Pressure Care

It is well-known that most pressure injuries are preventable. Given the unnecessary suffering of the individual and the cost to the economy, prevention is the best strategy.

 

How can pressure injuries be prevented?

Pressure injury prevention, although difficult, is possible.

There are general recommendations from the NHS for reducing the risk of an individual developing a pressure injury1:

  • Daily skin checking for early signs and symptoms of pressure injuries; this may need to be completed by the individual’s care team or support network.
  • A healthy, balanced diet that contains enough protein and a good variety of vitamins and minerals.
  • Smoking cessation, as smoking increases the risk of pressure injuries due to the damage caused to circulation.

In addition to these general recommendations, the key intervention for prevention is pressure redistribution through regular repositioning1. This is critical for those deemed at risk of developing a pressure injury as it is believed to be one of the most effective methods for preventing skin damage2.

If an individual is able to reposition themselves, they should be encouraged to do so at least every six hours. For those at high risk of a pressure injury, they should reposition at least every four hours3. Any individual unable to manage repositioning independently should be assisted to reposition either through their care team or specialist equipment; this will be reflected in their care plan.

 

How can specialist seating help?

Sadly, within the pressure care world, seated posture and positioning have been historically neglected, but CareFlex are on a mission to raise awareness of the importance of specialist seating as a part of a client’s 24-hour posture and pressure management plan.

Specialist seating can promote repositioning and pressure redistribution through the chair functions and accessories it offers. To maximise the effects of repositioning, it’s also important that the individual’s posture and weight distribution is addressed. Specialist seating systems can promote optimum posture and distribute the user’s body weight evenly throughout the chair over the maximum surface area.

A good practice statement by the EPUAP, NPIAP AND PPPIA international collaboration states that a seating support surface that meets the individual’s needs for pressure care by addressing their body size, posture,  mobility and lifestyle should be considered4. A true holistic approach.

 

How can CareFlex specialist seating help?

A comprehensive assessment by skilled and experienced professionals will ensure that the chair dimensions are configured to the user and that the appropriate functions and accessories are provided. The aim is for initial weight distribution to be as equal as possible and for the optimum seated posture to be established to maximise the effects of regular repositioning, which can also be achieved through the chair’s functions and accessories.

  • Integrated pressure relieving WaterCell Technology can provide a reliable and dynamic solution for individuals at risk of pressure injury. It will enable the user to achieve a stable and functional posture without compromising on pressure management and comfort.
  • Adjustable seat depth and width, along with contoured seat options, can aid pelvic stability to reduce shear and friction forces and reduce the pressure over the sacrum and coccyx. Pelvic alignment can also encourage a symmetrical posture with equal weight distribution.
  • Back support options, including waterfall, contoured and lateral supports, will encourage an upright trunk to further promote equal weight distribution.
  • Footrests, with a range of cushion options, can also encourage equal weight distribution reducing the pressure at the heels.
  • Armrests, with hand grip options, can aid repositioning and enable the user to stand.
  • Tilt-in-space can be utilised to change the user’s centre of gravity and therefore alter the points of pressure. Research has suggested that tilt-in-space and back angle recline, when used in combination, can be effective in providing both muscle and skin perfusion at the ischial tuberosities5.
  • Motorised actuation can allow the user to adjust chair functions independently. It can also assist the client’s support network with repositioning, easing the effort required.
  • AutoTilt actuation can enhance the standard pressure management functions already built into CareFlex chairs by moving them through small degrees of tilt at short intervals to redistribute pressure. This function can be more cost effective than a client having to source a care package for regular repositioning.

 

Pressure-relieving cushions cannot achieve this level of regular repositioning or pressure redistribution alone.

 

How can specialist seating be justified?

It is no secret that specialist seating comes with a cost implication; however, pressure injuries come with a significantly higher financial impact.

Pressure injury treatment costs6:

  • £1,064 for a grade 1 ulcer.
  • £14,108 for a grade 4 ulcer.

(These costs will be higher if infection occurs or if surgical intervention is required.)

Daily cost to the NHS of treating pressure ulcers7:

  • More than £1.4 million every day.

With evidence suggesting that approximately 2,000 individuals develop pressure ulcers every month, and with prevalence rates sadly steadily increasing8, now more than ever a drive for specialist seating is needed to change the lives of individuals whilst improving the economy.

 

What about individuals who have already developed a pressure injury?

For individuals who have already developed a pressure injury appropriate management is essential to encourage healing and reduce the risk of secondary complications9.

CareFlex specialist seating can be provided in instances where an individual has a pressure injury but their care must be managed by the appropriate professional. There is also the option to select a docking cushion should the user require a higher level of pressure relief. Read more on CareFlex’s WaterCell Technology, and how our specialist seating can have a positive impact on the management of pressure injuries in Michael’s story.

 

References:

  1. NHS (2017) Overview: Pressure ulcers (pressure sores) Available from: https://www.nhs.uk/conditions/pressure-sores/
  2. Sprigle S, Sonenblum S (2011) Assessing the evidence supporting redistribution of pressure for pressure ulcers prevention: a review J Rehabil Res Dev 48(3):203–213
  3. National Institute for Health and Care Excellence (NICE) (2014) [CG179] Pressure ulcers: prevention and management Available from: www.nice.org.uk/guidance/cg179
  4. European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP), Pan Pacific Pressure Injury Alliance (PPPIA) (2019) Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide Available from: https://www.epuap.org/pu-guidelines/
  5. Jan YK, Crane BA, Liao F, Woods JA, Ennis WJ (2013) Comparison of muscle and skin perfusion over the ischial tuberosities in response to wheelchair tilt-in-space and recline angles in people with spinal cord injury Archives of Physical Medicine and Rehabilitation 94(10):1990-6
  6. Dealey C, Possnett J, Walker A (2012) Cost of Pressure Ulcers in the United Kingdom Journal of Wound Care 21(6):261-266
  7. Guest JF (2017) The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK Journal of Wound Care 26(6)
  8. NHS Improvement (2019) NHS Safety Thermometer Available from: https://www.safetythermometer.nhs.uk/index.php
  9. NHS (2017) Treatment: Pressure ulcers (pressure sores) Available from: https://www.nhs.uk/conditions/pressure-sores/treatment/