bits of information – not a large chunk of information at one time.

Additionally, online education platforms offer healthcare workers the ability to take courses when the timing is most convenient for them.