A pilot audit of the frequency and pattern of occurrence of Medical

Adhesive Related Skin Injuries (MARSI)

Jacqui Fletcher Clinical Strategy Director*

Welsh Wound Innovation Centre, Wales, United Kingdom

*Author details:

jacqui.fletcher@welshwoundinnovationcentre.com

Co authors: Andra Jones2 and John McRobert3

1 Welsh Wound Innovation Centre 2 Salford Royal

NHS Foundation Trust 3Brighton and Sussex

University Hospitals

This work was supported by the Welsh Wound

Innovation Centre and 3M Healthcare

IntroductionAnecdotally it appears patients suffer considerably from Medical Adhesive Related Skin Injuries (MARSI), a recent consensus ( McNichol et al 2013) suggest that

MARSI is under recognised across all care settings. Whilst the consensus document sets out guidance on how to prevent MARSI it is difficult to make them a

priority when it is not possible to state the frequency of occurrence.

AimThe aim of this audit was to test the data collection form which would be used to determine the frequency and pattern of occurrence of MARSI.

ConclusionIt appears that MARSI do occur in patients with both healthy and fragile skin and that the data

collection method is an appropriate way to capture the data. The data collection will now be

repeated in a broader range of specialities (ITU, Vascular, Hospice, Care Homes, Paediatrics) .

Methodology.Prior to an audit across multiple settings a small pilot study was designed and

carried out across 2 orthopaedic units in the UK for 1 week. The settings

differed only in that unit A had recently introduced a ‘kind’ adhesive tape. Data

collection forms were distributed to the 2 units by a central audit

coordinator, they visited the units on a daily basis to remind staff of the data

collection.

Forms were distributed to a single orthopaedic ward by the audit co-ordinator.

Each ward was given an overview form (see figure 1) which identified the

characteristics of the area and the overall numbers of patients who were

inpatients during the week long period over which data were collected. The

wards were also given a supply of forms (see figure 2) on which to record the

details of occurrence of any MARSI which occurred). To ensure forms were

not duplicated the top section of the form was a patient identifier, this was

removed by the co-ordinator prior to the forms being submitted at the end of

the week, thereby ensure anonymity. Any patient who developed a MARSI

was asked if they would consent to a photograph and if they would be

prepared to briefly describe how the wound felt and had impacted on their

care.

At the end of the data collection period, following removal of the identifying

information forms were returned to the central co ordinator.

Fig 1 Overview form

Patient 1 2 3 4 5

Male /

Female

F Male F M F

Age

range

61 – 70 71 – 80 61 – 70 71 – 80 71 – 80

Skin is Healthy Not

complet

ed

Fragile Healthy Healthy

Type of

wound /

device

Surgical Surgical Surgical Surgical IV Cannula

Where Knee Left Hip Right Knee Hand

Describe

d as

Blister Blister Superfici

al

damage

Superficial

damage

Redness

Why Swelling Tape

difficult

to

remove

Dressing

removed

too soon

Adhesive

dressing

applied –

patient has

allergy to

adhesives

Image courtesy

of John

McRobert

Image courtesy

of John

McRobert

Image courtesy

of Jacqui

Fletcher

ResultsUnit A reported no instances of MARSI during the audit week. Unit B reported

5 patients with MARSI (see table 1). Staff reported the data collection form

easy to use and forms were well completed.

Table 1 MARSI identified

Examples

of MARSI

Fig 2 Individual patient

formDiscussionAll the patients who developed MARSI were over 60 years of age, however this reflects the

typical age range of the patients on the elective orthopaedic ward. Of more interest is the

fact that only 1 patients was identified as having previously fragile skin, 3 were deemed to be

healthy – and in 1 instance this information had been omitted.

Reference: McNichol L, Lund C, Rosen T and Gray M (2013) Medical Adhesives and Patient Safety: State of the Science

Consensus Statements for the Assessment, Prevention, and Treatment of Adhesive-Related Skin Injuries JWOCN 40 (4) 1 - 15