Tools of the Trade: Pressure Injury/Ulcer Prevention and Medical Devices

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Repositioning tool

by the WoundSource Editors

In today's health care market, we have numerous turning and repositioning tools, offloading devices, and sensor technology gadgets available. You may ask "Why do we need any of these technologies if we provide consistent quality of care?" "Consistent" is the key word in preventing ALL pressure injuries/ulcers. There are nursing shortages, gaps in education, and a need for nursing or caregiver efficiency.

There will always be a risk of pressure injury/ulcer development for our sick patients. If we can use advanced technology to promote "consistent" quality of care, we should do it. However, in our health care system, the battle for reimbursement drives what equipment we can use for our patients. We need to compare and assess the available options before selecting what enhanced prevention tools or devices we may want to utilize.

Pressure Injury Prevention Turning and Repositioning Tools

Cuing Innovations – The following tools provide the body location to offload and position every two hours:1

  • Turning and repositioning clock with an alarm to cue
  • Clock charts at the nursing station that are signed off by the Charge Nurse
  • Music/bells over the loudspeaker to cue every two hours
  • Turning and repositioning labels placed on the ends of the patient's bed as a reminder
  • Tracking, logging, and charting tools that are signed off by the nursing assistant and nurse
  • Pressure Visualization System – Advances in technology have made visual monitoring of the patient for pressure injury/ulcer risk an option for health care providers. Current technology on the market includes a device that recognizes and tracks the body position and pressure affecting all 12 bony prominences. It then provides feedback and alerts, along with a generated detailed report. This system is compatible with most support surfaces.
  • Wireless Sensor Monitoring System – A sensor, which monitors and tracks the patient's activity, is placed on the patient's chest. There are numerous generated reports available by shift hours, hall assignment, etc.2
  • Sensor Socks – Foot Monitoring System proactively tracks foot temperature. The socks monitor temperature of the feet, and if there's an unusual increase, as from an injury, they let the patient know.
  • Turning and reposition positioners – There are a variety of devices, pads, and slings that make turning easier and positioning more secure while helping to reduce pressure injuries.
  • Pressure Injury Prevention Devices

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The following devices are used to help offload pressure or reduce sheer to help reduce the incidence of pressure injuries/ulcers.

Offloading footwear – This type of footwear consists of therapeutic shoes designed to provide pressure redistribution.3
Protectors – Protectors are devices that help reduce injury to the skin caused by friction or shear forces. The most commonly used locations are the elbows and heels.
Positioners – Positioners offload by suspending, elevating, or changing position of the body area.

Pressure Redistribution, Support Surfaces, and Therapeutic Linens

Selecting the appropriate support surface is determined by many factors. This is key in preventing and managing pressure injuries/ulcers. You want to remember that your patients’ size and weight will determine the contact area between them and the surface. For example: You wouldn't want to use a two-inch seating cushion on a 300lb person. The cushion will not help redistribute pressure.

  • Therapeutic linens – These FDA-cleared bed linens and textiles are designed to address shear and friction factors.
  • Surgical surfaces (air, foam, or combination) – These are designed for patients undergoing a long surgical procedure, or for high-risk patients; used to redistribute pressure during a surgical procedure.
  • Powered covers – The electric powered cover is placed directly over a standard mattress, thereby promoting microclimate.
  • Low air loss – Continuous forced air flows through tiny pinholes within the mattress to promote microclimate.
  • Alternating pressure – Individual cells or air bladders inflate in alternating patterns to shift pressure. The patient will still need to be turned and repositioned on this mattress.
  • Air fluidized – Circulation of filtered air through silicone-coated ceramic beads creates a fluid or flotation of the patient on the surface.
  • Static flotation – This non-powered support surface uses one or more of the following components—air, water, foam, or gel—to redistribute pressure from vulnerable areas.

comparison_of_support_surfaces.png
  • Seating cushions – Foam, gel, and air components can be used with powered or non-powered surfaces.

comparison_of_seat_cushions.png

Conclusion

Enhancing your prevention program will drive good outcomes when equipment is selected and used correctly for your patients. Check equipment daily to ensure it is functioning properly. Are the powered pumps set on the correct weight? Is the device helping to remove the cause of pressure injury/ulcer risk? Ongoing education to staff, caregivers, and the patient is also important in reaching prevention goals. Understanding the best ways to prevent a pressure injury/ulcer is paramount in improving patients' outcomes and reducing overall health care costs.

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References
1. Carver C. Tools to Maximize Turning and Repositioning Programs for Pressure Injury Prevention. WoundSource. 2016. https://www.woundsource.com/blog/tools-maximize-turning-and-repositionin.... Accessed on October 8, 2018.
2. Medgadget. Siren Diabetic Socks Monitor Temperature of Feet, Detects Early Signs of Injury. 2018. https://www.medgadget.com/2018/04/siren-diabetic-socks-monitor-temperatu.... Accessed on October 8, 2018.
3. WoundSource.Offloading Footwear. 2018. https://www.woundsource.com/product-category/offloading-devices/offloadi.... Accessed on October 8, 2018.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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