When skin tears happen repeatedly, treating each new wound is only part of the work. The pattern deserves its own review. A nurse needs to understand where and when the injuries occur, what the surrounding skin is like, how the person moves through ordinary activities, and whether the current prevention plan is workable at home. The answer is individual. Repetition alone does not reveal a single cause or prove that someone has provided poor care.
Our earlier article, Skin Tears and Fragile Skin in Older Adults, explains why the first injury needs assessment in the context of the person. This article addresses the next question: what should change when a similar injury happens again? It does not tell a family member how to dress a tear, select a product or diagnose a wound from a photograph.
Key points
- Record when and where each tear occurs, including what is uncertain about its cause.
- Review intact skin, daily routines, movement and changes in health alongside the newest wound.
- Give each prevention action an owner, a review point and a route for earlier clinical advice.
Start with the pattern the record can actually show
“She keeps getting skin tears” conveys concern, but it gives the treating team little to compare. A useful record identifies the date and site of each injury, how it was noticed, what activity was happening, whether there was pain or bleeding, and what happened to the skin afterwards. Some details may be uncertain. The person may not remember a particular knock, or a tear may only be noticed during dressing or washing. Record that uncertainty instead of filling it with an assumed cause.
The pattern may be clustered around one activity, one part of the home or one area of skin. It may also be spread across different situations. Those are different clinical questions. A repeated injury at the same site may require a closer look at how that area is exposed or protected. Injuries in several locations may prompt a broader assessment of skin condition, movement, support and health. Neither observation is a diagnosis on its own.
The Victorian Department of Health advises that assessment of skin problems considers the older person's skin, health history, nutrition, mobility, continence and care routines.1 Its guidance is written for hospital care. At home, the same domains can help frame an assessment, but a hospital risk tool or timetable should not be copied into a home plan without clinical judgement.
Examine skin health as well as the latest tear
The newest wound often attracts most attention because it needs immediate care. A prevention review also looks at intact skin. Is it dry, irritated or exposed to moisture? Are there previous tears or areas where adhesive removal has caused difficulty? Does a limb have swelling or another change that needs assessment? These observations matter because a prevention plan aimed only at the latest dressing may leave the wider risk unchanged.
A nurse can document the wound and surrounding skin, compare it with the previous record, and identify whether medical or specialist assessment is needed. Queensland Health's chronic-wound pathway includes skin factors, the cause of the wound, relevant health conditions, the care goal and review triggers in a structured assessment.2 That pathway is for residential aged care, so it supports the questions to ask here; it is not a set of instructions for a person to carry out independently at home.
The older adult's account deserves equal attention. A protective sleeve that catches on clothing, a dressing that makes washing difficult, or a product that irritates skin may not be visible in the visit note unless somebody asks. Comfort, clothing choices, daily routines and preferences can determine whether a plan is used consistently. An effective review listens to the person before deciding that adherence is the problem.
The review should also note whether the person's health or treatment has changed since earlier injuries. A new illness, altered mobility, nutrition concern or medicine may affect the clinical assessment, though none should be assigned as the cause without further evaluation.1 Nursing can identify the timing and bring a question to the GP, pharmacist or treating specialist. It should not advise stopping a medicine or changing a dose to protect skin. If the person is worried that a treatment is contributing, that concern deserves a clear route to the prescriber and an answer that reaches the care team.
Look at ordinary contact and movement
Skin can be injured during routine activity, including transfers, dressing, bathing or moving through a narrow space. A review should ask what the person was trying to do at the time of an injury and whether that activity has changed. The aim is to identify a specific exposure that can be addressed without unnecessarily restricting valued activity.
Consider the difference between “avoid bumping your arm” and a plan that identifies where contact occurs, who will review the environment, and whether a different way of carrying out the activity is acceptable to the person. The second is more useful because someone can check whether the proposed change has helped. If transfers or balance are involved, nursing may need to communicate with physiotherapy or rehabilitation rather than treating movement as an issue outside the wound plan. This is a coordination decision, not an assumption that exercise or equipment will prevent every tear.
It is also possible that a new injury followed a one-off event. A prevention review should not turn every incident into a permanent restriction. The question is whether the record shows a modifiable pattern, an unmet care need, or a reason to seek another assessment.
Check whether the plan has a named owner and review point
A prevention plan can contain sensible advice and still fail in practice if nobody knows who will do what. Which parts are completed by the older adult? Which tasks, if any, are authorised for a family member, support worker or nurse? Who supplies approved materials? How will a concern between nursing visits reach the treating team? These are care-plan questions, not just product questions.
The wound and skin care pathway describes how Clinics GRP Nursing assesses, follows up and escalates a concern within accepted scope. A nurse may recommend that the care team revisit a routine or seek medical advice, but changes to prescribed treatment and decisions outside nursing scope belong with the relevant clinician. Where several providers are involved, the update needs to reach the current care plan and the people authorised to use it.
A review point is especially important after a change. “Use the new approach and see how it goes” leaves the next decision undefined. The plan should say what the team expects to observe, when it will reconsider the approach, and what should prompt earlier contact. A prevention measure may be reasonable yet difficult to sustain; that becomes visible only when the person's experience is checked, not when the measure is simply listed in a record.
Do not let recurrence hide a wound that needs assessment now
Repeated tears do not make a new injury routine. Significant bleeding, increasing pain, spreading redness, fever, a wound that is worsening, or a person who becomes unwell calls for timely medical advice. If the wound is not following its expected course, the team should revisit the cause and care plan, as described in When a Wound Is Not Progressing as Expected.2
Call Triple Zero (000) for a medical emergency. Clinics GRP is not an emergency or 24-hour service. A family member should not have to decide whether a wound is infected or start a new treatment because of this article. The safe contribution is to describe what changed, seek the appropriate assessment and make sure the concern reaches the person responsible for the plan.
A recurrence review should leave a short, individual explanation of the likely exposures, the clinical uncertainties, the agreed actions and how the team will tell whether those actions are helping.
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Relevant care
References
- Victorian Department of Health. Identifying and preventing skin problems. https://www.health.vic.gov.au/older-people-in-hospital/pressure-injuries-and-skin-tears-0/identifying-and-preventing-skin-tears
- Queensland Health. Chronic wound assessment and management. Residential aged care clinical pathway. https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/clinical-pathways/residential-aged-care-clinical-pathways/all-pathways/chronic-wound-assessment-and-management
General information only; not individual clinical advice. Named clinical review and a recorded review date are required before public publication.