The View from Where I Sit

Tag: let's work together to stop the pressure

  • The Pressure Ulcer Research Service User Network (PURSUN)

    Between 2008 and 2010, PPI was limited by the ability to recruit service users. Following the establishment of PURSUN UK in late 2010, involvement activities increased across the programme. Furthermore, the methodology and focus of each work package have guided the nature of involvement.

    The Pressure Ulcer Research Service User Network UK (www.pursun.org.uk) has a minimum of two management meetings a year at which a core group of the most active members consider the direction of the network, the terms of reference, recruitment, the website and other network materials. Research involvement opportunities are sent out by way of the mailing list, as they arise. For example invitations to help interpret data, become co-authors or input into the study methods.

    All members of PURSUN UK are prepared for involvement through a minimum of one induction meeting with the PPI officer (either in person or by telephone). During this meeting, service users are encouraged to discuss the skills and experience that they bring to the group, as well as any support that they may need.

    The value of the Pressure Ulcer Research Service User Network UK to the service users involved

    As a PURSUN researcher, I have definitely benefitted from the virtual conferences, Zoom calls and emails about Pressure Ulcer Prevention at Home, pressure relief and an app to help people with general healthcare. I’ll also be joining a focus group and I’ll be partly responsible for creating an app to ‘stop the pressure’. Delia Muir and Holly Schofield take turns leading the Zoom calls. I started my role as a PURSUN researcher in 2020, and I believe that Bermuda needs to be included in the network and the impact that it is making. Maybe I should start a sister branch there.

    Wider impact of the Pressure Ulcer Research Service User Network UK

    In addition to PPI throughout the programme, PURSUN UK has begun to impact the wider tissue viability and PPI communities. For example, members of PURSUN UK have been invited to speak about their experiences at several events.

    Locally, this has included training for tissue viability link nurses, presenting to PURPOSE principal investigators, speaking at the launch of the NIHR Bradford Wound Prevention and Treatment Healthcare Technology Co-operative and working with medical students. Nationally, members have presented at the Tissue Viability Society conference, tissue viability education events and the INVOLVE (a national PPI advisory group) conference.

    They have developed an effective model for presenting service users’ experiences in which the PPI officer, interviews a member of PURSUN UK in front of a live audience. This provides an alternative to a traditional presentation for people who do not feel confident presenting personal experiences in that way. This model has received very positive feedback from both audiences and the service users involved. They have found that real-life stories are extremely powerful and can create a common focus for professionals from a variety of backgrounds.

    Collaboration with industry

    Medical devices also play an important role in pressure ulcer prevention and treatment. With this in mind, PURSUN UK has collaborated with industry partners on projects such as education days and product development workshops. This collaboration has helped to diversify the involvement opportunities offered to PURSUN UK members and has been useful in terms of members’ personal development, as it has given people an insight into another aspect of tissue viability research. This work has also generated some funds for PURSUN UK, moving the network towards a sustainable model post PURPOSE.

    Developing and sharing patient and public involvement methods

    • the use of role play and video to facilitate PPI in the interpretation of data from the severe pressure ulcer study
    • the adaptation of the Patient Learning Journey model for use in a research context
    • the use of a live interview model as an alternative to traditional presentations
    • the addition of a service user group to the consensus methodology used in the risk assessment study
    • individualised support for steering committee members, including one-to-one debriefs with the PPI officer
    • the integration of service user narratives into the dissemination of the quantitative pain studies.

    Further developments include a completely new service user network, which has given them the opportunity to be creative in their approach and develop innovative involvement models. These models have been shared with the UK PPI community. The PPI model used as part of the severe pressure ulcer study, has been presented at three national conferences (Involving People Wales and Tissue Viability Society) and forms part of an INVOLVE video resource on PPI in data interpretation and analysis [see www.invo.org.uk/resource-centre/conference/involve-conference-gallery/ (accessed 20 February 2015)].

    A video about the Severe Pressure Ulcer PPI event was also made by PURSUN UK and has been widely disseminated online [see https://youtu.be/bgg6zkbILrg (accessed 21st July 2015)]. The novel approach of using the Patient Learning Journey as a model for service users contributing to research rather than health education has also been included as a case study in the INVOLVE training and development guidelines [see www.invo.org.uk/training-case-study-13-2/ (accessed 20 February 2015)].

