The View from Where I Sit

Tag: pressure ulcers

  • ‘Pressure Ulcer Prevention in a Pandemic’


    “Pressure ulcer prevention and management is an art as well as a science.

    Different people with similar conditions need different care and that care should be holistic and tailored to the individual.”

    Linda Nazarko OBE Consultant Nurse West London NHS Trust

    Before the pandemic, I never got home visits, because I’m not bed-ridden. Previously, only people who are bed-ridden got home visits. Nowadays, I’ve been getting home visits from carers and district nurses, since the pandemic. I even received my Covid-19 vaccination, Astra Zeneca, by way of home visits.

    “Pressure ulcers remain a concerning and mainly avoidable harm associated with healthcare delivery.”

    National Pressure Ulcer Prevalence and Quality of Care Audit, November 2020

    I became a PURSUN researcher during the pandemic in 2020. I used to attend annual Spina Bifida Clinics before the pandemic from 2013. However, since the pandemic, I’ve had no success in booking Spina Bifida Clinics, due to the surge and resurge of Covid-19 cases. In addition to the PURSUN research, the Spina Bifida Clinics also help me to improve the way that I take care of myself.

    “The overall prevalence of PUs recorded, in terms or proportion of patients with 1 or more PUs, was 9.04%…The audit sought to understand not just the number of pressure ulcers that were present, but the care that was being delivered to the patients to prevent pressure ulcers occurring….Findings regarding implementation of preventative actions vary considerably between organisations and even between sites within organisations. Identification of these areas is important to the individual organisations as it allows them to focus quality improvement efforts into the areas that may make a difference.”

    Stop the Pressure: National Pressure Ulcer Prevalence and Quality of Care Audit 2020

    By December 2020, concerns about foot amputation were being raised by District Nurses, Tissue Viability Nurse and Podiatry. Since then, I’ve been wearing splints and callipers to protect my feet from any further damage. My feet have been x-rayed and scanned. I’ve also been prescribed antibiotics for my infected heel bone. Before the pandemic, I used to order and pick up my prescriptions from the Lloyds Pharmacy but ever since the pandemic they’ve been delivered to my house.

    I received assistance from my sister with groceries because online shopping was fully booked during the first three months of the pandemic.

    She stayed with me for three months but then had to leave after that because I was at risk of losing my Housing Benefit under assisted living, if she stayed any longer. Carers have been restricted on admission. There is more chance of emergency admission to the hospital.

    “A phased approach will be used to develop Pressure Ulcer surveillance in the NHS.. Clinicians with responsibility for Pressure Ulcer reporting (most likely tissue viability nurses) will need to ensure their organisations are aware of and prepared for the new surveillance system. As part of this, systems will need to understand the difference between surveillance reporting and clinical incident reporting. The purpose of surveillance reporting is to capture the full incidence and prevalence of Pressure Ulcers across a system to drive quality improvement at organisational level. The purpose of clinical incident reporting is to support learning from mistakes so action can be taken to keep patients safe.”

    A new national Pressure Ulcer Surveillance system using The Model Hospital System, November 2021

    Pressure ulcer prevention in a pandemic taught me how to:

    • network with colleagues who are working to improve the measurement, reporting and prevention of pressure ulcers and harm
    • Reflect on national developments and learning including learning from Stop the Pressure: National Pressure Ulcer Prevalence and Quality of Care Audit
    • Learn from outstanding practice in pressure ulcer reporting
    • Implementing the new national Pressure Ulcer Surveillance system and learning from pilot sites
    • Change the way you view pressure ulcers – eliminating the focus on a voidability
    • Developing effective training and education of frontline staff that will empower frontline teams to take ownership for improving care processes and preventing pressure ulcers
    • Understand how you can reduce pressure ulcers and harm from pressure ulcers
    • Improve sustainability in the reduction of pressure ulcers during Covid-19
    • Understand plans for a new national pressure ulcer data system to support quality improvement
    • Understand the factors that increase the risk of pressure ulcer development, and explore effective risk assessment tools
    • Develop a better understanding of pressure ulcer prevention at the end of life
    • Reflect on a case study in reducing pressure ulcers in Covid-19 patients
    • Improve Nutrition and Hydration
    • Learn from Clinical Negligence claims related to pressure ulcers
    • Ensure you are up to date with the latest evidence and definitions
    • Self assess and reflect on your own practice
    • Supports CPD professional development and acts as revalidation evidence.
    • group approval for revalidation purposes

