Highlights from Excellence in Skin Safety, A Conversation with Skin Experts

Question: What happens when you gather some of the world’s leading experts on skin health and facilitate a conversation? Answer: A dynamic, passionate, informed discussion of why the body’s largest organ cannot be overlooked and why maintaining its integrity is essential to care. 

During the June 2016 WOCN® Society and CAET Joint Conference, “Crossing Borders, Breaking Boundaries,” in Montréal, Québec, Canada, 3M gathered a group of health care professionals to explore 1) the state of skin health, 2) why research and education are vital to advancing skin care best practices, and 3) the importance of industry collaboration and partnerships. The panel of experts included Dimitri Beeckman, RN, BSc, MSc, PGDip(Ed), PhD, Professor at University Centre for Nursing and Midwifery, Ghent University, Belgium; Denise Nix, MS, RN, CWOCN, Consultant, Nix Consulting Inc, Minneapolis, MN; Kimberly LeBlanc, MN, RN, CETN(C), Advanced Practice Nurse and Ostomy, Wound Care Consultant, KDS Professional Consulting, Ottawa, Canada; Daphne Broadhurst, BScN, RN, CVAA(c), Clinical Specialist, Medical Pharmacies, Ottawa, Canada; and Debra M. Thayer, MS, RN, CWOCN, Lead Technical Service Specialist, 3M, St. Paul, MN. The discussion also was captured on film and will be premiering September 1 at 3M.com/Cavilon.

The following excerpts their dynamic conversation. 

Skin: not a primary consideration. Although skin is the largest organ in the body, it is often ignored or is at least not a primary focus in today’s health care environment. “It’s mainly a secondary problem … because it’s not the main concern at the beginning of admission,” says Dr. Beeckman. “Generally, patients are admitted to the hospital with other problems.” Skin also is not on the minds of the patient and family because they are focused on the issue that bought them to the facility. “They don’t expect to come to the hospital for cardiac surgery and leave with a problem on their skin,” says Nix. The panel agreed vital organ checks during admission often do not include a thorough skin check and that patients aren’t asked about their skin history, such as whether they have experienced skin tears, a leg ulcer, or dry skin. “I think there’s a real gap in assessment skills for a lot of clinicians,” says Thayer. 

Closing the assessment gap. The experts discussed how the assessment gap needs to be addressed early in nursing, medical school, and graduate programs. Including information on the importance of skin assessment protocols in a more comprehensive manner could be a massive step both in mitigating common skin issues that develop in various care settings and in helping clinicians be champions for skin safety. 

Thayer believes health care facilities have an obligation to new grads to offer additional education to enhance understanding of why skin assessment is so important. “That’s where orientation is woefully inadequate because often [these prospective clinicians are only spending] 1 to 3 hours on skin [in their courses],” she says.

Leblanc provided valuable insight on why assessment and detailed reporting are so important. “If skin tears are documented, it’s only as a ‘skin tear’,” she says. “No additional information is provided about the circumstances or overall skin health. Patients often don’t think their skin should be a priority. Some patients and families have come to expect that if you’re elderly you’re going to get a skin tear. That’s an attitude we need to change. You don’t [automatically] get skin tears because you’re old and have poor skin.”

Nurses need to be guided not only about why assessment is important, but also about the sensitivities that surround patient care relevant to exploring the skin. Nurses must balance the need to be respectful while treating all aspects of the patient. “Our nurses conduct a thorough head-to-toe skin inspection,” Nix says. “How you touch the patient, how you talk to the patient, spreading skin folds. That’s something we don’t necessarily learn in nursing school.”

Skin matters: the importance of research and partnerships. Although many of the panelists have backgrounds in wound and skin care, Broadhurst provides the vascular perspective and the value partnerships have played in advancing industry understanding of skin protection. “Skin impairment has been an under-recognized condition in the vascular access world,” she says. “We had a report of a child who developed an exit site infection, and we looked to the literature to see how we could care for this. There was literally nothing on skin impairment related to central venous access device sites. I came across the Medical Adhesive Related Skin Injury (MARSI) statements, which was invaluable for us but it wasn’t specific to vascular access.” She subsequently turned to industry to help. Through an unrestricted grant, she was able to bring together an international panel to develop consensus statements and recommendations to provide guidance to the vascular access nurse about various skin impairments and issues that arise, from contact dermatitis to skin stripping. The panel also looked to the wound care literature, which emphasized the importance of treating the cause. That language wasn’t common to the vascular access world. 

“Industry has been invaluable in helping disseminate that information,” Broadhurst says. “We don’t have the reach of our industry partners. They have spread the word about algorithms, MARSI statements, and other information.”

WOC nurses leading the way. This discussion may have elicited as many new thoughts as answers. One thing remained clear throughout the discussion: WOC nurses are leading the way in driving the discussion on skin and advocating its importance in total patient care. Each expert closed the conversation with thoughts on what nurses should consider when providing care. Beeckman says, “Good skin care isn’t just about following steps. Be open, informed, and creative in the things to you do.” Nix thinks empathy is key. “Show nurses how their good work is making an impact,” she says. LeBlanc tells nurses to think about the skin as an organ. “Don’t just look — really see it,” she says. “Realize that no disruption to skin integrity is minor.” Broadhurst advises nurses to follow the basic principles of wound care to prevent damage. For example, allow chlorhexidine solution dry before applying a dressing. Apply a skin barrier to protect the skin. 

Thayer says nurses need to remember what they do makes a difference. “We need more WOC nurses and nurse specialists at the bedside doing mentoring and education,” she says. Realizing their own excellence will help clinicians provide excellence in wound care. 

To learn more about this series and to access all the episodes starting September 1, visit 3M.com/Cavilon.