As we age, our skin can experience changes that make it more vulnerable to damage.
Older people, especially those who are frail, are at significant risk of developing pressure injuries and skin tears.
Hospital acquired pressure injuries and skin tears are considered an adverse event. Most pressure injuries and skin tears can be prevented by following simple steps such as maintaining good nutrition and hydration, regular but careful mobilisation, good skin hygiene and a good moisturising regime.
This topic defines pressure injuries and skin tears and their impacts; describes methods of screening and assessment for risk; and recommends interventions to prevent and manage pressure injuries and skin tears. In addition to following health service policy and procedures, consider the following actions and discuss them with colleagues and managers.
Skin and impacts of damage
Pressure injuries and skin tears are the most common wounds that affect older people as a result of being in hospital.
Skin and ageing
Older people are at risk of skin damage, as changes due to ageing affect skin integrity, making it vulnerable to damage, pressure injury or skin tears.
Identifying skin problems
As clinicians, we need to be alert to risk factors, use a recommended risk screening tool and complete a physical examination of the patient’s skin.
Preventing skin problems
Most skin injuries and tears can be prevented through good nutrition and hydration, regular mobilisation, good skin hygiene and a moisturising regime.
Classifying pressure injuries and skin tears
Effective management and treatment of pressure injuries and skin tears depends on their stage or classification.
Responding to pressure injuries and skin tears
Responding to pressure injuries and skin tears requires being aware of the factors that promote healing and addressing injuries and tears.
Pressure injuries and skin tears and discharge planning
A smooth transition from the hospital to home or residential aged care facility involves comprehensive and clear discharge planning and communication.
Further information - pressure injuries and skin tears
Educational and information resources available on preventing, assessing and managing pressure injuries and skin tears in older people in hospital.
All public and private hospitals are required to be accredited to the Australian Commission on Safety and Quality in Healthcare’s (ACSQHC) National Safety and Quality Health Service (NSQHS) Standards. The primary aims of the standards are to protect the public from harm and to improve the quality of health service provision. Assessment to the second edition of the NSQHS Standards commenced in January 2019. The second edition comprises eight standards that provide a nationally consistent statement about the level of care consumers can expect from health services.
The Comprehensive Care Standard (Standard 5) aims to ensure that patients receive comprehensive health care that meets their individual needs, and considers the impact of their health issues on their life and wellbeing. It also aims to ensure that risks of harm for patients during health care are prevented and managed through targeted strategies. These include integrating patient care processes to identify patient needs and identifying actions related to falls, pressure injuries, nutrition, mental health, cognitive impairment and end-of-life care.
Information is presented in the Older People in Hospital learning topics that complements Standard 5 and other NSQHS Standards including the; Partnering with Consumers Standard (Standard 2), Medication Safety Standard (Standard 4), Communicating for Safety Standard (Standard 6) and Recognising and Responding to Acute Deterioration (Standard 8).
Reviewed 10 November 2021