    Supporting further research

    http://medhealth.leeds.ac.uk/info/423/skin/1717/pressure_2 (accessed 31 August 2015). www.jlapressureulcerpartnership.co.uk (accessed 20 February 2015).

    A website has been developed by PURSUN UK www.pursun.org.uk (accessed 20 February 2015).

    In addition, PURSUN UK has contributed to the international consensus document Optimising Wellbeing in People Living with a Wound, published by Wounds International www.woundsinternational.com/clinical-guidelines/international-consensus-optimising-wellbeing-in-people-living-with-a-wound (accessed 20 February 2015).

    Working with service users has also enabled them to more effectively engage with local and national media. Yorkshire Evening Post www.yorkshirepost.co.uk/news/at-a-glance/general-news/yorkshire-group-spearheads-bedsores-care-drive-1-3786988 (accessed 20 February 2015).

    Daily Mail www.dailymail.co.uk/health/article-2093904/Bed-sores-How-does-local-hospital-compare.html (accessed 20 February 2015).

    https://www.ncbi.nlm.nih.gov/books/NBK321107/#s2-5

  • Stop the Pressure: Pressure Ulcer Prevention and Management Virtual Conference

    I learned alot at this year’s Healthcare UK Conference. It started at 10:00 with the Chair’s Welcome and Introduction. Then at 10:20, I learned about The New National Pressure Ulcer Surveillance System. At 11:00, they discussed Supporting Learning with frontline staff in pressure ulcer prevention. By 11:30, I had a Comfort Break and Virtual Networking. By 11:45, I was learning about Pressure Ulcer Assessment, Reporting & Management. At 12:15, there was a presentation about Case studies in Small Breakout Groups. During the 12:35 session, I was Addressing Diversity in Pressure Ulcer Prevention.

    At midday by 13:00, I had a Lunch Break and Virtual Networking. Again, at 15:30, I had another Comfort Break and Virtual Networking. At 15:45, I learned about Nutritional Assessment and Pressure Ulcers. And to end the conference at 16:15, there were Question and answers. This included a survey to grade each session.

    During this conference, I also learned about Erythema and how it contributes to pressure ulcers. http://www.healthcareconferencesuk.com.

    Erythema

    Erythema is a type of skin rash caused by injured or inflamed blood capillaries. It usually occurs in response to a drug, disease or infection. Rash severity ranges from mild to life threatening. https://www.drugwatch.com/health/rash-and-skin-disorders/erythema/#:~:text=Erythema%20is%20a%20type%20of,from%20mild%20to%20life%20threatening.

    National Institute for Health and Care Excellence (NICE)- They provide national guidance and advice to improve health and social care. https://www.nice.org.uk/.

    National Wound Care Strategy Programme- The National Wound Care Strategy programme (NWCSP) seeks to improve care for people with wounds. http://www.nationalwoundcarestrategy.net.

    Model Health System- The Model Health System is a data-driven improvement tool that supports health and care systems to improve patient outcomes and population health. It provides benchmarked insights across the quality of care, productivity and organisational culture to identify opportunities for improvement. The Model Health System incorporates the Model Hospital, which provides hospital provider-level benchmarking. Access to the Model Health System is currently available for all NHS commissioners and providers in England. http://www.model.nhs.uk

    My Improvement Network are committed to investing in education for health care professionals and are proud supporters of RCN Projects. http://myimprovementnetwork.com.

    Pressure-Ulcer-March-2022Download

  • Pressure Ulcers, Transferring Equipment and Techniques

    Now that I’m a PURSUN Researcher, I’ve been studying pressure ulcers, prevention and cures. During my research, I’ve noticed we’ve discussed pressure points, mattresses, dieting, hygiene and PICOs, but nobody said anything about transferring techniques and equipment.

    Ever since my journey to fight against pressure ulcers has started, my transferring techniques have changed. While living in Bermuda, I was taught to ‘bum shuffle’ from, let’s say, my wheelchair to the bed or a chair. However, I was told that this is wrong. Climbing in and out of bed can also be risky, especially when barefoot. As a result, my transferring techniques have changed since then.

    Nowadays to prevent pressure ulcers, it has been suggested that I use a banana board or a sliding sheet from BACES in Bradford.

