Skin Prep QUESTION

[nurserin]

Hi 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!

[E. Chester, LPN]

comment by [color=#0e614d]laurie swezey rn, bsn, cws,cwocn on april 1, 2011 at 1:19pm

in reference to skin prep and heel protection - "skin prep is great to protect from friction/maceration, but will not prevent the damage caused by pressure." (swezey, 2011)

bibliography

swezey, b. (2011, april 1). wound educators. retrieved april 9, 2011, from woundeducators.com: http://www.woundeducators.net/profiles/blogs/preventing-heel-pressure-1

[alphabetsoup]

I typically use skin barrier film to prep for adhesives (like for VACS). I have heard of facilities using skin prep for the purpose that you describe, but really, is it evidenced-based best practice? I have also used Granulex spray, Xenaderm ointment, and Vasolex ointment for the same purposes- to protect and moisturize skin and minimize friction. But offloading the skin is the key- turning the body and elevated the heels.

[E. Chester, LPN]

Alphabet, I completely agree with you. Remove the cause of the wound, and it "may" heal. In the case of pressure ulcers, pressure is the key.

Offloading is one manner of "prevention"; the key word in F-314. You can heal all the wounds you want; however, if your resident heals and redevelops or develops in-house, guess who gets the tag if the wound is determined to be avoidable. The larger number of proper interventions you have in place, the better off for all involved.

[Chris D]

Concerning skin prep--does it matter if you use alcohol based or non alcohol based. We never use it on open skin anyway..

[217shana]

I have worked with wounds for the past 7 years and we use skin barrier prep to the peri-wound area to prevent maceration. We also use skin barrier prep to blisters, stable eschar and boggy heels to help protect the skin from friction and to form like a protective layer to that area. Also we are told that it helps to "toughen" up the skin.

[itthybitthythpider]

According to the Smith and Nephew site, it's only used to "prevent friction from the removal of tape." http://global.smith-nephew.com/us/SKIN_PREP_8631.htm

I may have to try it to peri-wounds. We have a lot of maceration here from moisture around wounds and I haven't been able to figure out why. But the Smith and Nephew site also says it allows the skin to breathe, so I'll see if it works for us.

Just curious, why do you use skin prep for eschar and not granulex?

[Terbobun]

I worry about nurses like that, ughh. Sounds like you did a nice job..you got a doctors ok on treatment..(did they go ahead and just cancel the orders you obtained?? Did they call the doctor again to change the order?) Hope so or thats a problem. Ive been a nurse for 39 years and believe me, there are people who should NOT be nurses!!!!! Ignore the idiots, they will just get you in trouble. And steal your soul. Seriously. Align with nice caring nurses who put the patient ahead of everyone or everything else. And leave that place. If the DON knows about their treatment and doesnt act on it , you dont want to work there.

QUOTE=nurserin;4124394]Hi 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!

[Jlmoore52189]

Info on using skin prep as prevention of stage 1 pressure wounds

Liquid Skin Protectants - Skin and Wound Care | WoundSource