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Technology Tackles the Pressure Ulcer

 |  By smace@healthleadersmedia.com  
   May 07, 2013

When healthcare technology is really on point, it provides a quick return on investment, improves quality, and usually disrupts business as usual. This week, I have the perfect candidate.

The Agency for Healthcare Research and Quality estimates 2.5 million people in the US develop pressure ulcers per year, 60,000 of whom die from complications. Despite advances in bed technology and many aspects of wound care, the number of hospitalizations for pressure ulcers reported to the Centers for Medicare & Medicaid Services increased 80 percent between 1993 to 2006, despite an increase of only 15 percent more patients.

One of the causes of HAPU, or hospital-acquired pressure ulcers is too much time spent in one position. A study in the February 2013 issue of the journal Wounds, "Pressure Map Technology for Pressure Ulcer Patients: Can We Handle the Truth?" found that a new pressure-sensing technology, deployed on beds, improved the timeliness of patient turning improved greatly.

The study's authors concluded that the new technology enabled between 56 and 63 percent less potential tissue damage that would otherwise have occurred because patients weren't turned enough to relieve pressure points on their torsos and heels.

Outside of healthcare, sensor technology is catching on in a variety of applications, ranging from automotive tech to computer gaming. Now, sensors are tackling HAPU.

Here's how the system works. A thin mat, part of the MAP system developed by Wellsense, Inc. of Nashville, gets placed on a mattress with a color monitor attached. The mat contains thousands of sensors and is secured to the top of the mattress with straps.

These sensors measure pressures through a sensing area about the size of a single bed. These sensors display specific areas of pressure, and as clinicians reposition patients, the system provides live feedback to them so they can see the changing pressure in real time. The monitor acts as an educational tool for staff, patients, and family by showing where the pressure points are located.

Another key feature: a bed alarm that clinicians can set to sound at a desired interval to alert nurses or other clinicians when it is time to turn a patient. For this study, the alarms were set for two hours.

Matthew Q. Pompeo, MD is medical director of  the long-term acute care facility where the Wounds study was conducted. Pompeo has been handling wound patients for 17 years, and says he conducted the trial in three stages.

In stage one, he put the mats on the facility's 55 beds, but "didn't really say much" to staff about what the mats were for. This established a baseline turning frequency. In the second phase, staff could see the pressure map on the video screen so they could reposition patients, but still did not know that the turnings themselves were being recorded. Not surprisingly, turning frequency did not improve much.

In the final phase, the center's staff were made aware that the turnings were being recorded around the clock, and at that point, turning of patients improved significantly.

Oddly enough, there isn't much science behind the turning standard of care being two hours, Pompeo says. "One of the original articles that made that popular was done simply because that's how long it took them to finish their rounds and start over again," he notes.

With the MAP system, clinicians can customize the frequency of turning to match patient needs, which can vary. Some patients can go as long as 3 or 4 hours without being turned, Pompeo says.

The key is that the technology starts a process of measurement, so caregivers can begin to answer the questions of which kinds of patients need to be turned more frequently than others, he says.

That is a key point to me. Just because a technology gets installed, we shouldn't make unsupportable assumptions about the frequency of a given practice or procedure. Let the requirements of care always drive the practice of care, and don't assume that just because an alarm can be set to go off at a prescribed time, that it must be set to that interval for every patient.

Every technology also has its limitations. Although pressure exerted over a duration of time is the main contributor to these ulcers, Pompeo says another minor contributor is shear – forces going not directly into the tissue, but perpendicular to it – a kind of friction. Over time, sensors will probably evolve to measure all of the forces in play. But the 80/20 rule applies here, as many other places, and the MAP system is moving the conversation in the right direction.

Now for the disruption I mentioned. As you probably realize, all hospital beds are not created equal. In fact, over the past ten years, according to Pompeo, "there's been a race to the bottom as far as pricing and in some degrees, quality. Beds are probably about a third of the price they are now per rent per night compared to ten years ago."

Pompeo hastens to add that a bed a third the price is not necessarily a bed a third the quality. But beds "have taken a hard hit," and he says data from the MAP system will shed light on which beds are better, and which are not, in terms of their tendency to promote pressure ulcers.

As for the price of this technology, Pompeo says it is roughly equivalent to the cost of renting the bed itself, which is somewhere in the $15-20 per day range. Giving the enormous cost of treating pressure ulcers, that seems affordable. And the cost of sensors is riding its own downward cost curve down, as most any other technology.

During the study, patients also loved having the MAP system at the bedside. "Their families would become very engaged, start paying attention to it and sort of understand it," Pompeo says.

As for caregivers, the reaction has been more subdued, but the good ones realize that the technology can show management that they are doing their job properly.

Response to the Wounds study is still rolling in, but Pompeo did talk at a National Pressure Ulcer Advisory Panel event with officials from CMS. "They were quite interested, because they want to do this evidence-based medicine and really try to be proactive with things, so we'll see," Pompeo says.

I came away from my conversation with Pompeo inspired to look for more applications of low-cost, ubiquitous sensors throughout healthcare. The Internet of Things promises a revolution in the inside and out of hospitals, and the healthcare benefits now seem to be within our grasp.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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