    The Bradford and Airedale Community Equipment Service (BACES) is a partnership between Bradford Social Services and the NHS in Bradford and Airedale.

    This service has been set up to provide you and your family with a wide range of equipment, to help you live more independently.

    Banana Transfer Board

    This Banana Transfer Board is designed to assist in the seated transfer of a patient between two surfaces.

    Transfers from Bed to wheelchair, wheelchair to Chair, wheelchair to toilet and the like, are just some of the uses the board can be put to. It was made from an extremely durable and hard-wearing materials, the transfer board is curved to facilitate positioning and features anti-slip pads on the underside for safer location and a convenient carrying handle. The board has a maximum user weight of 200 kgs (over 30 Stone) and can be easily cleaned with soapy water/alcohol/disinfectant and a non-abrasive cloth. I’ve tried this but it’s too hard on the buttocks and doesn’t help with shearing pressure.

    Hoists
    Hoists provide support for lifting and moving those in need from one place to another without causing undue stress or discomfort. They are used for moving from bed into a wheelchair, or vice versa, the range can carry a variety of weights and are good for the bathroom, bedroom, and all points in between. Part of the medical supplies and aids range, they also offer battery monitors, chargers, and slings for your hoist so you can be fully prepared to face the day. There are also travel cases available if you need to go somewhere and take your hoist with you, and specialist hoists for wet environments like the bathroom.

    Lateral Transfer Slide Board

    This is designed for use with the Transfer Glide Sheet, this Lateral Transfer Slide enables easy transfers between beds, trolleys, tables and treatment couches.

    It works by creating a stable, slip-resistant platform between the two points and by providing a smooth top surface over which the patient can easily be moved without the need for lifting. User comfort is enhanced by the slide’s tapered edges, which pass easily under the body, whilst the handles around the perimeter provide plenty of convenient places to grip and hold it steady. I’ve tried this but it’s risky and slightly flimsy.

    All our equipment is clean and maintained to the highest standards.

    What equipment do we offer?

    Equipment to help with:

    • moving, handling and walking 
    • bathing, showering and toileting 
    • household and kitchen tasks 
    • nursing tasks

    Commodes can also be used for pressure relief.

    Proper Transfer Techniques

    • The push-up – Use the wheelchair armrests (or wheels if you don’t have any) to push up out of the seat with your arms. You should straighten your arms fully so that your elbows are locked. Then ensure that the buttocks and lower back are fully out of the seat.
    • The forward lean – Lean forward as far as you can – imagine that you are trying to rest your chest on your knees! This movement is particularly good for relieving pressure on the coccyx.
    • Leaning side-to-side – Whilst seated, shift your body weight onto your left side to lift your right side out of your seat. Then repeat on the other side. Like the push-up, this movement relieves pressure from the buttocks and the lower back. However, because this is a more subtle movement it’s great to perform whilst you’re out and about!

    Why is proper transfer technique so important?

    Correct technique should minimise risk of skin injuries. Incorrect technique can increase your risk of falls during transfers. Managing the injuries which result from poor technique can be difficult and lengthy. Prevention is far superior to cure!

    https://www.bradford.gov.uk/adult-social-care/living-independently/bradford-and-airedale-community-equipment-service/

    https://www.completecareshop.co.uk/medical-supplies-aids

    https://www.yorkshirecareequipment.com/advice-tips/pressure-relief-techniques-for-wheelchair-users/

    Click to access the-role-of-the-physiotherapist-in-the-prevention-and-management-of-pressure-ulcer-cathy-quinn-201119.pdf

  • Hygiene and Amputation

    With foot deformities and insensate feet, Spina Bifida patients are at risk of foot skin breakdown, pressure ulcers, and osteomyelitis. Rarely, pressure ulcers progress to squamous cell carcinoma. Spina Bifida patients may require limb amputation for osteomyelitis, foot ulcers, and squamous cell carcinoma. There is concern that transtibial amputations would have poor functional outcomes in Spina Bifida patients because of lower-extremity weakness.

