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Call to empower care staff in monitoring skin integrity

Care workers are critical to preventing wounds among aged care residents and they need to be empowered to act, says an aged care wounds specialist.

The usual strategy in aged care is to have care workers provide the basics, such as showering or assisting with meals, but they have a key role to play in wound prevention, said Hayley Puckeridge, Uniting wound clinical nurse consultant.

She called on aged care organisations to empower their care staff because they are critical to observing skin integrity issues as they saw residents at their most vulnerable including when naked.

Hayley Puckeridge

“That is the prime opportunity to do that full head-to-toe assessment and if they see any breaks, redness or dryness, it can be treated before it becomes a problem,” Ms Puckeridge told Australian Ageing Agenda.

Ms Puckeridge was speaking to AAA on Tuesday at Uniting’s two-day wound conference in Sydney, which she organised as part of an organisation-wide education program that aims to fill knowledge gaps in preventing and treating wounds.

“I am trying to make people rethink and refocus how they look at wounds,” she said.

Ms Puckeridge has spent the last year providing full-day training to almost 2,000 nursing and care staff across Uniting’s services in NSW and the ACT on wound prevention and management.

The 260-plus delegates are now the wound champions for their respective services and will meet with Ms Puckeridge every month.

She said among identified common challenges is a lack of understanding on venous ulcers, which were more prevalent than pressure injuries in aged care and often needed surgical intervention or better treatment.

Another focus was ensuring early referral for specialist treatment.

Two sessions on Tuesday based on diabetic foot ulcers were among key topics aimed at providing best-practice information on these issues, she said.

Insect-based treatment

Elsewhere, Stephen Doggett, director of the Department of Medical Entomology at Westmead Hospital, told delegates why they should consider maggot therapy.

Maggot debridement therapy (MDT) involves placing live disinfected maggots on chronic and necrotic wounds in order to debride and dinsifect a wound and promote healing.

MDT has an 85 per cent success rate, where the alternative would be amputation, doesn’t require hospitalisation, and is cheap, usually costing between $200 and $500 per person, Mr Doggett said.

Despite this, MDT is an underused resource in Australia with challenges including a lack of acceptance by the medical community, he said.

Ms Puckeridge said she would investigate whether MDT could be used within Uniting’s services.

Opportunity to change habits

Saviour Buhagiar

Uniting director of residential aged and health care Saviour Buhagiar said the event aimed to expose staff to the latest thinking and techniques.

Keeping up to date with advice, equipment and treatments were among operational challenges to providing the best wound treatment in residential aged care, he said.

“Getting people to understand what they have done for many years might need to change is a critical feature because people tend to fall back on habits,” Mr Buhagiar told AAA.

RELATED COVERAGE: Aged care provider puts focus on tackling wounds

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4 Responses to Call to empower care staff in monitoring skin integrity

  1. Don Pember March 7, 2018 at 1:57 pm #

    Absolutely. The carers, closest to our elders should be recognised as the key care givers. Generally, clinicians sitting on IT care plans are removed from our elders. Yes empower the Carers, they are The aged care warriors.

  2. Tina Bishop March 8, 2018 at 10:43 am #

    Head to toe assessment is the role of the Registered Nurse, even if Carers, Assistants in Nursing are taught these skills, the responsibility is with the RN.

    WE need to ensure minimum Safe staffing are in these facilities, 20% RN’s. 30% EN’s and 50% Carers.

  3. Kylie Elder March 9, 2018 at 8:29 am #

    Agree. Carers definitely need to be able to monitor skin integrity for early signs of deterioration. They know their residents and can easily monitor skin whilst they assist these people with their daily activities. But what do they do with this knowledge? It needs to be reiterated, that whilst carers are the best people to recognize changes to skin, there needs to be access to trained nurses to escalate these changes to so that evidence based action can be taken with the resident as an active participant. We cannot have one without the other.

  4. kylie wise March 10, 2018 at 5:02 pm #

    Keep loading more responsibility on the unskilled care staff: who needs RNs anyway? Who cares if they’re qualified for the task as long as it fits our de-skilled household model.

    We’ve been banging on about fundamental wound care skills for years but things aren’t improving. The standard of wound management in most facilities is woeful; filthy wound trolleys that cross infect every room they go to, cupboards full of Melolin and Primapore, simple skin tears that become festering ulcers through mismanagement.

    Staff have long been ‘exposed to the latest thinking and techniques’ but we’re just not getting it: have a good look at the number and type of wounds you’re dealing with.

    It’s 2018, If you were really serious about this it would been addressed long ago.

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