STAR Project

Funding body
Stage 1:
Smith&Nephew ($30,000)
School of Nursing, Curtin University of Technology ($3,000)

Stage 2:
Office of the Chief Nurse ($50,000)
School of Nursing and Midwifery, Curtin University ($50,000)

Project description
Anecdotally skin tears are described as the second most common wound found on older disabled or physically unwell people (pressure ulcers being the first).  While skin tears do not usually cause serious health problems for the individual, they do disrupt the integrity of the skin, predispose to infection, can be the source of physical and emotional discomfort, and their treatment can be costly. In order to quantify the extent of this problem for older people and to ensure that best practice prevention and treatment protocols exist and are implemented, it is necessary to ensure that we have a common language to describe these wounds.

There is currently no universally accepted definition of a skin tear. Nevertheless there is a skin tear classification, the Payne Martin, but its usefulness and validity have received little attention, and it is not commonly used in Australia.

This project involves a large collaborative research program with Curtin University’s School of Nursing and Midwifery which has the ultimate goal of reducing the numbers of skin tears on older persons by implementing effective prevention and treatment programs across different care settings.  Stage 1 involved the development of a refined classification of skin tears.  Stage 2 involves a case control study to identify those characteristics, personal and situational, that appear to predispose individuals to develop a skin tear. 

Project update
Stage 1 was completed in early 2007 when consensus among a group of Australian wound management experts on a skin tear classification was achieved.  The resultant STAR Classification System was tested and found to be simple and easy to use and the process undertaken to achieve consensus has been published and presented at National and International Wound management conferences. 

The tool has been used in two state-wide wound prevalence surveys and has been widely utilised across Australia (after being made freely available for use by other organisations) in all heath care sectors and internationally.  Feedback has been very positive regarding its utility.  In February 2009 the DONs from the Office of the Chief Nurse, WACHS and the CCI’s Nursing and Health Workforce Strategy Committee (private and aged care sector) endorsed the adoption of the STAR Classification system state-wide.

Stage 2 was commenced in December 2008 and consists of a case control study to identify the risk factors for skin tear acquisition in a Western Australian tertiary hospital.  A Project Nurse has been employed to conduct the study and the data collection phase of stage 2 of the study is complete. We extended the data collection period by one month to achieve our target numbers (450 clients)  as originally data collection was to be completed by end May. The data has now been entered and analysis has  commenced, dependent upon results, once analysed the data will be used to inform the third stage which will involve the development of a skin tear risk prediction tool and risk management guidelines for use in hospital, aged care and community settings.  The fourth and final stage will then be the implementation and evaluation of the effectiveness of the tool and guidelines across different health care settings.

Publications
STAR: A consensus for skin tear classification, February 2007 [PDF]
Carville, K., Lewin, G., Newall, N., Haselhurst, P., Michael, R., Santamaria, N., Roberts, P. 2007. STAR: A consensus for skin tear classification. Primary Intention 15(1): 18-28.

STAR: Skin Tear Tool  - Latest Version - 04/02/10 [PDF]
For permission to use or reproduce the STAR tool please contact NNewall@silverchain.org.au or kcarville@silverchain.org.au

Related links
Wound Care Manual
An up to date practical guide for the management of all types of wounds.

For further information please contact
Nelly Newall
Clinical Research Co-ordinator
Email  NNewall@silverchain.org.au