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Welcome to the 2006 Heartland Conference

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Title: Welcome to the 2006 Heartland Conference


1
Welcome to the 2006 Heartland Conference
2
Pressure Mapping Whats The Point?
3
Our Goal
4
To Prevent This!
Wound measurement using VEV MD
5
Evidence Based Medicine
  • We used to say outcomes measures
  • Why do we insist on an x-ray for a broken wrist
    yet we will provide AT with a short paragraph or
    two
  • Orthopedics get paid because they use objective
    tools like Biodex, Cybex, etc.

6
Where Does Pressure Fit In Our Assessment
Hierarchy?
  • Patient
  • Position
  • Pressure

7

Focusing On The Wrong P Can Cost You!
  • Client and OMalleys
  • Beautiful seating solution in clinic but a wood
    stool at the bar defeats the benefits
  • Caregiver and Vet in bed
  • Why five years of sacral pressure ulcers only in
    August?

8
Multi-System Analysis
  • Braden Scale
  • for Predicting Pressure Sore Risk
  • Validated Long term care Geriatric tool
  • Useful to expand areas of investigation
  • Nutrition, incontinence and out of chair
    activities

9
Client Postural Issues?
  • Client Information Check list-
  • Jeannie Minkels for example.
  • Use camera as part of documentation
  • Illustrate the challenges at the beginning
  • Illustrate the solution recommended

10
Learn About the Patient
  • Gather any background information you deem
    pertinent and record in the client information
    tab.
  • General, equipment related for future reference.
  • Dont rewrite the patient file but do include the
    Cliffs Notes of what is relevant to what you
    are doing.
  • Learn about their lifestyle and goals. Lifestyle
    can trump good seating.

11
Be Prepared!!
  • Dont keep the IPM system in the closet.
  • No one wants to wait 30 minutes while you set up.
  • Have it up and running ready to use
  • Install it on all the computers you use

12
But First Two Key Items
  • Wash your hands! For your sake and theirs, before
    and after the evaluation! Gloves??
  • Make sure you use an isolation bag! Ours our a
    thin dry cleaning type bag

13
So What Do We Actually Do With The Client?
  • Introduce pressure mapping
  • Capture how they are currently doing
  • Demonstrate the clients challenges
  • Document least costly solutions
  • Provide as necessary an appropriate alternative
  • Communicate our findings effectively

14
Introduce Pressure Mapping
  • Explain the process
  • To remove any apprehensions
  • Involve client and/or caregivers in the process
  • Allow them to interact with the technology
  • They wont be able to while you do the assessment
    or they will confuse your work
  • Make sure you use your hands to limit hammocking

15
Clients Background
  • 45 year old SCI client 25 year post injury C5
    Quadriplegia
  • Long standing history of right side Stage I ulcer
    (has been worse)
  • Now problem with left side Stage I ulcer and NOT
    problems on right side.
  • Cannot stay up longer than 4 hours

16
Current Complaint
  • Unable to be up for longer than 4 hours due to
    redness in both Ischial Tuberosities, with left
    being the worst.
  • Secondary is concern over the tail bone pressure
    which occurs with current position and/or recline
  • Goal of assessment/intervention able to be up 6
    hours min, but preferably 8 hours each day.

17
Capture Them in Their Existing Seating
  • Now that they have sat for a while in their
    existing mobility device scan, store and describe
  • Keep your comments related to the specific scan
    stored.
  • General information should be in client
    information tab
  • Confirm what you see with your hands! Dont trust
    all you see on the screen confirm it!
  • Make notes with the thought in mind that you need
    to understand them 3-6 months down the road.
  • Make sure you turn the client away from the
    screen so they can no longer interact with the
    pressure mapping system.
  • This will help answer the question
  • Why do we need to make changes or spend money?

18
Some Reminders
  • Consistently place the mat in the same
    orientation so there is no confusion later.
  • Position the mat square on the seat
  • Confirm with your hands that the sensing mat is
    not hammocked
  • Make sure the client is in a normal or neutral
    position you can replicate with other surfaces

19
Current Seating
What is suspicious in this picture? Note the
hexagon.
20
Use Your Hands!!
What really is at the 135 mmHg location??
21
Pressure mapping systems help you redistribute
pressure they do not
  • Relieve pressure
  • Or
  • Reduce pressure

22
What About The Numbers???
  • A particular number at a particular site does
    not success or safety.
  • Key numbers to watch are
  • Highest pressure-Where is the potential trouble?
  • Focuses attention on key at risk areas
  • Sensing Area- More is better! (Quantity of
    distribution)
  • Are we expanding or contracting the area of the
    pressure distribution on the surface?
  • Coefficient of Variation - Lower the the
    Better! (Quality of distribution)
  • How evenly is the pressure distributed over the
    surface?

23
OK This Means What?
  • Keep in mind that we are doing a case study of
    one.
  • No normative data is available yet to guide our
    decisions for a particular patient type.
  • The numbers are only bench marks to refer to as
    we seek a better solution.
  • Is a proposed position or product affording a
    better pressure distribution than another?

24
Dont Forget Asymmetry!
Make sure the its the client not a misplaced
sensing mat?
25
Thats More Like It!
26
Demonstrate What Their Challenge Is
  • If possible have the client sit upright on a
    firmer surface like a mat table or a foam
    cushion. This should be part of the larger mat
    evaluation.
  • Scan, store and describe where the boney
    prominences are. Confirming with hands and
    noting coordinates on screen.
  • This will help answer the questions
  • What is the clients boney architecture like?
  • Is it all there? How rotated is the
    pelvis,etc.?
  • Why will or wont a simple solution be
    sufficient?

