Skin Prep QUESTION
0Feb 13, '10 by nurserinHi ALL!!
OK, I'm not an idiot but I am a new RN and I currently, still, working in a nursing home. I was a CNA for about 8 years in LTC, Home health and also acute care. At my work place, we (nurses) do our own treatments daily and since I have been there I noticed how much skin prep we use. We are ordered, by our WC nurse, to put it on heals, bunions, callaces, elbows, SCABS, reddened areas, (all for prevention of pressure ulcers) you name it. From experience, I have always seen skin prep as a use for "prepping" the skin (ie: wounds) for protection against tape and all that good stuff. We have minimal, actual wounds that need to be changed BID or PRN. I went to the Smith & Nephew website for some answers and it spoke of only skin protection from tape and such. I have found myself peeling fitted sheets off heels of residents who are ordered to have skin prep applied BID. To me, that seems like it's doing more harm than good. I always thought that pressure ulcers basically start from the inside out...Please correct me if I am wrong, and if I'm right, please send me info, or websites, for proof so I can show my job they are wasting their money!!! It's basically a waste of time to me and if all my patients are to be applied to every bony prominence, then do they sell it in a body wash???!!!! That just seems soooo much easier!!! Thanks so much!
0Feb 26, '10 by sorlandoI've been a nurse for about 11 years and done wounds for about 5 years and never heard of using skin prep to 'prevent pressure sores'. The only way to prevent pressure sores is to reduce pressure. Skin prep can be used to help protect skin from moisture. I think there is a type of peri wipe that contains some skin prep for this purpose. As for the skin prep on the elbows, it may be providing a thin layer of protection against friction shear.
1Feb 27, '10 by bell104I've been a wound care nurse only for about the past 6 months or so. When I first started at a long term care facility, I noticed a lot of skin prep being used in my facility. In my experience so far, skin prep can toughen the skin and provide a barrier against friction. I found it most beneficial on residents with boggy heels. Applying skin prep a few times a day did toughen the skin and I think prevented further breakdown to the heels. I also use it on blisters but that's it. As far as peeling bed sheets from the resident's skin, if they need the skin prep for prevention then the heels should also be elevated off the surface of the bed to reduce pressure, which would eliminate the bedsheet issue. I looked for info online regarding using skin prep for this purpose but have never come across any. If you find any let me know but in my experience it is appropriate in some situations.
1Apr 13, '10 by flynn126I too, wondered about the extensive use of skin prep in my LTC. My past experience, as a NA and nursing student, was that skin prep was only used to help remove tape and adhesives in dressing changes.
I was able to find a little information on an internet related to the expanded use of skin prep, sorry I don't remember where, possibly a vendor site. Some additional uses bulleted creation of a thin protective barrier, and reduce friction. The skin prep product is also sold in other forms like spray on and swabs.
1Apr 13, '10 by MelinaLiquid barrier films (I've always used 3M Cavilon No Sting) will protect intact or damaged skin from urine, feces, other body fluids, tape trauma, and friction. I use them all the time to prevent maceration around trach stomas. 3M has a ton of info on its use here. (under the "resources" tab.
4Mar 30, '11 by E. Chester, LPNFull-Time Wound care nurse for two years. Here is the way to justify "Skin prep to bilateral heels q.s." (Yes, my nurses hate it.)
F-314 states, " Based on the comprehensive assessment of a resident, the facility must ensure that a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing."
According to Smith-Klein as seen here,
http://www.americandiabeteswholesale...p-wipes_17.htm , Skin preps reduce friction.
When utilizing the all-too-familiar Braden Scalen, most nurses believe their job is complete. In LTC however, this is only the beginning. Dr. Barbara Braden also has protocols that go along with your outcomes on the Braden Scale that MUST be implemented in a partial effort to avoid an F-314 tag. If you fail to initiate these protocols, you WILL get F-314 and probably at "widespread" level.
As we can see, even at the lowest level of risk, "At Risk - 15-18", the protocol clearly states to "manage friction and sheer". As seen above in the visible link, Skin Preps reduce friction.
Skin preps to bilateral heels Q.S. with supporting documentation of the same being done accomplishes all of the above. Two years, five surveys, and ZERO F-314 tags.
You still must manage the other co-morbidities for residents; however, this has proven to demonstrate an effort being made on the part of your facility to AVOID heel wounds, DTIs, etc.
As a side note, we utilize skin prep on DTI (without open areas), blisters (not open), and yes scabbed areas (eschar) in addition to stable eschar, and they all do exceedingly well on preps.
Again, NO F-314 TAGS or any tag with regard to wounds in five surveys.
0Apr 7, '11 by Al.RobertsWCSThis note is to Nurserin. Bravo... you have it right on the nose. Using skin prep for prevention of pressure ulcers is a big joke. Of course if you go to a manufacture's website it's going to say anything to increase the sale of there products. There is nothing else for me to say. Any new comers please read the first post of this topic. I can't say it any better that she did...
Al R. CWCA
0Apr 8, '11 by E. Chester, LPNWith all due respect to the WCS, I think we are missing the rationale for the use of skin prep.
It is NOT utilized for the prevention of decubiti, it is utilized to address one of the risk factors for the development of decubiti; friction.
Feel free to check the link to Dr. Braden's link on protocols associated with Braden Scales. If you do not address the risk factor, you will get tagged (F-314 at a level greater than "Isolated") (quote from a state survey team leader this year, 2011).
This is also the rationale for Granulex; it prevents fricton. http://www.webmd.com/drugs/drug-3729...0&pagenumber=4