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7th EPUAP Pressure Ulcers Prevention and Management: Have we made a difference?
Anne MacFarlane, Sue Sayer
Shared experiences of two Scottish Hospitals in the evaluation and resultant implementation of Repose mattresses and heel protectors as part of their hospital protocol in the prevention and treatment of pressure ulcers.
Conclusions: In WGH (Western General Hospital, Edinburgh), Repose mattresses have demonstrated dramatic reduction in costs (£34,603 over 6 months) whilst the prevalence and hospital acquired pressure ulcers have not significantly altered. In HH (Hairmyers Hospital, East Kilbride), Repose heel protectors have clearly indicated benefits with a significant reduction in incidence results (from 17% to 0%). Satisfaction surveys carried out during the trial periods indicated that these products required low maintenance and were easy to use making them popular with nursing staff, patient and procurement staff. These two products are now part of the Guidelines for Pressure Ulcer Prevention and Management in both hospitals.
Pressure Relief With Visco-Elastic Foam or With Combined Static Air Overlay? A Prospective, Crossover Randomized Clinical Trial in a Dutch Nursing Home
Martin van Leen, MD; Prof Steven Hovius, MD, PhD; Ruud Halfens, PhD; Jacques Neyens, PT, PhD; Prof Jos Schols, MD, PhD
In this small study, a visco-elastic foam mattress with a static air overlay provided better prevention than a visco- elastic foam mattress alone (5.2% vs 22.2%).The Braden scores of the patients in both groups did not change dur- ing the 6-month test.The decision to use repositioning only when there were signs of a pressure ulcer is accept- able when a static air overlay is in position.The 22.2% incidence of pressure ulcers in the foam group, however, may stress the need to continue repositioning when us- ing this type of mattress.
After this study, and also based on the results of a cold foam vs static air mattress study,10 the institution where the study was conducted chose to make use of a static overlay mattress as part of its standard PU prevention protocol. For every at-risk patient lying on a cold foam or visco-elastic foam mattress, the static air overlay was added as a second step instead of repositioning at De Naaldhorst nursing home.
Challenging the pressure sore paradigm
P. Price, S. Bale, R. Newcombe, K. Harding, University of Wales College of Medicine, Cardiff, UK
Abstract: This study determines the effectiveness of a new now-unit-cost system in patients at very high risk of developing pressure sores. In a prospective randomised controlled trial, a low pressure inflatable mattress and cushion system (Repose) was compared to a dynamic support mattress (Nimbus II) used in conjunction with an alternating pressure cushion (Alpha TranCell) in 80 patients with fractured neck of femur and high scores on a pressure sore risk assessment scale. All patients received best standard care, including turning at regular intervals. Skin condition was assessed in 17 locations on admission, preoperatively, and seven and 14 days postoperatively. No difference was found between the group s in skin condition or the occurrence and severity of pressure sores at any time point.
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EPUAP Berlin 2006 - Poster presentation Pressure Ulcer Prevalence Audit: What are the benefits of doing it?
Anne Ballard Wilson
Conclusions: A reduction in Pressure Ulcer Prevalence of 2% over the 5 years cannot be seen as significant, but it is encouraging that the prevalence is no higher. There has been a definite shift away from the use of dynamic systems within the Acute Hospital Division. Due to the increased availability of Repose mattresses, patients are being “upgraded” more quickly. In the past, nursing staff may have waited several days to obtain “higher level” equipment, with pressure areas already deteriorating. Although cost impact has not been looked at within the scope of these audits, the Trust was spending in excess of £300,000 in 2001 on dynamic equipment. The budget for all pressure relieving equipment is now £62,000 per annum.
8th European Pressure Ulcer Advisory Panel Open Meeting, Aberdeen, Scotland May 5-7th 2005
Clinical evaluation of the effectiveness of a multimodal static pressure relieving device
J. Osterbrink, H. Mayer, Gerhard Schröder
Purpose of Study: The aim of the study was to provide proof of the effectiveness of a support aid for the prevention or treatment of pressure sores. The system under review was REPOSE, a range of air filled polyurethane products comprising a mattress overlay, a cushion, foot protectors and a wedge. Results: Superiority (p=0.009) for Repose over a small-cell system in terms of the wound healing tendency, and a comparability to a large-cell system (p=0.212) Patients significantly more satisfied with the Repose over both the other systems (p<0.001 for the small-cell system, p=0.024 for the large-cell system)
Pressure Relief in a Field Hospital – No Problems, Only Solutions
David Chatwin, Skin and Wound Care, Derriford Hospital, Plymouth
The use of a new overlay mattress in patients with chronic pain: impact on sleep and self-reported pain
P Price, S Rees-Mathews, N Tebble, J Camilleri. University Hospital of Wales, Cardiff, Wales
Conclusions: In this pilot study of a new mattress overlay, statistically significant improvements in sleep and pain were noted over a four-week period.
