A Case Study Examining the Beneficial Effect of the Dolphin Therapy Surface for a Community Patient
Sunita Shrestha, Tissue Viability Nurse, Harrow, Central London Community Healthcare NHS Trust
This case study is of a 94-year-old female patient, suffering from dementia. She had been bed-bound, surviving only on fluids and fortified supplement drinks for the past two years. The patient’s son lived far away and she was therefore completely reliant on care.
In December 2016, the patient had a course of antibiotics and had diarrhoea as a result. This lead to tissue breakdown, with the subsequent development of pressure ulcers. In Feb 2017 the community TVN become involved. By this time the patient had developed an ungradable pressure ulcer on her sacrum which was later debrided and classified as a category IV pressure ulcer. She also had multiple Category I pressure ulcers on both trochanters and black necrosis on both heels.
In addition to her pressure ulcers above, this lady had dry and oedematous skin further placing her at increased risk of further pressure ulcers. Due to lack of social care package there were long gaps between carer visits and hence personal care and repositioning. She was being nursed on a powered hybrid. Her wounds were not healing.
Introduction of Dolphin Therapy
The TVN had previously used the Dolphin Therapy surface with highly complex patients when she was working in the acute sector and had experienced very positive outcomes both in terms of pressure ulcer prevention, healing, comfort and positive patient experience.
She therefore made the decision to contact Medstrom Healthcare to request Dolphin Therapy for this patient.
The patient was placed on Dolphin on 20th Feb 2017 and has been on the surface since.
By May 2017 all the patient’s Category I pressure ulcers had healed. No further pressure ulcers had developed. Both heels had fully healed. The sacral pressure ulcer has shown consistent improvement but had not yet fully healed.
In addition to utilising Dolphin Therapy, carer training and awareness was increased but the lack of a care package and nursing input remains unchanged. Nutritional intake and status of the patient remains unchanged.
Due to the patient’s dementia, it is difficult to judge whether she is more comfortable on Dolphin but non-verbal cues indicate that she is.
The process of ordering Dolphin is easy and great support is provided by the Medstrom clinical advisors. Thorough training was provided by the Medstrom clinical nursing team for the community nursing team, supplemented by the Medstrom engineers at the patient’s home for carers. The service provided by Medstrom is outstanding, with the surface delivered and installed usually within four hours. The Medstrom team offer 24 hour clinical and technical support throughout therapy.
Selecting Dolphin Therapy for complex patients who are bed bound and have multiple comorbidities delivers not only obvious health benefits for the patient, but also avoids the high incremental treatment costs associated with pressure ulcers; 24-hour care packages, TVN time, dressings etc.
The use of Dolphin Therapy for this patient group along with the support of the Medstrom Clinical and Technical team provides answers for the concerns that are cited for patients not being able to remain at home during end of life care:
• Unresolved symptom control
• Breakdown in provision of home care provisions – use of specialist surface
• Lack of support for carers