FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Thursday September 1st
Proceedings of the 14th Annual European Pressure Ulcer Meeting
Oporto, Portugal
EPUAP Annual Conference 2011 Oporto Portugal
Moisture Related Skin Excoriation: a retrospective review of assessment and management
across 5 Glasgow hospitals
Bianchi J 1* , Johnstone A 2
1* Independent Medical Education Specialist, Scotland, Janice.bianchi@gmail.com
2 NHS Greater Glasgow and Clyde, Scotland
Introduction
Skin excoriation is an extremely debititating and often
very painful condition. It can also lead to the
development of moisture lesions and/or pressure
ulcers. In recognition of this, a skin excoriation
grading tool was developed by members of the
National Association of Tissue Viability Nurses
Scotland in conjunction with Quality Improvement
Scotland. The tool was introduced across NHS
Greater Glasgow and Clyde (NHS GGC) between
January and June 2009. This was followed by the
introduction of clinical guidelines and a protocol on the
use of for Faecal Management Systems (FMS)
recognising that faecal incontinence can cause
extreme irritation and skin injury to the perianal area
due to bacteria and digestive enzymes within faecal
matter (Johnstone 2005). In order to determine
whether the excoriation tool and FMS guidelines were
being implemented, a retrospective review of case
notes was carried out across 5 NHS GGC hospitals.
The main aim of the study was to answer the
questions:
1 Was there evidence that the excoriation tool was
being used?
2 Was a consistent approach in the management of
patients with excoriation including the use of FMS?
Methods
One year after implementation, a retrospective review
of the case notes of patients who had been referred to
tissue viability services with skin excoriation was
carried out. For the purposes of this study, data were
collected on demographics, length of stay, treatment
options and concordance with guidelines/excoriation
tool.
Results
A total of 35 sets of case notes were reviewed. Of
these 25 patients fitted the criteria for the study, the
remaining 10 patients had chronic wounds but no
evidence of skin excoriation.
Table 1 details demographic details, it is noteworthy
that that many patients had a prolonged length of stay,
this was due to deteriorating medical condition in many
but skin damage could not be excluded as a
contributory factor.
Table 1: Summary of demographic data and length of stay
Age Sex LOS
Range 39-89
Mean 63.4
F 16(64%)
M 9 (36%)
10-180 days
Mean 40.8 days
73
Table 2 details the many different products being used
to treat excoriation, some of which are outwith the
recommendations of the excoriation tool.
Table 2: Treatments recommended in excoriation tool vs
treatments used
Recommended: barrier cream, barrier film
Used: Cavilon (cream, lollipop, spray); flamazine; canesten HC;
hydrogel; aqueous cream; clotrimazole; fucidin, zinc and caster oil;
doublebase; purilon; conotrane; 50:50 white soft paraffin in liquid
paraffin; E45
The excoriation tool uses a 1-3 grading system, there
was no evidence of this system being used. The
preferred option was the use of various adjectives
such as: red; excoriated; erythema; raw; fragile;
tender.
All 25 patients were either admitted with or developed
acute faecal incontinence prior to the onset of
excoriation. NHS GGC Guidelines suggest FMS
should be considered when this occurs. Casenote
review indicated FMS were considered in 9 (36%)
patients and used in 5 (20%).
Discussion
From the evidence presented here, there is little
evidence that the excoriation tool had been used to
inform decision making.
Additionally the clinical guidelines on FMS do not
appear to have been fully implemented with only a
small percentage of patients assessed for the device.
Clinical relevance
The onset of acute diarrhoea can cause skin injury
within a short period of time. It is therefore essential
that systems are put in place to minimize tissue
damage. This study indicates that despite the fact that
guidance was available, uptake was poor, therefore
we need to develop better methods of disseminating
information. A treatment pathway with consideration
for circulation may be the next step.
Acknowledgements
We appreciate the help of NHS GGC medical records
Conflict of Interest
This study was supported by an unrestricted
educational grant by ConvaTec
References
[1] Johnstone A Wounds UK. 1;3:110-114, 2005
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