Recognizing the feet as being at risk from pressure damage
Sue Bale, Patricia Price, Sally Rees-Mathews, Keith G Harding
Abstract: This article reports the findings of a survey and an a udit under taken to investigate the provision of foot support in a university teaching hospital. Phase 1 surveyed strategies employed to support feet and phase 2 audited the use of the Repose Foot Protector, manufactured by Frontier Therapeutics, specifically designed to provide pressure support for the feet. Patients with reduced mobility, nursed out of bed in a chair, have been highlighted as a group potentially at risk of tissue damage to the heels. This survey of current strategies employed to support feet included 289 patients. Patients included were from both hospital and community settings. The survey reported a lack of specialist equipment for the heels of patients with reduced mobility sitting in a chair. Only 67 (23.2%) patients were allocated foot support (typically a stool, with or without a pillow) to use while seated out of bed in a chair. The audit of requests for a new device to protect feet included 100 patients. The main reasons for requesting this device included pressure relief (81 occasions), to treat ‘foot drop’ (32 occasions) and in promoting comfort (31 occasions). There was a significant improvement in the skin condition of the heels and comfort (P<0.0001) from study entry to exit. This audit indicated a high level of both staff and patient satisfaction.
Repose: the cost-effective solution for prompt discharge of patients
Abstract: Pressure ulcer prevention is expensive and at times difficult to achieve. Formation, or the potential formation, of pressure ulcers can lead to delayed patient discharge, particularly when the appropriate equipment is unavailable on the day of discharge. This article reviews the potential of Repose, an inflatable mattress overlay, to be an inexpensive and clinically effective alternative to alternating air mattress systems.
The use of a new low-unit cost support system (Repose) for patients with fractured neck of femur: an RCT. Challenging the paradigm.
P.E.Price , S Bale and K.G.Harding,
Conclusion: This low-pressure overlay appears to offer a similar level of benefit in preventing the development of pressure sores in this high-risk group, and merits further investigation due to the potential for major cost reduction.
Two clinical evaluations of the Repose system
Ann MacFarlane, Sue Sayer
Abstract: Background: Pressure ulcer prevention is expensive and at times difficult to achieve within budget. Objectives: Two evaluations of the Repose pressure ulcer prevention system were carried out concurrently in two centres across a wide range of acute clinical settings to establish cost-effectiveness, product durability and clinical efficacy. Methods: In one centre, patients in a 24-bed orthopaedic ward were recruited over a three-month period to evaluate the clinical effectiveness of the Repose heel protector (measured by a reduction in heel pressure ulcer incidence) and its ease of use (as assessed by an evaluation form). In the other centre, the Repose mattress overlay was evaluated throughout a hospital to establish its clinical efficacy (measured by reduction in pressure ulcer prevalence), its performance and cost benefits compared to the existing bed lease scheme. Results: Use of the Repose heel protector reduced the incidence of heel pressure ulceration from 17% to 0%, while the use of the mattress overlay reduced prevalence from 7% to 2–3%. The majority of staff found b oth products easy to use, with the main criticism levelled at its repackaging once used. Use of the products conferred significant cost benefits. Conclusions: Both hospitals involved in the evaluation now have Repose included in their best practice guidelines.
The Evaluation of a Prototype Handling Device to assist with Horizontal Lateral Transfers
Mike Fray and Sue Hignett
Abstract: A novel combination of existing technologies were used to design a prototype handling device to assist with the horizontal lateral transfer of patients. The development of the device suggested that there would be savings for both time and effort. A detailed ergonomics evaluation was conducted to evaluate the expected benefits. Experienced patient handling advisors carried out a comparison trial using three other frequently used lateral transfer devices. Data were collected on the handling methods used; the patient experience; the user experience; and the forces required to complete the transfers. The prototype device performed better than the comparators in terms of time, force, ease of use by the users. It also scored well for the patient outcomes of comfort and security. The statistical analysis showed that the data tended to significance and the post-hoc tests showed that the variation was consistent with the novel design.
Reduced heel pressure damage when using the Repose Foot Protector
Abstract: An evaluation of the Repose® heel pressure ulcer prevention system was conducted in an orthopaedic setting to establish its clinical efficacy in reducing the incidence of heel pressure damage, following a literature review of appropriate pressure-reducing devices. The study involved patients from a 24-bed orthopaedic ward over a six-month period. The results showed that the use of the heel protector led to a significant reduction in the incidence of heel pressure ulceration from more than 6% to 0%. A significant reduction in cost was also identified. The results indicate that the use of a heel protector alongside individualized pressure ulcer prevention has a significant impact on preventing heel pressure damage.