Multi-disciplinary management of type 1 and 2 skin tears using a silver-based hydrofiber dressing.

Skin tear is a common problem encountered in the emergency department. If it is not properly managed, it can lead to wound infection, skin necrosis and a need for further surgical intervention and skin grafting. Current management is to cleanse the wound, replace the thin skin tear followed by coverage with a dressing that is inducive for wound healing. Several dressings have been suggested for the coverage of these wounds. But, up to now, there has been no mention of the use of a silver-based hydrofiber dressing in the management of this condition. The objective of this study was to explore the use of a silver-based hydrofiber dressing for the management of paper-thin skin tears. We retrospectively reviewed all patients with Type 1 or 2 skin tears that had undergone management using a silver-based hydrofiber dressing between October 2019 and October 2020. Demographic data and medical history was obtained by retrospective chart review. Data that was collected included: age, sex, comorbid illnesses, defect location, defect size, complications, number of times the silver-based hydrofiber dressing was replaced and the number of days required to achieve complete wound healing. A total of 65 patients were included in the study. There were 42 males and 23 females. There were 28 patients whose age was greater then 85 years old, of which 14 patients were over 90 years old. The mean number of outpatient visits was 2. The mean defect size was 33 cm2 (range 1 cm × 1 cm to 18 × 10 cm). The mean number of days required for total wound healing was 13 days (range 7-21). We did not encounter any patients that required further surgical debridement or split-thickness skin grafting. The use of a silver-based hydrofiber dressing was well tolerated by the elderly population as it provided an easy, efficient, economical and effective form of management of skin tears. We suggest that a silver-based hydrofiber dressing can be used as a first-line treatment method for type 1 and 2 skin tears.

[The Utilization of Lean Management in Nursing Handover at a Psychiatric Acute Ward].

BACKGROUND & PROBLEMS: Efficient handover is essential to ensuring high levels of caring quality and patient safety. In our psychiatric acute ward, it was noticed that there were many valueless tasks being performed during the nursing handover process that negatively affected efficiency. PURPOSE: To apply lean management principles to improve the nursing handover process in the psychiatric acute ward. RESOLUTION: In order to find the rightful solution, our task team analyzed the problem using the Value Chart of Lean Management and detected that the handover process was slowed down by motion, waiting, and defects. According to the rules of lean management, group discussion, decision making, and the cost-benefit matrix, we proposed improvement solutions including visual stocktaking, adjusting handover patterns, switching the handover location, and systematizing nursing handover procedures. RESULTS: The time required for stocktaking was shortened from 5 to 2 minutes (60% improvement). The waiting time was shortened from 114 to 49.6 minutes (56.6% improvement). The efficiency of the handover process increased from 66% to 90%. CONCLUSIONS: Applying lean management principles helped detect critical problems and reduce waste, which enhanced efficiency, improved handover, and helped maximize nursing value and benefit in an increasingly complex environment.

[Comparison of Clinical Diagnostic Effectiveness Between Psychiatric Inpatient and Wilson-Sims Fall Risk Assessment Tools].

BACKGROUND: The incidence of falls is very high among psychiatric inpatients. However, the lack of an effective, validated psychiatric inpatient fall risk assessment tool inhibits the ability of medical staffs to make correct judgments. PURPOSE: The purposes of this study were to compare the sensitivity, specificity, and accuracy of the psychiatric inpatient fall risk assessment tool (PIFRAT) and the Wilson-Sims fall risk assessment tool (WSFRAT) and to predict the fall risk factors in PIFRAT and WSFRAT for psychiatric inpatients. METHODS: Study data were collected from 2016/10/01 to 2017/03/10. Fall assessment data were collected from new patients during their 1st through 7th days after admission to a psychiatry unit in northern Taiwan. Data were analyzed using descriptive analysis, logistic regression analysis, reliability and validity testing, tool effective testing, and receiver operating characteristic (ROC) curve analysis. RESULTS: Both of the fall risk assessment tools exhibited low sensitivity (WSFRAT 57.1%, PIFRAT 50%), the specificity of WSFRAT (79.6%) was higher than that of PIFRAT (70.4%), and the accuracy of WSFRAT (76.9%) was higher than that of PIFRAT (67.9%). The ROC curve analysis revealed that the AUC of PIFRAT was .602 (95% CI [0.48, 0.73]). According to the Youden index, the best cutoff level is 7.5 points, in which the specificity is 88.8% and the sensitivity is 39.3%. To increase the sensitivity to 96.4%, the cutoff level must be set to 1.5 points. Moreover, the AUC of WSFRAT was .625 and the highest sensitivity was 82.1% when the cutoff point was set to 3.5 points. Further, multivariate logistic regression analysis revealed that fall risk was significantly higher among patients who had previously fallen than among those had not. Male gender (OR = 2.57, 95% CI [1.11, 5.94]), physical activity difficulties (OR = 3.43; 95% CI [1.40, 8.41]), and weakness (OR = 3.03; 95% CI [1.08, 8.49]) were each significantly associated with fall risk. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study identified four critical risk factors for falls. In the future, clinical healthcare professionals should be more aware of these factors and develop related fall-prevention interventions. The findings may serve as references for the future development of psychiatric fall assessment tools.