Skin Care

Residents who are dying are at high risk of tissue damage. They have reduced capacity for healing and prevention of injury should be the primary aim.

  • Careful positioning, avoid friction and shearing forces, bumps and scratches
  • No vigorous skin rubbing
  • Appropriate continence management program
  • Clean skin with pH neutral skin cleanser and dry thoroughly
  • Protect skin with water based skin emollients
  • Pressure relieving devices

A recent review [1] found that:

  • high specification foam mattresses are more effective at preventing pressure injuries than standard foam mattresses and should be used for people at high risk of pressure injury.
  • medical grade Australian sheepskins (but not synthetic sheepskins) have also been shown to be effective at reducing pressure injuries.
  • no conclusions were able to be drawn about high technology devices, such as alternating pressure mattresses due to the limited evidence base
  • pressure relieving devices should be chosen with regard to the resident’s requirements and comfort.

A resident sitting in a standard wheelchair, other than for a very short time, requires a pressure relieving cushion on the seat. It is preferable that the cushion also reduces shear forces. [2] It has been common practice to recommend a schedule for repositioning residents unable to move themselves. There is no evidence that one time interval is more effective than another. The APRAC guidelines [3] suggest a repositioning regime should be based on the assessed need of the resident. Questions to consider include:

  • what alternatives to repositioning are available, pressure relieving devices?
  • will the intervention cause more discomfort than is necessary?
  • what is the residents preferred position?
  • is it essential to alter the position of the resident?
Falls, friction and shearing forces can also result in skin tears. Skin tears are acute injury that results in the separation of skin layers. Although skin tears are common and painful injuries the evidence for how to prevent or treat them is still developing. Consensus guidelines [4] have recently been published.

Adhesive tapes used to secure dressings, catheters and medical devices can also cause skin injury if used or removed incorrectly. [5]
  1. McInnes E, Jammali-Blasi A, Bell-Syer SEM, Dumville JC, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2011 Apr 13;(4):CD001735.
  2. Brienza DM, Karg PE, Geyer MJ, Kelsey S, Trefler E. The relationship between pressure ulcer incidence and buttock-seat cushion interface pressure in at-risk elderly wheelchair users. Arch Phys Med Rehabil. 2001 Apr;82(4):529-33.
  3. Australian Palliative Residential Aged Care (APRAC) project. Guidelines for a palliative approach in residential aged care Enhanced version - May 2006. Canberra: Commonwealth of Australia, 2006.
  4. LeBlanc K, Baranoski S. International skin tear advisory panel: Putting it all together, a tool kit to aid in the prevention, assessment using a simplified classification system and treatment of skin tears. World Council of Enterostomal Therapists Journal. 2014 Jan-Feb-Mar;34(1):12-27.
  5. McNichol L, Lund C, Rosen T, Gray M. Medical adhesives and patient safety: state of the science. consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries. J Wound Ostomy Continence Nurs. 2013 Jul-Aug;40(4):365-80.

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Last updated 30 January 2017