Bedside Technologies to Enhance the Early Detection of Pressure Injuries

Abstract

Each year, more than 2.5 million people in the United States develop pressure ulcers. These skin lesions bring pain, associated risk for serious infection, and increased health care utilization. Moreover, the Centers for Medicare & Medicaid (CMS) no longer provides additional reimbursement to hospitals to care for a patient who has acquired a pressure ulcer while under the hospital's care. Thus, pressure ulcer prevention presents an important challenge in acute care hospitals. A number of best practices have been shown to be effective in reducing the occurrence of pressure ulcers, but these practices are not used systematically in all hospitals. The Challenges of Pressure Ulcer Prevention Pressure ulcer prevention requires an interdisciplinary approach to care. Some parts of pressure ulcer prevention care are highly routinized, but care must also be tailored to the specific risk profile of each patient. No individual clinician working alone, regardless of how talented, can prevent all pressure ulcers from developing. Rather, pressure ulcer prevention requires activities among many individuals, including the multiple disciplines and multiple teams involved in developing and implementing the care plan. To accomplish this coordination, high-quality prevention requires an organizational culture and operational practices that promote teamwork and communication, as well as individual expertise. Therefore, improvement in pressure ulcer prevention calls for a system focus to make needed changes. Toolkit Designed for Multiple Audiences The aim of this toolkit is to assist hospital staff in implementing effective pressure ulcer prevention practices. The toolkit was developed under a contract with the Agency for Healthcare Research and Quality through the ACTION program (Accelerating Change and Transformation in Organizations and Networks), with additional support from the Health Services Research and Development Service of the Department of Veterans Affairs. It was created by a core team with expertise in pressure ulcers and organizational change at the Boston University School of Public Health. An expert advisory panel and quality improvement teams at six participating medical centers provided input. The toolkit's content draws on literature on best practices in pressure ulcer prevention and includes both validated and newly developed tools. The toolkit was tested in the six participating medical centers. Their feedback influenced this final version and their experiences are reflected in many of the examples provided.

Evaluating the sensitivity, specificity and clinical utility of algorithms of spatial variation in sub-epidermal moisture (SEM) for the diagnosis of deep and early-stage pressure-induced tissue damage

“…15,17,18,[26][27][28][29][30][31] The role of localised inflammatory oedema/SEM was recognised as 'one of the earliest signs of cell death in pressure injuries' in the 2019 Clinical Practice Guidelines 24 emphasising the importance of SEM as an aetiological biomarker in predicting impending skin damage. 32 Results from this study add to the body of evidence that spatial SEM tests have clinical utility in aiding HCP determination of healthy versus damaged tissue. These spatial SEM results demonstrated key identifying features of fluctuations in absolute SEM values in healthy and pressure-damaged skin and tissue.…”

“…In the aggregate, results from this study in combination with laboratory studies, 14 inter-operator reliability studies, 19 damaged and healthy tissue studies, 26,49 longitudinal assessments 18 and other SEM studies 15,29,31,32,35,[50][51][52] through different tests of SEM have repeatedly shown that SEM is a predictor and a reliable indicator of the early onset of pressure-induced skin and tissue damage. Furthermore, a health economics analysis performed by Padula et al (2020), shows that prevention using the SEM test is cost-saving and is dominant in quality interventions when compared to the current standard of PI/PU care.…”

Clinical profile of the SEM Scanner — Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning

“…Impedance devices (e.g. Nova ® Dermal Phase Meter, MoistureMeter D ® ) have examined device-dependent absolute SEM measures as an indicator of pressure-induced damage [37]. These devices have not been approved for patient use and are available for research only.…”

The cost-effectiveness of sub-epidermal moisture scanning to assess pressure injury risk in U.S. health systems

“…In conclusion, evidence identified in a clinical systematic review supported the use of SEM measurement devices as effective tools for early pressure injury detection. 22 In this health economic analysis, SEM scanners are a cost-effective means of documenting pressure injury risk based on moisture levels on patients' skin and underlying soft tissue. This technology circumvents the high cost of most pressure injuries in facilities and may achieve an ROI in less than one year.…”