    “We continue to have a challenge with patients developing pressure ulcers, and also a challenge with having some standardisation and consistency of care. There is considerable variation of about what happens in practice, in particular, underuse of evidence based care and overuse of ineffective interventions.”

    Jacqui Fletcher OBE Clinical Lead, The National Wound Care Strategy Programme, November 2021
    http://www.healthcareconferencesuk.co.uk
  • NORTH AND WEST YORKSHIRE ASBAH COMMUNITY CONFERENCE

    NORTH AND WEST YORKSHIRE ASBAH COMMUNITY CONFERENCE

    After 50 years of service, The North and West Yorkshire ASBAH had their first ever Community Conference. It was held on the 16th of October, at Hollins Hall Hotel, Golf and Country Club in Bradford. This was a day planned especially for people in the Spina Bifida and Hydrocephalus communities to come together and celebrate. There was lots of information on continence care, PIP and DLA form advice, education, and pressure ulcer prevention and cure.

    During the first workshop, I joined the PURSUN Group from Leeds, to do a presentation on Pressure Ulcer Prevention and Cure. It was very good to meet Delia Muir and share my experiences on the subject.

    Heather Chapman was at the ASBAH Charity conference, talking to wheelchair users about nutritional therapy by Wheely Therapy. Nutritional therapy is the application of nutrition science in the promotion of health, peak performance and individual care.

    Nutritional therapy practitioners use a wide range of tools to assess and identify potential nutritional imbalances and understand how these may contribute to an individual’s symptoms and health concerns. This approach allows them to work with individuals to address nutritional balance and help support the body towards maintaining health.

    Nutritional therapy is recognised as a complementary medicine. It is relevant both for individuals looking to enhance their health and wellbeing and for those with chronic conditions wishing to work with or ‘consult’ a nutritional therapist in collaboration with other suitably qualified healthcare professionals.

    I also learned about SEND. This presentation workshop was about guidance on the special educational needs and disability system for children and young people aged 0 to 25, which started on 1 September 2014. The questionnaire that the presenter gave out, was a very good teaching tool.

    Additionally, there were stalls and activities for the children. There were free prizes and charity merchandise on display as well. One of our sponsors, Irwin Mitchell, provided bags with freebies inside too. They also support the SHINE Charity.

    Dr. Kate Wildig was the guest speaker who ended the whole conference. North and West Yorkshire ASBAH has a good support group. Use It!

    https://fb.watch/fgJu3S12UL/

    https://form.jotform.com/katyravenasbah/conference-registration-form

    https://www.linkedin.com/company/north-and-west-yorkshire-asbah/

    https://www.nwyasbah.org/nwyasbah

    https://www.carefreesmarthomes.co.uk/group/disability-diary/discussion/b86d1cfe-90c2-42e7-9229-e3043c3b46cc

    http://www.wheelyhealthy.co.uk

    https://www.gov.uk/government/publications/send-code-of-practice-0-to-25

    https://www.hollister.co.uk/en-gb/products/ostomy-care-products

    https://www.irwinmitchell.com/?ref=google&infinity=ict2~net~gaw~ar~353754706478~kw~irwin%20mitchell~mt~e~cmp~MEC+Brand+HV+Irwin+Mitchell+Exact~ag~Brand+-+HV+Core&&ds_lpt_start&ds_lpt_end&gclid=CjwKCAjw-rOaBhA9EiwAUkLV4hbptkb2WjS1oL5NWyP1zEv8oaEMV66IqQXjPXb8DbSqSlgIv38NDxoCl8IQAvD_BwE&gclsrc=aw.ds

    https://www.bbuk.org.uk/adults/adults-resources/
    https://theelitevenueselection.co.uk/?fbclid=IwAR0ZkWVptOo3R3Op17iYaqol5fZ5lsQ8b-9Nc8cqAgOD8A1lVR1P088UJdI

