Lorraine Grothier

UK Head of Medical Affairs

 What is a Skin Tear?

“A skin tear is a traumatic wound caused by mechanical forces,

including removal of adhesives. Severity may vary by depth (not
extending through the subcutaneous layer)” ISTAP 2018

ISTAP Best Practice document 2018

 Skin Tears- significantly impact on the healthcare economy,
patients and carers
When we focused on
pressure ulcer
prevention we took
our eye off the ball
There is a lack of with Leg Ulcers… now
research/evidence.. Prevalence in Acute the focus is on Leg
Often resulting in care is similar to or Ulcers lets not forget
misdiagnosis and greater than that of just how prevalent
inappropriate Pressure Ulcers! Skin Tears are…
management.

skin tear
 Prevalence of Skin Tears- what is the true scale of the problem?

According to the ISTAP guidelines a study in the US suggested more than 1.9
million insitutionalised adults develop a skin tear each year.

Long term care In the community In acute care

2%-92% 4.5%-20% 6%-11%
As skin tears are frequently underreported or misdiagnosed, the full extent
of the practical and financial burden to healthcare systems is not fully known
this is demonstrated by the wide variance in the prevalence shown here..

1.Malone et al 2019. 2. Strazzieri et al 2017 & LeBlanc 2017. 3. Carville & Lewin & Le Blanc 2008).
 Who is at risk?

Extremes of age
Skin Dry/fragile skin
Previous skin tears

History of falls
Impaired mobility
Mobility Assistance required for
activities of daily living
Mechanical Trauma

Comorbidities
Polypharmacy
General (use of multiple medications)
Health Impaired cognition
(sensory, visual, auditory)
-Malnutrition
Best Practice Recommendations for the Prevention and Management of Skin Tears in Ageing Skin, LeBlanc (2018)
 Effects of a skin tear on the patient

Skin tears
o Cause Pain and anxiety
o Increase healthcare costs
o Reduce patients quality of life
o Cause distress to patient , family and carers
If you were the patient, which would you prefer?
Who are ISTAP?

= The International Skin Tear Advisory Panel

An expert panel dedicated to improving
outcomes for individuals at risk and/or
experiencing skin tears across the
continuum of care through education,
research & advocacy.

An International panel of
representatives including:
North America, South America,
Europe, Asia, the Middle East,
Australia, New Zealand & Africa.
 Rationale for Guidelines

A descriptive, cross-sectional, online international survey

(2010) involving 1127 HCP’s from 16 Countries found:

70% reported a problem with current assessment and

documentation tools

90% favoured a simplified method

81% admitted to using no tool or classification system

admitted to ignoring or not documenting

40% these wounds
Best Practice Recommendations for the Prevention and
Management of Skin Tears in Ageing Skin, LeBlanc (2018)
ISTAP Guidelines Published 2018

ISTAP Best Practice

recommendations
2018
 International Group of Experts

‘Recommendations’ vs. ‘Statement’

Created to improve interventions and clinical

outcomes after ISTAP identified gaps and areas of
misconception amongst clinicians

Draft document produced by the working group

leading to an extensive review.

Additional international expert consultation to

reflect international practice across the world.

Resulted in a consensus by all members of the

extended ‘expert working group’ on ALL
statements presented in the document.

Best Practice Recommendations for the Prevention and Management of Skin Tears in Ageing Skin, LeBlanc (2018)
 Achieving Consensus

 Delphi Process was used to agree on the statements.

 A full literature review is conducted

 Statements taken from the literature/evidence are

scrutinised and then feedback is given anonymously
throughout multiple rounds of review (at least three)

 >80% agreement of the group is required from all

members on every statement to achieve consensus
 The Best Practice Recommendation is split into 6 sections;

1.What is a skin 2.Risk Factors

tear? and Causes

6.Conclusions 3.Identification
and the future and assessment

5.Prevention of 4.Management
skin tears of Skin tears

Best Practice Recommendations for the Prevention and

Management of Skin Tears in Ageing Skin, LeBlanc (2018)
 The evolution of skin tear classification

Payne-Martin ISTAP Classification

Classification System System was developed
STAR Classification
was developed as to simplify the
System is validated by
means of grading skin classification of skin
a small number of
tears by the extend of tears, categorising
clinicians and used in
tissue loss, measured them as either Type 1,
the UK, Australia and
as a percentage. This Type 2 or Type 3
Japan
tool was not validated Validated by 839
HCP’s.. Ongoing.

