As a registered nurse with 37 years experience, I sometimes have to cross that divide, and become a patient. As a patient, I’m regularly several steps ahead of those who are caring for me: often I make mental notes to criticise their performance at my next dinner party. I hope my experience provides an opportunity to reflect on your own practice.
Recently, I required a 7-day electrocardiogram monitor, which necessitated my chest hair being unceremoniously removed in two places, to facilitate monitor fitting via two rather large adhesive electrodes placed into the deforested regions. My thoughts were “This will hurt, when I remove them next week!”
Despite wonderful advice and support, indeed the only information I didn’t receive, was how to painlessly remove the electrodes; it wasn’t even an afterthought as I was ushered out of the clinic. In my experience, medical adhesives generally adhere more the longer they remain in place, becoming increasingly difficult to remove. In my case, there would also be a 7 day period of follicular regrowth, which implied pain during the removal process.
Medical adhesive related skin injuries (MARSI) cause preventable harm to those we care for. It is a quality-of-care issue in care organisations, as many of these injuries are preventable. This may be manifested by local incident reporting following complaints from patients and families. Such injuries, include:
- Skin stripping
- Skin Tears
- Allergic reaction
- Irritant dermatitis reactions
- Tension blisters
The gravity of these injuries becomes more apparent, particularly with the elderly, preterm/new born infants, those with underlying skin conditions and those receiving anticoagulant and steroidal therapies. These injuries can be more serious than “just” superficial skin damage. They may also lead to increased hospital stay and increased care costs by necessitating further and more complex treatments e.g. antimicrobial/antibiotic therapy or dermatological referrals. The costs to the individual affected may never be calculated, particularly the potential risk of permanent scarring and altered body image issues. Preventable patient harm may lead to uncomfortable questions concerning the quality of care an organisation provides. This could lead to a loss of confidence in the organisation in general and in the individual carer/clinician in particular.
As clinicians we should always consider the consequences of our care management plans, so they effect positive outcomes and ensure such issues are avoided. As carers, we can reduce the occurrence of MARSI if we adopt a few simple measures:
- Obtain patient history of previous experience of adhesive dressings/tapes prior to use
- Avoid using adhesive dressings/tapes if known to cause allergy, sensitivity, or other forms of skin damage
- Ensure an adhesive remover is incorporated into your dressing change regime and care plans
- Report any MARSI in incident/datix reports
- Identify risk factors
- Prepare skin correctly
- Observe skin for signs of impaired integrity
- Address excessive moisture such as urine, exudate
- Ensure skin is clean and dry before application
- Apply barrier film in high risk patients – provides protective interface between skin and adhesive
- Do not shave patients – use clippers
- Select and correctly apply the medical adhesive
- Remove adhesive correctly – Consider using a medical adhesive remover
In my case, being provided with a medical adhesive remover like Lifteez would have remedied the situation.
Unfortunately, I ended up with folliculitis, irritant dermatitis and discomfort from skin stripping, which lasted the rest of the week.
Ironically, despite my boast of critically appraising those who care for me, I found myself defending the omission of the above prophylactic measures to my wife. Why? Because I didn’t want to make a fuss, as I know the pressures healthcare workers are under. Would I have done the same if the patient was my wife or another family member? I don’t think I would’ve been so understanding.
How would you feel? Leave your comments under the blog.
Ralph Boutflower, Clinical Nurse Advisor, Medicareplus International Ltd.