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Domain 8 – Skin


These physical health domains tend to be easier to score – if that is possible!!


Skin works well in general, it’s role in a very broad sense is to keep everything in and to much more importantly to keep out infection.  If skin is there and intact, it tends to do its job.  So even if someone’s skin is very fragile and bruises easily, although it may not be pretty, it is working.


There might be a risk of pressure damage and this could be a relatively low level of risk of pressure damage, someone mobile, possibly someone mobile but incontinent.  Then there are the minor skin issues that require some creaming, but only daily as a maximum, not more frequently than that.  Risk of pressure damage can be higher if someone is underweight, incontinent & immobile.  Healing skin is skin that tears, but is healing, if its healing, then its keeping out infection, so minor cuts or minor pressure damage that is healing.


The DST is about risk, pressure damage is a risk factor and therefore skin at risk of pressure damage, so at risk of skin not being able to do its job is a risk.  Risk of pressure damage is scored numerically under a system called “waterlow”.  Under 10 is not considered a risk, 10-15 moderate risk, 15-20 high risk and 20+ very high risk.  There will almost always be a waterlow score, so check that.  In general though, someone relatively immobile and incontinent would have a high risk of pressure damage.  If that was the case, they are likely to be on a turning rota and would be re-positioned every few hours.


It is also worthwhile finding out what cushions and mattresses are in place.  Someone at risk of pressure damage may well have special cushions to sit on and/or a special mattress or mattress cover.


Eczema and/or psoriasis can be well managed, alternatively it may not be so under control and that needs treatment and/or someone to check it multiple times a day.


If skin needs become greater, then skin is no longer intact and therefore infection can set it.  If the infection is not controlled it is possible to get septicaemia, which can prove fatal.  This could mean that pressure damage not responding to treatment or very deep pressure damage which is responding, but it would take a while to heal.  It may also be when someone has a series of pressure sores that although each end up healing, as soon as that happens another one breaks out, which means that overall, the person is never free of pressure damage.


Then there can be a really big problems with skin.  It about pressure damage that’s bone deep, it’s about skin that is not healing or there are multiple wounds, such as gangrene.  This is rare, as fortunately these kinds of problems don’t arise that often, but they can.  This would require very specialist dressing and specialist monitoring.