1993 2007 2018

Urgo Medical- Skin tear CPD Module 2019

 ISTAP classification system reduces confusion

STAR ISTAP
5 categories often causes confusion, especially The ISTAP system uses a simple method with 3
due to overlapping. specific categories, either Type 1, 2 or 3

Urgo Medical- Skin tear CPD Module 2019

Where does UrgoTul fit into the ISTAP best practise
recommendation?

* Lipidocolloid mesh

UrgoTul is therefore recommended by ISTAP to

be used on all types of skin tears regardless of
the levels of exudate.
Best Practice Recommendations for the Prevention and Management of Skin Tears in Ageing Skin, LeBlanc (2018)
 ISTAP have suggested the perfect dressing for managing Skin
Tears should..

Be flexible and mould to contour Not cause trauma on removal

Be easy to apply and remove Afford extended wear time

Provide a protective anti-
shear barrier Provide secure, but not
aggressive, retention
Optimise quality of life and
cosmetic factors Optimise the physiological
healing environment
Be non-toxic

Be cost-effective
Control Bleeding X
UrgoTul meets 10/11 – and as we know bleeding should be controlled prior to treatment
 ISTAP recommend compression to be applied on the lower limb
when appropriate.

Let’s utilise our

‘Compression therapy should be considered if full compression
range!
the wound is on the lower limb’- ISTAP 2018

1.Best Practice Recommendations for the Prevention and Management of Skin Tears in Ageing Skin, LeBlanc (2018) 2. Urgo Medical- Complete compression solution leave piece
These guidelines create an opportunity to develop a local skin
tear pathway.

Improves
proactive
Appropriate Standardises the practice and
diagnosis of approach to the care appropriate
and management of referral
skin tears skin tears.

Improves
Accurate Patient
classification Improves
reporting & outcomes
of skin tears
documentation
 Data Collected Pre-Implementation

Current bandage regimes were

applied on healthy volunteers by
both specialist and ward nurses.
Data of sub bandage pressures
was collected using pressure
monitors and demonstrated
inconsistency in pressures
achieved.

Training needs analysis revealed

Only 7% of hospital staff applied
compression to treat lower limb
skin tears
Lower Limb Skin Tear Pathway
Results of treatment outcomes using the pathway (12 patients 16 wounds)
 A quick summary of the key stages of the publication-
alongside continuous support throughout from the Matrix
Team.

June 2018 • Designing May 2019 July 2019

publication-
• Key stakeholders • Lorraine and in line with • Wounds UK
• Publications publish Part 1 • Wounds UK Publish
meet to discuss Tracy discuss current pulled Part 2
the pathway and a plan of practice- together and
data collection action and Vowden’s finalised
start to design
May 2018 the pathway. October 2018 June 2019 20% ms
 Introducing… Tracy Vernon- Lead Nurse, Skin Integrity.

In 1993, Tracy became Tissue Viability Sister I Doncaster and her career has progressed over the years to
being the Trust’s Lead Nurse for Skin Integrity.

Tracy has been involved in numerous aspects of Tissue Viability/Skin Integrity, working in a variety of
capacities:

 Editor of Wound Care Journal

 Committee member of Wound Care Society
 Committee member of the National Association of Tissue Viability Nurses
 Involvement in the NICE Clinical Guideline 29 – The prevention and treatment of pressure ulcers
 Poster award winner at TVS conference
 JWC runner up 2019
 Publications in journals
 Advisory Boards

She is currently working with the local CCG delivering a training programme having devised
a strategy to educate the Practice Nurses in the local area.
Run video