Best Practices for Using Pressure Mapping Systems

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(No Transcript)
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Our Goal
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To Prevent This!
Wound measurement using VEV MD
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Best Practices for Using FSA Pressure Mapping
Systems

• Todays Goal
• Why use Pressure Mapping?
• How to use it correctly?

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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 little objective
  evidence.

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Where Does Pressure Fit In Our Assessment
Hierarchy?

• Patient
• Position
• Pressure

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Pressure mapping systems help you redistribute
pressure they do not

• Relieve pressure
• Or
• Reduce pressure

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So What Do We Actually Do With The Client?

• Introduce pressure mapping
• Capture how they are doing currently
• Demonstrate the clients challenges
• Document commonly used solutions
• Provide as necessary an appropriate alternative
• Communicate our findings effectively

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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

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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

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Learn About the Patient

• Gather any background information you deem
  pertinent and record in the client information
  notebook.
• 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.

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Clients Background

• SCI client has C5 Quadriplegia
• 45 year old male Diving accident at 20.
• 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

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Current Complaint

• Unable to be up for longer than 4 hours due to
  redness in both Ischial Tuberosities, with left
  being the worse.
• 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.

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Capture Them in Their Present Seating

• Now that they have sat for a while in their
  existing mobility device scan(F2), store(F2
  again) 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
  FSA system.
• This will help answer the question
• Why do we need to make changes?

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Some Reminders

• Make sure the ribbon cable is along the right leg
  and mat is blue side up
• Make sure the mat is square on the seat
• Make sure the sensing mat is not hammocked
• Make sure the client is in a normal or neutral
  position you can replicate with other surfaces

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Current Seating
What is suspicious in this picture? Note the
hexagon.
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Use Your Hands!!
What really is at the 135 mmHg location??
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Ah 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!
• Are we expanding or contracting the area of the
  pressure distribution on the surface?
• Coefficient of Variation - Lower the the
  Better!
• How evenly is the pressure distributed over the
  surface?

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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?

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Dont Forget AsymmetryOr Lack Of It!
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Thats More Like It!
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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(F2), store(F2) 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?

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On A Firm Flat Surface
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Document the Most Commonly Used or Paid for
Solution

• Your years of experience or the typical funding
  parameters may lead you to a particular solution
• Scan(F2), store(F2) 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 or how the most likely or commonly paid for
  solution did or did not work?

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A Standard Solution

• Foam cushion pressures still unacceptably high,
  and highly focused

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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 usual?

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Standing Chair After Adjustments
F9 is right IT Good pressure distribution Up 6
hours am 4 hours evening - meeting goal
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Power Chair After Adjustments
8 by 9 Roho insert in foam good pressure
distribution not as good though as the Standing
Chair up only 4 hours
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Before therapist correction
Stand-up chair
After therapist supported left PSIS area
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Dont Forget Remote!

• Use Remote to monitor the performance of the
  proposed solution 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. If they tilt did the go
  far enough to get benefit.

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Some Common Mistakes

• We stop using our hands and let technology make
  decisions for us.
• We try every choice in the clinic. Our time
  evaporates and we dont know what we have by the
  time were done. Princess and the Pea syndrome
  in reverse.

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Pressure Mapping Is An Excellent Teaching Tool.

• Training and testing for caregiver and client
  compliance
• Caregiver and Vet in bed-demonstrate why lifting
  versus sliding across a bed is necessary
• No that solution your buddy has will not work for
  youSee!
• Dont over-inflate that ROHO!!
• Use remote feature to check for weight shifts or
  tilts
• Client lifestyle
• Beautiful seating solution in clinic but a wood
  stool at the bar defeats the benefits

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What Do You Do When It All Looks Bad?

• Sometimes you overdrive the solution and have to
  back up
• 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 FSA as a biofeedback tool to
  help a nervous T3 discover how much(little) they
  have to move to achieve pressure reductions for
  at risk areas.

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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 maybe lurking under the surface?
• Some 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.

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How 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

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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

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Compare and Choose
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Print Your Choices
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Print Your Choices
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Other Tools In FSA 4D

• Histograms
• Track pressure in multiple chosen areas
• Add pictures
• Add shear, temperature or any other FSA sensing
  mat to the same client file
• Balance assessment

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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 FSA, 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.

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Evidence Based Practice Many Come To Rely On

• Kaiser requires PMs for use as a benchmark to
  become a contracted vendor with them.
• Those with the most success using PMs take time
  to educate their Case Managers and other payers.
• It also provides information that demonstrates
  why you did what you did, a.k.a. Risk Management.

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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.

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Remember Our Goal
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www.pressuremapping.com

• For more information on
• Product
• Applications
• Technical specifications
• Clinical use
• Research bibliography

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THANK YOU!