Whatever term you use to describe the result of sustained pressure injury: pressure ulcers, wounds, or sores, it must be acknowledged that preventing them is an ongoing concern for senior care communities.
So why are pressure injuries such a problem in the senior care sector? Well, firstly they are painful for residents to experience, they can lead to further medical complications and even fatalities that could have been altogether avoided, and also because what's important to CMS and Medicaid has got to be important to us as caregivers too.
According to the Mayo Clinic, "Bedsores — also called pressure ulcers and decubitus ulcers — are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone."
Not all pressure sores are avoidable because when we're trying to prevent them, we're often fighting a powerful force beyond our control: gravity. Pressure injuries develop for a number of reasons and are associated with a variety of risk factors but simply put, they form because of some sort of pressure applied to the skin which damages the soft tissue cells deep under the skin's surface. This most commonly happens around a bony prominence and as cells die, the wound forms.
Sometimes medical devices or other non-organic items can be blamed for pressure injury development. Improperly placed catheters and oxygen tubes have been known to cause pressure wounds as they press on the skin for long periods of time but often it is simply a case of prolonged exposure to gravity in a still position.
The treatment of pressure ulcers can require a lot of resources including time and money. Prevention measures can also be resource-consuming, but we've heard it said that an ounce of prevention is worth a pound of cure, and we think this applies when it comes to pressure management.
So, prevention is the goal but how to go about it? Well, the skin is our largest organ as Amy Bruggeman so rightly says in our Best Practices Pressure Injury Prevention and Documentation webinar, yet when our internal organs sustain damage, the skin is where they take resources from to maintain basic vital functions during the “flux” of critical illness. This leaves the skin more vulnerable to sustaining damage.
It's thought best to take steps to protect it both internally as well as externally for a multi-faceted approach to skincare and PI/PU prevention. By this we mean, that improving nutrition and the internal health of the resident can have a positive impact on the integrity of their skin, and by simultaneously managing external forces and equipment that can damage that skin we’ll have a better chance of preventing pressure injuries.
Improving the resident's all-around health will aid in their cells' ability to be more resilient against pressure damage. Encouraging a healthy blood supply and circulatory system can help with tissue cells' regeneration and strength. Improving the nutrient and water intake of high-risk residents can also help in the prevention of pressure injuries as it provides more fuel to the deprived skin cells, but improving internal systems in this way may not effectively prevent pressure wounds alone.
High-dependency residents will need to be frequently turned or moved in order to mitigate the risk of pressure injury, but frequently repositioning residents is time-consuming and often physically demanding for nursing staff. Making sure you position them correctly to manage the loading of weight on vulnerable areas where pressure wounds are likely to form over a bony prominence is also key to successful prevention. One major consideration is that of backrest positioning.
When a resident lays flat on their back, the pressure on the body is distributed much more evenly than in an upright seated position. When a person is sitting up in bed or in a chair there is considerably more loading on the spine and sacrum than in a supine position as the weight of the trunk and head creates more pressure on a much smaller surface area. In addition to this, shear forces can result in migration down the bed which is known to cause pressure on already vulnerable areas of the body.
Residents who are not independently mobile and therefore have a high risk of developing PI/PUs are likely to be spending the majority of their time in either a chair or bed and may spend some of their time in an upright position. There are many benefits to being in a seated position such as improved respiratory function, reduced need for patient repositioning, and creation of opportunities for independence and social interaction but it can cause a problem in terms of sacral pressure which will need to be managed. That's why we created BodyMove technology.
Our signature Empresa FloorBed features a multi-sectional mattress platform that incorporates BodyMove auto-regression functionality. This specifically focuses on mitigating the effects of tissue interface pressure and shear forces. How does it work? Well, Accora developed a multi-directional mechanism that moves the backrest upwards and backward simultaneously when the backrest is raised. Similarly, when the knee-break element is raised, the thigh section travels toward the foot of the bed as it rises.
Conventional non-regression nursing beds can increase pressure loading in an upright, seated position due to the compressed nature of the body in this posture and the increased loading of weight upon the spine and sacrum versus a supine position. Instead of compressing the sacral area as other profiling beds do, the Empresa creates more surface space by moving the mechanisms of the leg rest towards the foot of the bed and the backrest towards the head of the bed as it rises.
As the backrest raises, it moves towards the head of the bed by 4 inches, and the legrest moves towards the foot of the bed by a further 2 inches. This creates 6 inches of pressure-reducing surface space which other beds don't offer. Accora's dynamic BodyMove technology creates space and reduces sacral pressure where other nursing beds compress and pinch the body.
One study found that our BodyMove auto-regression system reduced the average pressure over the sacral area by 23% when compared to a standard nursing bed, both using the same mattress. Don't just take our word for it though. The pressure maps speak for themselves.
Over 200 factors may affect the risk of tissue necrosis and the subsequent development of pressure ulcers, but pressure and a person's lying position are certainly inextricably linked. A multi-faceted approach to pressure injury prevention is advisable but one key area of focus should be optimal positioning and the mitigating of shear forces. This is also vital in the treatment of pressure ulcers as well as in their prevention.
An additional benefit of the BodyMove technology in Accora products is the reduction of the need for nursing staff to frequently reposition residents. Significantly reducing patient migration when moving to a seated position will help caregivers to manage their time more effectively as well as reduce the risk of sustaining lower back damage from manually positioning and repositioning residents. Therefore, BodyMove technology has far-reaching benefits to residents, staff, and the facility as a whole in long-term care settings.
At Accora, we're always looking for ways to improve the clinical outcomes for our end users, and our BodyMove auto-regression system is certainly a part of that mission in that it helps residents stay social and engaged while supporting effective pressure management. While we know that pressure injuries cannot always be prevented, there is plenty that we as long-term care professionals can do to reduce the risk of pressure injury and mitigate the effects of forces beyond our control. Accora’s dynamic BodyMove mechanism is one tool that can help with that.
If you are interested in learning more about assessing and preventing pressure ulcers in senior care communities, then our recent blog Pressure Ulcers - Definition, Assessment, and Prevention may be of interest to you and for time-efficient reminders about the fundamentals of PI prevention, our Pressure Injury Prevention Cheat Sheet can also be a useful tool.