By Kathi Thimsen RN, MSN, WOCN
Oliver S. is a resident in a nursing home. You have consulted on his case for management of perineal excoriation and rash. Your orders included the use of a cleanser and a skin protectant (both products are on the facility formulary).
Upon implementation of your orders, the resident complains of severe burning immediately following the application of the cleansing product. Rinsing relieves the complaint but immediately after the protectant is applied, the resident cries out with pain.
Repeated applications of the products result in the resident having persistent complaints of pain and burning. The skin after the fourth application is warm to touch and indurated at the excoriated edge margin and the patient is refusing use of the products.
The facility calls you and reports the situation. Your response should immediately ask:
- What products were used on the patient?
- What are the ingredients in the products?
- Does the patient have known allergies to any of the product ingredients?
The next steps of care should address the reduction and elimination of the product residual on the skin, as well as decisions on appropriate treatment to reduce pain, reduce the potential of additional trauma to the resident and skin, and promote the healing of the skin injury.
Ingredient implications to practice
Compromised individuals are the population that is most prevalent in care settings. Persons may have existing allergies or sensitivities to products, drugs and ingredients. Yet, in skin and wound care practice the aspect of care related to sensitivities or allergies is not always addressed or known.
Complicating patient management of altered or injured skin is the potential of product formulation (ingredient) penetration and absorption through the skin, altered skin or mucous membrane. Chemicals absorbed by the skin increase the potential for allergic reactions and systemic complications.
Cases of skin and wound products implicated in neglect, abuse, and malpractice (not to mention product liability) are shown to have been preventable. Having knowledge of a product, ingredients, and the penetration and absorption potential will serve a clinician well in providing appropriate and safe practice.
Skin and wound care products may or may not be over the counter (OTC) drugs or medical devices. Some are categorized as cosmetics. Some are even mislabeled and therefore misleading. Do you know the difference? Many products are manufactured outside of the United States and do not require the scrutiny of Food and Drug Administration (FDA) regulations. Recent headlines have included drug production of low quality, less potency, or dangerously high concentration of ingredient components. Being an informed clinician and consumer increases the potential for quality outcomes of care.
This series of ingredient related blogs will discuss the role of ingredients, what the clinician needs to know, how to decipher a label or ingredient listing and support your clinical recommendations.
About The Author
Kathi Thimsen RN, MSN, WOCN is a leader in the field of wound and ostomy care, publishing articles, presenting at conferences nationally and internationally, and serving on numerous committees and education boards including the International Association of Forensic Nurses Ethic Committee.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.