Skin tear prevention and management among frail older adults in a Taiwanese long-term care facility: a best practice implementation project.

Abstract

Introduction: Skin tears are common among frail older adults in long-term care and remain inconsistently managed despite international guidance.

Objectives: This evidence implementation project aimed to enhance compliance with evidence-based skin tear prevention and management practices in a 120-bed residential facility in eastern Taiwan.

Methods: A pre-post clinical audit design guided by the JBI Evidence Implementation Framework was undertaken. Baseline compliance with six evidence-based criteria derived from International Skin Tear Advisory Panel (ISTAP) recommendations was assessed using the JBI Practical Application of Clinical Evidence System (PACES). Barriers were identified and addressed through documentation redesign, staff education, development of a local protocol, and procurement alignment. Compliance was assessed at the resident level 6 months following implementation.

Results: At baseline (n = 120 residents; 19 with skin tears), compliance across all six audit criteria was 0%. Following implementation, compliance with structured risk assessment was 85% (102/120), while compliance with preventive measures was 90% (108/120). Among residents with documented skin tears at follow-up (n = 5), compliance with ISTAP classification, appropriate initial management, and use of atraumatic silicone-based dressings were 100% (5/5), while compliance with ongoing monitoring was 80% (4/5). A reduction in the point prevalence of documented skin tears from 15.8% to 4.2% was also observed; however, this was not a pre-defined audit outcome.

Conclusions: Integrating evidence-based practices into routine documentation systems, clinical workflows, and procurement procedures was associated with improved compliance with audit criteria. Structured audit and feedback using the JBI implementation approach was feasible in addressing evidence-practice gaps in long-term care settings. Ongoing monitoring is required to sustain practice changes over time.

Spanish abstract: https://links.lww.com/IJEBH/A697.