ABSTRACT

Endoscopy patients frequently have multiple risk factors associated with skin tears including advanced age, critical illness, nutritional compromise, and mobility issues. Upon identifying an opportunity for improved skin tear prevention an evidence-based quality improvement (EBQI) project was designed and implemented.
A multidisciplinary approach was taken to identify prevention measures specific to the endoscopy setting. We developed a skin tear prevention protocol (STPP) including a skin tear assessment tool (STAT) for patients >65 years old. Patients with a positive risk receive skin preparation prior to adhesives, safe turning/transferring techniques, stockinette sleeves, and the use of adhesive remover.
A feasibility study with a pre/post timed series survey design was used to measure nursing knowledge on skin tear prevention and the usability of the protocol. Prior to implementation, baseline knowledge was assessed via an 8-question survey. Knowledge was again measured using the same survey at one month, and at three months post implementation. Survey results identified an 88% increase in nursing knowledge.
After 3 months the STPP and STAT were evaluated using the RN Opinion of Effectiveness Survey. For the STPP, 77% “agreed’ or “strongly agreed” the STPP is helpful to my practice. For the STAT, 82% “agreed” or “strongly agreed” the STAT accurately identified patients at risk for skin tears.
Throughout the feasibility study there were 603 risk assessments completed with 537 at risk patients ≥ 65 years old identified. Endoscopy nurses implemented 911 nursing interventions. This project demonstrated a gain in nursing knowledge and a 66% skin tear reduction in endoscopy.