Authors (including presenting author) :
Chan KWJ , Mak PT , Hui HM , Chan HF , Yau SF
Affiliation :
Department of Occupational Therapy, Grantham Hospital
Introduction :
In Grantham Hospital, patients in different units such as Palliative Medical Unit (PMU), Infirmary Ward, Cardiac Medical Unit (CMU), Tuberculosis and Chest Unit (TBCU), may experience poor mobility or postural abnormalities, which may increase their risk of developing pressure injuries. In the past, we used to provide pressure-relieving aids to these patients based on our clinical observation and experiences. However, some of these patients still reported discomfort in sitting even with the use of the prescribed seating cushions, which limited their sitting and training tolerance. In order to have an accurate and evidence-based assessment on pressure distribution of different pressure-relieving aids, a new set of Pressure Mapping System (X-SENSOR) was purchased in February 2021. Pressure Mapping is a non-invasive tool that can provide real-time visual images and numeric values of patients’ sustained pressure on a weight-bearing surface. With the use of this system, Occupational Therapy (OT) service in pressure injury assessment could be enhanced by using the objective result to select appropriate pressure-relieving aids e.g.seating cushion, determine pressure redistribution strategies, and hence, optimizing patients’ satisfaction in sitting and positioning. In addition, real-time images and snapshots of pressure mapping could be used to demonstrate the effect of postural changes on pressure distribution, hence facilitating the education on the importance of weight-shifting and training on self-repositioning skills in pressure relief.
Objectives :
1. To facilitate and justify the selection of pressure-relieving aids to the indicated cases
2. To educate and provide feedback to patients on the importance of weight shifts with the real-time visual image shown on the Pressure Mapping System
Methodology :
Patients who subjectively complain of discomfort in positioning/ sitting or are at risk of developing pressure injury as noticed by ward nurses would be recruited into pressure mapping assessment after being screened by Occupational Therapists. Firstly, needs of pressure mapping assessment would be introduced to the indicated cases so as to ensure their understanding of the rationale behind as part of the care plan. Secondly, several pressure-relieving aids such as gel cushions, air cushions, foam cushions would be selected for patients based on their needs. Thirdly, pressure mapping assessment would be carried out to the indicated cases with those selected pressure-relieving aids. Besides, education would be provided at the same time to patients with live images supported in the pressure mapping system, so as to increase their understanding on the pressure-relieving effects and the importance of weight shifting. The live image of pressure mapping of different pressure relief aids used would also be captured for further analysis. Comparison of the captured live images of pressure mapping with different pressure-relieving aids would be conducted according to the following aspects: a) average pressure on the skin; b) peak pressure; and c) contact area. At the end, the pressure-relieving aid which showing better effect in pressure-relieving with i) lowest average pressure on skin; ii) lowest peak pressure; and iii) largest contact area would be recommended to patients.
Result & Outcome :
The pilot program was started in July 2021. Up to 31st December 2021, a total of 6 cases in different units including Infirmary Unit, PMU, CMU and TBCU were assessed with the Pressure Mapping System and corresponding recommendations were provided based on the assessment results. For chairbound cases, after prescribing a seating cushion based on the results from pressure mapping and clinical judgment, we found that patients were able to tolerate longer sitting hours with improved satisfaction. Their motivation to sit out and participate in rehabilitation were also improved based on our clinical observation. For bedbound cases, selection of bed mattresses could also be done with the use of a pressure mapping system and hence, facilitate OT to provide recommendations on the choices of bed mattresses for both ward staff and patients’ families. In conclusion, Pressure Mapping is a comprehensive assessment that is able to justify and facilitate the selection of pressure-relieving aids and hence, optimize patients’ satisfaction in sitting and positioning. This program will continue to proceed in our clinical services.
