“health & wealth for wales” “health & wealth for wales”

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“Health & Wealth for Wales” “Health & Wealth For Wales”

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Page 1: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Page 2: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Right Equipment…. Half the Story

Jacqui FletcherClinical Strategy Director

Welsh Wound Innovation Centre

@jacquifletcher3.....

Page 3: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

• Equipment drives me crazy

• It solves so many problems

• It creates so many problems

• We abuse it on a regular basis – then blame it when it ‘doesn’t work’

Page 4: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Outline of the session

• Inappropriate use of equipment — a source of skin damage and complaint  

• The effective use of add-on equipment — risk/benefit analysis, optimising pressure relief decision-making 

 • Getting the best from your resources

— releasing time to care 

Page 5: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Poor use of equipment

• An HTA report by University of York

• Multi centre RCT • PRESSURE trial 1971 patients,

compared alternating overlay to alternating mattress replacement

Page 6: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

PRESSURE trial

•Technical problems with mattresses 207 (on 131 overlays) and 370 (on 223 replacements)

•Problems were

Nixon et al 2006

Page 7: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Problem Overlay Replacement Total

Plug / electricity not turned on

40 (19.3%) 33 (19.2%) 73 (19.3%)

Transport / static mode

4 (1.9%) 25 (14.5%) 29 (7.7%)

CPR 24 (11.6%) 4 (2.3%) 28 (7.4%)

Connectors / tubing / mattress position

8 (3.9%) 11 (6.4%) 19 (5.0%)

Settings 53 (25.6%) 12 (7.0%) 65 (17.2%)

Alarming 20 (9.7%) 31 (18%) 51 (13.5%)

Deflated / low pressure

49 (23.7%) 45 (6.2%) 94 (24.8%)

Pump failure 0 (0%) 3 (1.7%) 3 (0.8%)

Broken part 4 (1.9%) 6 (3.5%) 10 (2.6%)

Unknown 5 (2.4%) 2 (1.2%) 7 (1.8%)

Nixon et al 2006

Page 8: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Inappropriate use of equipment — a source of skin damage and complaint

Page 9: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Patients vary considerably in size and body mass, yet we expect our equipment to cope with the majority of patients – is this reasonable?

Page 10: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Do you know if…..

• Your mattresses are the same size as your beds?

• Staff were taught (and do) the correct sequence to articulate bed frames?

• Your high specification foams contour fully to the bed frames?

• How your frames contour?

Page 11: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Flat Contoured

Mattress 195 cm 186 cm

Person 181 cm 210 cm

Page 12: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Articulation

• If the bed articulates in such a way the mattress moves away from the frame, staff tend to pad inappropriately

• If the bed articulates in such a way the foam is pushed down tight against the frame you can get the heels pressed against the frame / equipment

Page 13: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Page 14: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

When you do thisYou may get this……The heels travel along the mattress up to 15cm with the associated friction and shear forces

Page 15: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Doing this

can cause this

Page 16: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Changing shape?

Stress – force transferred per unit area of tissue (comes from both pressure and shear)Strain – measure of the amount of deformation

Page 17: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Strain and Stress

Excessive internal stresses and strains will hinder transport processes.Effect of internal stress and strain will vary depending on –

Morphology (size/shape) of the tissue layersStiffness and strength of the tissues

Aging, lifestyle, chronic injury, disease will cause changes in morphology/strength soft tissuesHeterogeneous response – external loading will produce different tissue responses at different body locations

Page 18: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Flat Contoured

Mattress 195 cm 186 cm

Person 181 cm 210 cm

When you contour the foam over the frame it squeezes under the seat – and tries (but fails) to stretch under the knees

Page 19: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

2 piece frame

3 piece frame

4 piece frame

Page 20: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

But the frame also needs a mattress!

Page 21: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Make the foam contour to the bed frame….

Stop the heels slidingStop the feet pressing on the bed endMakes the mattress longer!

Page 22: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

The effective use of add-on equipment — risk / benefit analysis, optimising pressure relief decision-making

Page 23: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Audit of appropriateness of equipment use

Not at risk At Risk

High Risk

VHigh Risk

Not done

Arise 2   1 1Foam 207 292 186 38 41Dolphin     1 1  Duo2 2 10 21 33  Other 2   2 1  Primo 4 18 56 88 1Repose 44 156 194 89 4

Page 24: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

You could use add on equipment

Page 25: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Meeting the challenges

• One patient had pillows in place but the patients heels were on top of the pillows and not overhanging and the other patient had nothing. At this stage the observer intervened to reposition the pillows for the first patient to ensure heels were overhanging the end of the pillows and asked carers to use pillows for the other…..

• Pillows remained in place for two of the patients effectively but for one patient the pillow had squashed since the last observation and heels were resting on the bed slightly. (at 30 minutes post Bundle intervention)

• Turley 2014

Page 26: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Poor use of equipment

• Overlays on bed frames• Replacements on top of mattresses• Mattresses up side down• Patient sat in chair with no cushion• Patient on incontinence pads• Blankets or pillows under heels

Page 27: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Getting the best from your resources — releasing time to care

Page 28: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Jones & Tite 2013

Page 29: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Introduction of hybrid mattresses

• In the first 3 months the Trust has made financial savings equating to more than 25K with no increase in pressure ulcers. The reduction of costs is associated with moving equipment, decontamination and rental charges.

• By effectively reducing the requirement for dynamic air mattresses we have also released nursing time back to care.

Page 30: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Getting it right

• Think about what makes the patient at risk

• Generally this is– Immobility– Insensate– Lack of blood supply / oxygenation

• Target the area at risk• A higher specification mattress isn’t

always the answer!

Page 31: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

If it is the heels that at are at risk because of poor blood supply

• Does the patient need a high specification mattress?

• Do a specific heel assessment

Page 32: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Can you actually see the skin?By the time you

prevent the clot And stop the patient slipping in the anti embolic stocking And add in a

pressure reduction device

How often is this all removed and what impact does it have on mobility?

Page 33: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Heel assessment

Page 34: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Releasing time to care

• Getting it right• Keeping it simple• Looking at the obvious – not creating

a different problem by solving a problem!

Page 35: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

References

Jones L, Tite M (2013) Do you really know how soon your patient is on an alternating mattress in a hospital setting? A study examining opportunities in safety, effectiveness and improved patient experience. Poster presented at Wounds UK Conference, Harrogate

Nixon J, Nelson EA, Cranny G, Iglesias CP, Hawkins K, Cullum NA, Phillips A, Spilsbury K, Torgerson DJ, Mason S; PRESSURE Trial Group Pressure relieving support surfaces: a randomised evaluation. Health Technol Assess. 2006 Jul;10(22):iii-iv, ix-x, 1-163.

Page 36: “Health & Wealth for Wales” “Health & Wealth For Wales”

“Health & Wealth for Wales”

“Health & Wealth For Wales”

Thank You

[email protected]

@jacquifletcher3.....