  • THREE SOFT TISSUE THERAPIES FOR SCAR TISSUE

    Active Release Technique Therapy

    A.R.T is somewhat similar to massage therapy in that a therapist will use their hands to manipulate soft tissues. During A.R.T, however, the patient or the therapist will actively flex and extend different muscle groups during manual therapy. This active motion improves circulation and helps to break down scar tissue. A.R.T can help people with:

    • Plantar fasciitis
    • Tennis elbow
    • Shin splints
    • Carpal tunnel
    • Neck pain
    • Back pain

    One study found that A.R.T was helpful for people with neck pain as it improved range of motion and the pressure pain threshold score.

    Graston and Astym Therapy

    In Traditional Chinese Medicine, there is a therapy called Gua sha, which is where a therapist uses a tool, such as a smooth stone, to scrape the skin. Gua sha improves circulation and helps to break down scar tissue. Many therapists have taken the gua sha concept and applied it to different physical therapy techniques, such as the Graston technique and the Astym technique.

    Therapists that follow Graston and Astym protocols use plastic and/or metal tools to rub down soft tissues instead of their hands. If you have deeper areas of scar tissue that can’t be resolved by manual therapy, then these types of tools can be beneficial since the therapist can apply deeper pressure. These tools also come in a variety of shapes, which can help therapists pinpoint difficult-to-reach muscle groups, like the iliopsoas. Lastly, these tools help stimulate new cell growth in soft tissues and help the body resorb scar tissue.

    Dry Needling

    Dry needling is a therapy where practitioners use thin needles to break up scar tissue and reduce inflammation in trigger points. Trigger points are tight muscle fibers that can form from soft tissue trauma, muscle imbalances, and repetitive motions.

    Some people may confuse dry needling with acupuncture treatments. While dry needling looks like acupuncture, Healthline points out some distinct differences.

    For example, acupuncture is rooted in T.C.M and is meant to improve energy flow in the body; dry needling’s main focus is on correcting overly tight muscles with scar tissue. If your soft tissue injury has caused muscle spasms, then dry needling may be a good option. Some people’s soft tissue injuries may cause extreme sensitivity to touch, so dry needling may be a better option for these patients instead of A.R.T or Graston/Astym therapy. 

    I’m glad to know this because I only have a Tissue Viability Nurse and none of these techniques were suggested to me. I intend on trying out these new techniques soon.

    http://theresumexpert.com/2022/07/27/3-soft-tissue-therapies-for-scar-tissue/

  • 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

  • Stop the Pressure Campaign

    “Stop the Pressure” is an initiative from NHS Midlands and East, which has been rolled out across the NHS. The campaign used data collected by NHS Safety Thermometer and worked to raise awareness and improve monitoring and management of patients at risk of damage.

    They found that the number of new pressure ulcers was reduced by 50% in one year.

    A key part of the success of the campaign was attributed to a preventive strategy with a number of elements, referred to as the SSKIN bundle, which was communicated with great clarity.

    The acronym SSKIN contains five key steps:

    • Surface – make sure patients have the right support
    • Skin inspection – early inspection means early detection
    • Keep patients moving
    • Incontinence/moisture – patients need to be kept clean and dry
    • Nutrition/hydration – make sure patients have the right diet and plenty of fluids

    As part of a worldwide effort to reduce the prevalence of pressure damage, November 19th, 2020, saw the international Stop Pressure Ulcer Day. This year it will be celebrated on March 24, 2022, through a Virtual Conference.

    https://www.independentliving.co.uk/advice/prevent-pressure-ulcers/#stop

    www.healthcareconferencesuk.co.uk

    www.socialcareconferences.co.uk

    www.facebook.com/HealthcareConferencesUK

    https://www.healthcareconferencesuk.co.uk/conferences-masterclasses/pressure-ulcer-prevention

    Pressure-Ulcer-March-2022Download

  • Let’s Work Together to Stop The Pressure!!!

    https://www.shasbah.co.uk/spina-bifida/spina-bifida-pressure-ulcers/?fbclid=IwAR1g0wzmeyBLMxAs78HfH9CZrUD0A4lf6C52TP3w-O3EMutQuLDXv1qBfMk


    MY PRESSURE ULCER JOURNEY

    I never knew what pressure ulcers were until I got one for almost all pressure points. I am currently facing possible amputation. If this happens what am I gonna do?