27
On A Firm Flat Surface
Dont put the client at risk doing this. A mat
table or firmer foam cushion might be good
choices.
28
Document the Most Commonly Used/Least Costly
Alternative
  • Your years of experience or the typical funding
    parameters may lead you to a particular solution
  • Scan, Store and describe what you did.
  • This may take recording a number of scans as you
    try a number of variables. You can use 4 scan
    view to compare your solutions head to head.
  • Be sure to describe what you did as you scan and
    store
  • This will help answer the question
  • Why the most likely or least costly solution did
  • or did not work?

29
A Standard Solution
  • Foam cushion pressures still unacceptably high,
    and highly focused

30
Provide an Alternative Solution if Necessary
  • If youre not satisfied with the normal
    solution try another and validate or challenge.
  • Again this may take recording a number of scans
    as you try a number of variables.
  • Be sure to describe what you did as you scan and
    store
  • This will help answer the question
  • Why are we recommending a solution
  • different than the least costly or usual?

31
Power Chair After Adjustments
8 by 9 air insert in foam good pressure
distribution not as good though as the full air
cushion up only 4 hours
32
Proposed Chair
On properly adjusted air cushion. F9 is right
IT Good pressure distribution Up 6 hours am 4
hours evening - meeting goal
33
Before therapist correction
Change In Posture?
After therapist supported left PSIS area
34
Dont Forget Remote!
  • Use Remote to monitor the performance of the
    proposed solution in real world use or over an
    extended period of time.
  • Remote can evaluate real time activities, e.g.
    bouncing down stairs.
  • Monitor with Remote to see if the client does
    weight shifts or tilts over time. Or, if they
    tilt, did the go far enough to get the hoped for
    benefit.

35
Some Common Mistakes
  • You stop using your hands and let technology make
    decisions for you.
  • You try every choice available. You may have a
    mountain of cushions to try but go with your
    experience first. Time is precious and trying
    everything can be confusing.

36
Dont Forget Training and Biofeedback
  • Training and testing for client and caregiver
    compliance
  • No that solution your buddy has will not work for
    youSee!
  • Dont over-inflate that air cushion!!
  • What does a client have to do for weight shifts
    or tilts to actually benefit them
  • Demonstrate appropriate positioning in Bed or Seat

37
What Do You Do When It All Looks Bad?
  • Sometimes you have to leave well enough alone
  • Clients trocanter is over 200 mmHg and has been
    for some time without incident only alternative
    is high pressure on proven risk area of right
    I.T. Monitor it.
  • Use the tool to teach movement-help the client
    find alternate pressure redistributing positions
    in their seating.
  • T3 and 2 wounds-use pressure mapping as a
    biofeedback tool to help a nervous T3 discover
    how much(little) they have to move to achieve
    significant pressure reduction for at risk areas.

38
Maybe its the Tool!
  • Wrinkles in mat
  • Poor placement of mat
  • Hammocking of mat
  • Out of date calibration
  • Damaged mat
  • Get your hands in there and find out

39
What Do You Do When It All Looks Good?
  • Sometimes everything you do in the seat looks
    good.
  • If it does, back up and take a good look at where
    the wound is or what their history is. What is
    not obvious and is unseen during the assessment?
  • Some research and experience indicates that while
    the client maybe referred for a seating related
    pressure issue, 50 of the time the problem is in
    the bed not the seat. So, go pressure map the
    bed even with a seat mat if you need to.

40
Why Do We Share WhatWe Just Did?
  • To help ensure it benefits the client
  • That they get what they need
  • And to get your good work acknowledged and paid
    for

41
Develop a Simple FourStep Report
  • Use comparison view to choose and tag the frames
    that tell the story
  • Print off the report with client information, in
    color or in grey scale for faxing.
  • Or copy and paste it into a new or existing Word
    document you use.

42
Compare and Choose
43
Print Your Choices
44
Print Your Choices
45
Pressure Mapping Reports Enhance Decision Making
in the Care Team
  • With objective information better decisions are
    made, e.g..
  • Due to Sacral wound a physician orders bed rest,
    but to you it looks a little high to be seating
    induced.
  • So you go check the bed with an IPM, and you
    clearly identify the cause!
  • Now you have objective data to discuss with the
    physician. Allowing more seating time and
    securing a better bed for the client.

46
Evidence Based Practice Many Come To Rely On
  • HMOs are requiring pressure mapping for use as a
    benchmark to become a contracted vendor with
    them.
  • Those with the most success using pressure
    mapping take time to educate their Case Managers
    and other payers.
  • It also provides information that demonstrates
    why you did what you did and when you did it,
    a.k.a. Risk Management.

47
Other Pressure Mapping Related Tools
  • Shear sensor
  • Temperature Sensor
  • Weight bearing assessment
  • Range of motion training

48
Conclusions
  • Pressure mapping systems are dumb. It takes
    intelligent interpretation and application of the
    data to make good decisions that benefit the
    client
  • They are powerful tools to help maximize care for
    your clients and to help ensure they receive it.
  • They also have become standard of care for those
    needing rehabilitation seating.

49
Remember Our Goal
50
THANK YOU!
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