The Pressure Ulcer Prevention Team is a unique, quality focused Service
provided by Bradford District Care Foundation Trust and Airedale,
Wharfedale & Craven Clinical Commissioning Group. The Team’s main
focus is to adopt a ‘Zero Tolerance’ to Pressure Ulcers and work towards a
reduction in prevalence. The Team consists of seven highly experienced
qualified nurses who have all spent significant periods of time working
within busy District Nursing Teams, so are aware of the challenges faced
on a daily basis. The role of the team encompasses working closely with
District Nursing Teams providing training, education and support, whilst
monitoring pressure ulcer incidence and assessing for appropriate pressure relieving equipment.
One of the most challenging aspects of the role is providing support during the assessment for pressure relieving equipment or when the patient chooses to decline these interventions. To assist with these challenges we have been using interface pressure mapping technology –The Foreside Pressure Mapping System from Sumed International (UK) Ltd. This system collects interface pressure data which is then displayed as visual images on a computer tablet. This clearly shows areas of high and low pressures and the effects of different equipment or positioning.
The Foresite system comprises of a sensor mat attached to a computer tablet which collects data and displays images.
Snapshots can then be taken to record specific images and
allow data review and interpretation after the
session has been complete. The Pressure Ulcer Prevention Team used the
Foresite pressure imaging system to collect
data and images, demonstrating interface pressures to ensure a
patient due to be discharged home was provided with the most effective pressure relieving seating whilst maintaining her
independence. The Team were also able to use the data and images to improve concordance by
demonstrating to a patient the effectiveness and importance of pressure reliving equipment with both visual images and data.
The data was collected and interpreted in accordance with The Interface Pressure Mapping Best Practice Guidelines (2014)
Pressure mapping data was collected for two different patients. Patient One had a number of equipment options but needed to be able to stand from the chair to maintain independence, whilst the effectiveness of the equipment needed to be demonstrated to Patient Two to improve understanding and concordance. The imaging and data obtained enabled the Pressure Ulcer Prevention Team to resolve the challenges they faced for both patients with minimal effort and disturbance for the patients.
The initial feeling of the discharge team was that the patient would be provided with a higher level of pressure relief by using an alternating air cushion following discharge home, where less frequent position changes could be offered. The Foresite Pressure Mapping System was used to assess the patient to ensure that this was the most appropriate piece of pressure relieving equipment available. The average peak pressure using the alternating air cushion was 33.62mmHg compared to a significantly lower reading of 24.42mmHg on a standard gel cushion. This difference was further highlighted as the gel cushion demonstrated a greater area of emersion into the cushion with a surface area of 937.09cm2 compared to 724.19cm2 for the alternating air cushion.
Not only did the patient report greater comfort from the gel cushion, but had
increased confidence in standing from the chair due to a more stable base.
The discharge team and the patient’s family were reassured that the gel cushion
offered better pressure relief, and the patient was subsequently discharged
home and has encountered no problems with regard to skin integrity.
Patient Two had a healed category 4 pressure ulcer to the sacrum, but was non concordance with the use of pressure relieving equipment. This had previously been an issue and had resulted in the deterioration of the pressure ulcer. The patient expressed that he would like to sit in the lounge and interact socially with family and friends, but had previously been non concordant with pressure relieving equipment.
The Foresite Xsensor Pressure Mapping System proved to be a powerful way to demonstrate the benefits of using pressure relieving equipment and resolved the patient non-concordance. The category 4 pressure damage remains healed.
ADD IN PATIENT SCREEN SHOTS SUPPLIED –LABELLED CASE STUDY 2
We have now implemented the use of pressure imaging more widely throughout our service and will be looking to monitor other associated benefits in terms of improved education, healing rates and reduced treatment and review costs.