    24 hour support will be needed. I don’t like the idea of amputation. The problem is, I’ve been having pressure ulcers, foot x-rays and MRIs/CTIs. I’ve had a series of meetings about my right foot. I’ve got antibiotics to take. Blood sugars, protein levels, blood circulation, feet pulses and kidneys all contribute to the feet. I also got to see photos from MRI scans. I got permission to take photos of them. The heel bone is infected. I know what it’s like to be cured of pressure ulcers, but they keep returning, especially on my feet. What’s going on?

    As a result, I have chosen to join the fight against pressure ulcers.

    During my first year of college, the pressure ulcers started. When this happened, I got a social worker, carers, District Nurses from the Chelsea and Westminster Hospital in London while studying. I also have a Tissue Viability Nurse and a Podiatrist. Before the pandemic, I visited the doctor’s office for appointments. Now I get home visits.

    One day, the wound on my right foot seemed smelly to the nurse as if it’s infected so I was on antibiotics for 7 days. Sensation and movement is limited from the ankles down as a result of lower spine damage due to Spina Bifida. Pressure ulcers can also be caused by bed mattresses or wheelchairs. Bermuda has a lack of resources and a lack of information. There are no Spina Bifida clinics/specialists in Bermuda. Lived with parents. Swimming in the salt ocean in Bermuda beaches has contributed to the healing process. Before England and College, I had no pressure ulcers.

    Pressure wounds usually take 3 months to heal. My wheelchair has a ROHO Cushion with air pockets. Now my footrests have air pockets. It’s ultimately an airbag under my feet. https://www.permobil.com/en-us/products?category=SeatAndPositioning

    Podiatry and District Nurses tend to clash from time to time. District Nurses visit three times a week while Podiatry only visited once. District Nurses know how to dress my foot correctly. Which one is more important?

    Pressure Sores (also called bedsores or decubitus ulcers)
    Pressure sores, also called bedsores or decubitus ulcers, are areas of broken skin and underlying tissues that have been damaged by pressure. Pressure (such as sitting in the same position for too long) restricts blood being supplied to the area, so the tissues become deprived of oxygen and toxins build up, which causes the skin and tissue cells to die. People with Spina Bifida may not feel this damage beginning because of reduced feeling in parts of their body.

    PURSUN GROUP IN LEEDS
    Prevention is better than cure! You must have tough skin. Pay attention to pressure points. Additionally, make sure you have good quality, well-fitting shoes that do not cause red marks on your feet. You may want to ask your GP to refer you to an orthotics centre to have shoes made especially for you. The styles are much better than they used to be!

    Make sure you have a well-fitting wheelchair with a pressure-relieving/ reducing cushion. Pressure mapping in the wheelchair cushion. Always use your footplates to support your feet and stop your legs from ‘hanging down’, which is bad for the circulation. Ergonomic Assessment required.

    Feet must be elevated above the head, especially in bed, for good circulation. Check your wheelchair does not leave red marks on your legs or body. When you see a reddened area of skin, tell your GP straightaway. Don’t wait to see if it improves on its own. If left untreated they can take a lot longer to heal. If you do have a skin breakdown, make sure your health professionals look at the reasons why it happened, and don’t just apply dressings. Change your sitting position frequently throughout the day and have a chair at home to sit in other than your wheelchair. Try to spend part of each day off your bottom. Check your skin regularly for pressure sores using a mirror to see areas of your body you cannot see otherwise. Pay particular attention to areas of skin where you have little or no feeling.