    However, there is no available literature on transtibial amputation outcomes in this population. More distal calcanectomy and Symes amputations have been successful in restoring ambulation in lower-level Spina Bifida patients. https://journals.lww.com/ajpmr/Fulltext/2015/11000/From_Wheelchair_to_Cane__Elective_Transtibial.10.aspx

    Foot Care for Amputees

    LOOK
    Check your feet every day for any changes and use a hand mirror to see underneath your feet.


    PROTECT
    Wear correct fitting shoes and never go barefoot


    PREVENT
    Don’t allow problems to occur – wash and dry your feet properly every day.


    SEEK
    If you notice any changes immediately seek medical advice from a foot care professional


    DO
    Have an annual foot check from a podiatrist.

    For more information, you can search http://www.limbs4life.org.

  • Leg Elevation Rules

    Elevating legs occasionally

    Rest– Immediately rest the affected area as much as possible. Experts recommend 24 to 48 hours of no weight-bearing activities. Continued use of a moderate or severely sprained ankle can delay healing, increase pain, or even worsen the injury. With a mild sprain, activity is generally tolerated after 24 to 48 hours of rest.
    Ice– To help reduce pain and swelling during the first 48 hours after injury, ice the area 20 minutes at a time every 4 hours, using an ice pack covered in a towel. If you don’t have an ice pack handy, an alternative would be to use a bag of frozen peas, corn, or other veggies. Try not to ice the injury for more than 20 minutes at a time, as it may actually cause further tissue damage.

    In the majority of studies, researchers found icing was effective in numbing muscle soreness, but observed — for up to 15 minutes after ice treatment — significantly reduced:

    • Muscle strength
    • Power
    • Fine motor coordination


    Compression– Using an elastic medical bandage, wrap the area to help decrease swelling and internal bleeding (if present). The wrap should be snug, but make sure you have proper circulation. Some signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling. If you think you need to use the wrap for more than 48 to 72 hours, you may have a more serious issue that requires prompt medical attention.


    Elevating your limbs and Exercise! Raise the injured body part above heart level so that gravity can move fluids away from the injured area.

  • PICOs and Pressure Ulcers

    Technology

    PICO is a canister-free, single-use, negative pressure wound therapy system consisting of a sterile pump and multi-layered adhesive dressings. Each dressing has 4 layers: a silicone adhesive wound contact layer, which is designed to minimise pain and damage during peel-back and to reduce lateral tension; an airlock layer for even distribution of pressure; an absorbent layer to remove exudate and bacteria from the wound; and a top film layer, which acts as a physical barrier and allows moisture to evaporate. The pump is operated by 2 AA batteries and delivers a continuous negative pressure of 80 mmHg to a sealed wound. Once activated, using a push button, the battery drives the pump for up to 7 days and LEDs provide alerts for low-battery status and pressure leaks.

    Standard PICO dressings come in 8 sizes: 10×20 cm, 10×30 cm, 10×40 cm, 15×15 cm, 15×20 cm, 15×30 cm, 20×20 cm and 25×25 cm. Multisite PICO dressings come in 2 sizes: small (15×20 cm) and large (20×25 cm).

    The latest version of the technology is the PICO7 system. This differs from the version of PICO notified to NICE by having an improved pump to minimise leakage and an integrated belt clip to allow for easier transport. The PICO7 pump contains a magnet and it should be positioned at least 10 cm (4 inches) away from other medical devices that could be affected by magnetic interference.

    Innovative aspects

    PICO differs from conventional negative pressure wound dressings in that it:

    • has no separate canister
    • is portable and disposable
    • has a proprietary dressing layer that is designed to allow even distribution of negative pressure across the incision and zone of injury.

    The Purpose behind the PICO

    PICO is intended for surgical incisions with low or moderate levels of exudate. This guidance focuses on the use of PICO dressings for closed surgical incisions. PICO dressings can be applied by healthcare professionals including surgeons and tissue viability nurses for people in a range of care settings. Training is needed to place the dressings correctly. My District Nurses are the only ones that can dress, undress and re-dress my wounds.

    Costs

    Standard PICO dressings are available in 8 different sizes. Each pack includes a single-use pump and 2 dressings. The list prices for PICO dressings range from £127.06 to £145.68 (including VAT).
    https://www.smith-nephew.com/key-products/advanced-wound-management/pico/.

    LET’S WORK TOGETHER TO STOP THE PRESSURE!!!