Pressure-Monitoring Tool May Decrease Pressure Ulcers in ICU

Larry Hand

December 19, 2013

Healthcare providers may be able to reduce the incidence of hospital-acquired pressure ulcers by using a real-time continuous bedside pressure measurement (CBPM) system that lights up in colors showing where bed pressures exist, according to an article published in the December 2013 issue of WOUNDS.

Aamir Siddiqui, MD, a plastic and reconstructive surgeon at Henry Ford Hospital, Detroit, Michigan, and colleagues conducted a 2-month study using the CBPM for 307 patients in 20 beds in the medical intensive care unit (ICU) at Henry Ford Hospital during January and February 2011. They then compared the frequency of pressure ulcers in those patients with the frequency from 320 other patients who were hospitalized in the same 20 beds a year earlier.

Pressure ulcers and postoperative respiratory failure are the 2 most common patient safety indicators and accounted for more than half of the $7.3 billion in healthcare system costs for all patient safety indicators from 2007 to 2009, according to HealthGrades.

Since October 2008, the Centers for Medicare & Medicaid Services has stopped reimbursing acute care hospitals at a higher rate for treatment of hospital-acquired stage III and stage IV pressure ulcers when billed as a secondary diagnosis.

The new system, called MAP (Wellsense), consists of a pressure-sensing mat placed on the bed, plus a connected bedside monitor that shows a pressure map. The map is essentially an image of a human body with pressure points lit up in blue, green, and red.

During the study period, 1 of the patients (0.3%) in the CBPM beds developed a stage 2 pressure ulcer of the sacrum, compared with 16 (5%) of the patients who were treated in the same beds the previous January-February period (P = .001). The researchers reported no technical or safety issues.

The pressure ulcer that developed during the study resolved within 2 months, the researchers write. Ulcers that developed in the control group included 6 stage II ulcers, 9 stage III, and 1 stage IV. The 2 patient populations were similar in terms of age, race, sex, and other factors, with a mean age of about 60 years.

Providers Satisfied

When the researchers surveyed the nurses and other providers involved in the study, 90% of respondents said the CBPM system improved pressure detection, 88% said the system helped them to reposition patients according to protocols, and 84% said the pressure map image provided for efficient and effective patient repositioning. In addition, 97% said the system's sensitivity configuration is consistent with protocols.

"Patient repositioning to offload high-pressure areas is an essential component of pressure ulcer prevention for bed-bound patients," Dr. Siddiqui said in a press release issued by Wellsense. "In most settings, the quantity and quality of offloading and repositioning are difficult to measure, but real-time continuous bedside pressure mapping unblinds caregivers to be able to see instant pressure distribution data and then off-load pressure accordingly."

The researchers acknowledge that the study involved 1 unit of 1 acute care hospital and that more study is needed. However, they write, "In addition to aiding in the repositioning of complex patients, CBPM may be able to level the playing field for new, less-experienced bedside caregivers."

Helps With "Dovetailing"

Joyce M. Black, PhD, RN, associate professor at the College of Nursing, University of Nebraska Medical Center, Omaha, agrees with that point. She was first author of a 2011 paper describing the results of the National Pressure Ulcer Advisory Panel Consensus Conference. She also evaluated an earlier experimental version of a system and would consider adopting one depending on price. (A spokesman for Wellsense indicated in an email to Medscape Medical News that outfitting a 20-bed ICU unit with the system would cost about $80,000 annually.)

"I think anything to make people aware of pressure ulcer risks is a good thing," Dr. Black told Medscape Medical News. "Inexperienced nurses can get a little bit of a forest-and-trees phenomenon. They are not able to do what we call 'dovetail,'" or perform multiple tasks, such as repositioning while in a patient's room for another purpose.

She wonders, however, whether use of the system may be leading to excessive repositioning, citing recently published research that showed no differences in pressure ulcer incidence when patients were turned at 2-, 3-, or 4-hour intervals over a 3-week observation period.

The turning "may be done more frequently than the patients needed to be turned. It makes me question, 'did other things get dropped from what [the nurses] were doing?'"

She also wonders whether the pressure-sensing mat might be interfering with certain hospital beds that are designed to leak air to keep a patient's skin dry. The study article does not address this point. "We can put so many things on a bed that the benefit of the bed is lost," and the cost of the air-leaking feature is also lost, she said.

Hawthorne Effect

"Clearly there's a bit of a Hawthorne effect here because, now, you are on notice that something is happening to your patient and you're therefore going to be more responsive to it," Dr. Black said, referring to the tendency for people to perform better during an experiment. "At least it's a good Hawthorne effect. It's making people change their practice and move the patients in response to pressure."

She continued, "These patients probably were turned more than the average person would have been because we don't have any other way to know how long that pressure has been there."

Nevertheless, she sees good in the system "as long as you can keep your pressure ulcer rates down and not exhaust your nursing staff."

The authors and commentator have disclosed no relevant financial relationships.

WOUNDS. 2013;25:333-339. Abstract

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