    Massage is now advised against as recent evidence suggests that it is not beneficial for pressure areas and may be harmful.

    https://www.nursingtimes.net/clinical-archive/tissue-viability/does-massage-help-to-prevent-pressure-ulcers-15-08-2011/https://www.nursingtimes.net/clinical-archive/tissue-viability/does-massage-help-to-prevent-pressure-ulcers-15-08-2011/


    Hygiene: Access to Showering facilities instead of bathing facilities in England. District nurses clean and dress wound 3x a week maximum, in addition to personal daily showering. Skin care included Aqueous cream. No scented creams are allowed on broken skin. I shower daily but due to pressure ulcers and a PICO, I also use a LIMBO to cover my damaged foot to keep it clean and dry.

    Why does immobility cause pressure ulcers?
    Poor mobility/immobility: Patients who are unable to independently change position are at increased risk of developing a pressure ulcer, due to pressure exerted over bony body parts which results in reduced blood flow to the tissues and subsequent hypoxia.

    CURE

    I also use a Profile bed, I prefer loose clothing vs tight clothing like dresses or sweat suits. Compression socks/stockings/orthopaedic shoes/socks because sensation and movement is limited from my ankles down.

    Incontinence can also contribute to pressure ulcers. Pressure ulcers must be kept clean and dry.
    Previously during the first four months of my first year in college, I skipped meals for the sake of my studies. I was also given a Dietician who put me on a high protein diet. My meal plan looks something like this:


    Breakfast
    Mid-morning snack
    Lunch
    Mid-afternoon snack
    Dinner
    Dessert

    Why does malnutrition cause pressure ulcers?

    Unplanned weight loss is a major risk factor for malnutrition and pressure ulcer development. Suboptimal nutrition interferes with the function of the immune system, collagen synthesis, and tensile strength.

    Pressure Ulcer Prevention at Home

    • Treat your skin gently to help prevent pressure ulcers.
    • When washing, use a soft sponge or cloth.
    • Use moisturizing cream and skin protectants on your skin every day.
    • Clean and dry areas underneath your breasts and in your groin.
    • DO NOT use talc powder or strong soaps.
    • Try not to take a bath or shower every day

    https://tvs.org.uk/stop-pressure/

    https://www.shinecharity.org.uk/self-care/skin-and-tissue#Sores

    https://nhs.stopthepressure.co.uk/patients.html

    https://medicinehealth.leeds.ac.uk/leeds-institute-clinical-trials-research

    Click to access SHASBAH-news-summer-2021.pdf

    Every day has to be a STOP THE PRESSURE day when you are a person living with skin vulnerability or reduced mobility.

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

    STOP THE PRESSURE, START THE RELIEF!!!!

    STAY TUNED FOR THE REST OF THIS SERIES ON PRESSURE ULCERS!

  • 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.

  • The frequency of lymphoedema in an adult Spina Bifida population

    The Fight Against Pressure Ulcers

    Lymphoedema


    Lymphoedema is a swelling often of your legs which is due to fluid collecting in the tissues under the skin. This can leave you prone to cellulitis and skin breakdown, and can interfere with independence as your legs get heavy and difficult to move. Ask your GP to arrange treatment with pressure stockings or appliances, which are very effective.

    The National Lymphedema Network (lymphnet.org) defines lymphedema as “an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arms and/or legs, and occasionally in other parts of the body. Lymphedema can develop when lymphatic vessels are missing or impaired or when lymph vessels are damaged or lymph nodes removed.

    Feet
    It is suggested that you see a podiatrist/chiropodist regularly to have your toenails cut and hard skin removed if you have loss of feeling or poor circulation in your feet. Use a foot-softening cream on your feet and moisturiser on your legs to prevent cracking as bacteria can enter this way. If your skin is very dry, use aqueous cream instead of soap when bathing. Dry carefully between your toes and treat athlete’s foot straight away. Creams and sprays are available from pharmacies and larger supermarkets.

    There have been very few studies to date documenting the occurrence of lymphedema in the Spina Bifida population, despite a case series in 2001 that suggested that the occurrence may be higher than in the general population. A total of 240 electronic medical records from the Adult Spina Bifida Clinic from January 2005 to August 2008 were retrospectively reviewed.

