|
CURRENT PRESSURE ULCER PREVENTION WORK IN POLAND
Mr Adam Ireneusz Zbronski
Director, ‘Real’ Office for Pressure Ulcer
Prevention,
Main Council of Nurses & Midwives Consultant,
10–561 Olsztyn, Poland.
To continue our work aimed at standard pressure ulcer
prevention dissemination, in Autumn 1997, Main council of Nurses and Midwives
and Office for Pressure Ulcer Preventive treatment, sent a questionnaire
to all the hospitals throughout Poland. The questionnaire regarded pressure
ulcer prevention awareness. We received 364 response letters, in which
hospitals declared their eagerness to introduce standard pressure ulcer
prevention into practice. Therefore we think that the problem of pressure
ulcers can be considered to be of great interest.
The analysis of the questionnaire has indicated that the
primary needs in hospitals are organisational help and staff training.
According to the Minister of Health’s Act of 1997 concerning the
kind of preventive, diagnostic and rehabilitative services performed by
a nurse without doctor’s instructions, a nurse is authorised to choose
a method of treatment, and treat a pressure ulcer up to third grade, only
on condition of having been trained in this subject. At present, the problem
of course organisation and defining nurses’ competence is being discussed
at ministry level. The problem of pressure ulcer grade IV and V treatment
still remains open. A separate aspect of our work is to disseminate the
methodology of introducing standard pressure ulcer prevention to Polish
hospitals.
Another extremely important problem, which may condition
using standard pressure ulcer prevention in practice, is to influence
the government to add it to the list of services which are free for insured
patients. This would be synonymous with repayment of the costs of prevention
to hospitals. So far the list comprises only of diseases and trauma prevention,
early diagnosis of diseases, treatment and disablement prevention. We
aim at extending this act to include pressure ulcer prevention as well.
The above priorities and involvement of medical staff
and social care workers allow us to hope that standard pressure ulcer
prevention will become a permanent practice in Polish Medical care.
MULTI-CENTRE EVALUATION OF A NEW PRESSURE
RELIEVING MATTRESS
Ms Kate O’Dea* and Gareth Wood†
*Manager Clinical Services, Hill-Rom, Ashby de la
Zouch, Leicestershire, UK.
†Manager Product Development, Hill-Rom, Montpellier, France
Problem
There is currently no consensus regarding how
pressure relieving surfaces (PRS) should be evaluated and manufacturers
have been criticised for the paucity of evidence of product efficacy.
In order to address these issues Hill-Rom carried out a hierarchy of laboratory
and clinical tests on a new mattress prior to it being made generally
available. This poster describes how the new mattress was evaluated in
the varied clinical situations in which it will be expected to perform.
Methods and Materials
A new mattress was developed which is capable
of providing both alternating and continuous low-pressure and which uses
new method of ensuring correct cushion inflation pressures. Nine hospitals
from five different countries participated in the evaluation, which used
unbranded ‘beta’ units. Any patient who was at high risk of
developing pressure sores was eligible for the study and was allowed to
remain on the mattress so long as they remained at risk. Data was collected
at the time of placement, at weekly intervals, and at completion of treatment
(study exit). Sixteen separate features of the mattress were evaluated
resulting in 410 responses. Forty-two patients completed the study.
Results
Twenty patients had a total of 42 pressure sores
at time of placement, and 18 of these were full thickness wounds. None
of these pressure sores deteriorated and 80% either improved or healed.
No patient developed any new pressure sore or skin marking. The feature
most highly rated was the ability to choose between the two modes of operation.
Nurses and patients commented on the device and the designers took these
comments into account before the mattress was finalised.
Discussion and Conclusions
There are practical difficulties in carrying
out randomised control trials, particularly prior to final production
of a PRS. Providing that laboratory tests, (interface pressure mapping,
Laser Doppler, thermography and TCPO2 measurements) indicate that a PRS
is likely to be efficacious, subjecting the device to use in a variety
of clinical situations is a valid and practical method of estimating the
performance.
CONFIDENCE IN INTERFACE PRESSURE MEASUREMENTS
TO EVALUATE PRESSURE RELIEVING SUPPORT SURFACE
Ms Kate O’Dea* and Richard Barnett†
*Manager Clinical Services, Hill-Rom, Ashby de la
Zouch, Leicestershire, UK.
†Hill-Rom, Charleston, SC, USA.
The prevalence of pressure ulcers throughout the United
States and Europe ranges from 4% to 18.6%. Clinicians have long understood
the problem as is evident in the many strategies employed to provide solutions.
One of these approaches is the use of pressure relieving support surfaces.
There is currently no consensus regarding how such surfaces should be
evaluated and compared.
Problem
Scientific data on surface performance is frequently
presented as measurements of the pressure generated between the patient
and the surface. (interface pressure). However, exactly how accurate,
valid and helpful to the user is this information?
Methods
Utilising a high-resolution full-body interface
pressure system, several different analysis methodologies were analysed
and compared.
Results
Local pressure measurements were found to provide
incomplete analysis, of limited value to the clinician, as does data collected
using one body type and position with few repetitions. Single site measurements
and data collecting using low-resolution measurement systems can be blind
to areas of significantly high pressure. Furthermore, in displaying the
data it is important to avoid illogical colour sequences and scales, which
can be misleading to the untrained eye. The presentation illustrates these
problems.
Conclusions
Interface pressure measurements, however conducted,
supply information on only one aspect of surface performance. If the experimental
design of such studies does not adequately address, sample size, subjects,
positioning, method of measurement and display of the data, the validity
of the conclusions are questionable. Clinicians attempting to evaluate
interface pressure data need to pay significant attention to these points
in order to determine the level of scientific method used to support marketing
claims.
|