    This is why incontinence/ moisture management, movement, and sensation are important for Spina Bifida patients.

    10 Methods to tackle swollen feet

    1. Drink 8 to 10 glasses of water per day
      Though it might seem counterintuitive, getting enough fluids actually helps reduce swelling. When your body isn’t hydrated enough, it holds onto the fluid it does have. This contributes to swelling.
    2. Buy compression socks
      Compression socks can be found at a drug or grocery store or even bought online. Start with compression socks that are between 12 to 15 mm or 15 to 20 mm of mercury.

    They come in a variety of weights and compressions, so it might be best to start off with lighter-weight socks and then find the kind that provides the most relief.

    1. Soak in a cool Epsom salt bath for about 15 to 20 minutes
      Epsom salt (magnesium sulfate) may not only help with muscle pain. It may also reduce swelling and inflammation. The theory is that Epsom salt draws out toxins and increases relaxation.

    Just make sure to get Epsom salts marked with the USP designation. This means that it meets standards set forth by the U.S. Food and Drug Administration and is safe to use.

    1. Elevate your feet, preferably above your heart
      Prop your feet on cushions, pillows, or even things like phone books, when you sleep. If you’re looking to reduce foot swelling while pregnant, try elevating your feet several times a day as well. Aim for about 20 minutes at a time, even on an ottoman or a chair.

    Try to avoid standing for long periods of time and stay off your feet when you can.

    1. Get moving!
      If you sit or stand in one area for a long period of time (like at work), this can lead to swollen feet. Try to move a little bit each hour, even if it’s a walk to the break room, a walk around the block at lunch, flexing your knees and ankles, or a lap around the office.
    2. Magnesium supplements can be helpful for some people
      If you retain water, you might have a magnesium deficiency. Eating foods high in magnesium can help. Magnesium-rich foods. Trusted Source to add to your diet include:
    • almonds
    • tofu
    • cashews
    • spinach
    • dark chocolate
    • broccoli
    • avocados
    • Taking 200 to 400 milligrams of magnesium daily might help with the swelling. But before you take any kind of supplement, ask your doctor. Magnesium supplements aren’t right for everyone, especially if you have a kidney or heart condition.
    1. Make some dietary changes
      Reducing your sodium intake can help decrease swelling in your body, including in your feet. Opt for low-sodium versions of your favourite foods, and try to refrain from adding salt to meals.
    2. Lose weight if you’re overweight
      Being overweight can cause reduced blood circulation, leading to swelling of the lower extremities. It can also lead to extra strain on the feet, causing pain when walking. This can result in being more sedentary — which can also cause fluid buildup in the feet.

    Losing weight can help ease the strain on your feet and possibly reduce foot swelling as well. Talk with your doctor about whether you need to lose weight and healthy ways to go about doing so.

    1. Massage your feet
      Massage can be great for swollen feet and can also promote relaxation. Massage (or have someone massage them for you!) your feet toward your heart with firm strokes and some pressure. This can help move the fluid out of the area and reduce swelling.
    2. Increase your intake of potassium-rich foods
      A potassium deficiency can contribute to high blood pressure and water retention. If you have no dietary restrictions, consider eating foods containing potassium. Some potassium-rich foods. Trusted Source include:
    • sweet potatoes
    • white beans
    • bananas
    • salmon
    • pistachios
    • chicken
    • Try drinking orange juice or low-fat milk instead of soda, too. If you have any medical conditions, especially kidney issues, talk with your doctor before adding lots of potassium to your diet.

    How long should I elevate my feet to reduce swelling?


    The more the swelling and the longer there has been swelling, the longer and more frequently your need to elevate your legs. Start with 20 minutes twice a day. This might do the trick. If not, go to 30 minutes or even an hour.

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

    https://www.shinecharity.org.uk/self-care/skin-and-tissue

    https://mobilitymgmt.com/Articles/2011/06/01/Lymphedema.aspx