Earlier is better in the prevention of Pressure Injuries/Ulcers (PI/PUs), where a timely intervention can potentially reverse the damage and prevent the wound from breaking through the skin.
#PreventionMadeReal
To find out more, download our most recent real world publication presented at EWMA 2020 Virtual Congress here:
Reducing Pressure Injury/Ulcer (PI/U) Ulcer through the Introduction of Technology
Or select from our real world evidence detailed below.
Nicky Ore. et al., Head of Clinical Governance, Mersey Care NHS Foundation Trust EPUAP, Lyon, France, 2019
Aim to prevent and reduce the numbers of pressure injuries/ulcers (PI/PUs) developed within the community care setting
A total of 445 PI/PUs were reported by Mersey Care NHS Foundation Trust Community Services during Q1 2019/20
This included:Present on admission Developed whilst on the caseload Deterioration whilst on the caseload
2 pilot district nursing sites identified for a 12-week PURP with a focus on palliative care patients
Patients scanned 4 - 5 days per week
Intervention was implemented depending upon the results of the SEM Scanner readings
16.1% PI/PU incidence in the pre-study pilot period
11.8% PI/PU incidence achieved during study pilot period
Incidence during the study period reduced by 26.9%
Trust Executive Team agreed to procure SEM Scanners for every District Nursing Team and Ward 35 (Intermediate Care)
SEM Scanner implemented into clinical practice across all District Nurse Bases
Click here to download in PDF format
EWMA, Bremen, Germany 2016
The results of the SEM Scanner pilot at a community facility demonstrated that using the SEM Scanner (in combination with traditional standards of visual skin assessment) led to more sensitive and specific patient diagnosis. When acted on, these combined evidences resulted in a dramatic drop in PI/PU incidence
Danielle Nation, Matron, Athlone Rehabilitation Unit Central London Community Healthcare
The Athlone rehabilitation unit was identified by Director of Quality for Central London Community Healthcare (CLCH) to evaluate the SEM Scanner from 11th November 2019 to 3rd January 2020
PI/PU incidence for 12 month prior to the Pressure Ulcer Reduction Programme (PURP) period obtained:
2207 SEM Assessments conducted
Patients were scanned on average for 17 days
• PI/PU incidence during PURP 0/44 = 0% (95% CI: 0, 8%) • Relative reduction in HAPI/U incidence: 100% • 43% of all SEM readings were ≥ 0.6 ° Visual discolouration, indicating developing pressure damage, was noted at 88% of assessments • 10 patients were admitted with PI/PUs (n=1 had 2 PI/PUs) • For 100% of patients, healthcare practitioners reported that the SEM Delta value had changed their clinical decision making • 100% of patients received additional interventions on the basis of SEM delta values
Introducing SEM assessments into the care pathway has reduced PI/PU incidence during the evaluation by 100%. During the evaluation the Registered Nurse undertook the assessments however the Healthcare Assistants are keen to adopt the assessment activity as it fits well into the personal care process
Sharon O’Keeffe, CNS Tissue Viability & Pat McCluskey Advanced Nurse Practitioner, Cork University Hospital, Ireland
Tissue Viability Conference, Southampton, UK, 2019
To compare the clinical utility of using a SEM Scanning device versus subjective visual skin inspection in the early detection of Category 1 Pressure Injury/Ulcer (PI/PU)
To observe whether SEM data triggers the allocation of preventative interventions
To compare the rate of Hospital Acquired Pressure Injury/Ulcer (HAPI/U) before and during the SEM Scanner evaluation
32 orthopedic/plastic surgery patients
Waterlow ≥ 10 (at risk to very high risk)
12 week duration
3 consecutive readings taken from sacrum, heels and ischial tuberosities
SEM Delta of ≥0.6 = increased risk of PI/PU
Pre-evaluation HAPI/U incidence rate = 12%
No patients developed a HAPI/U during the evaluation
72% (n=23) patients showed evidence of incipient tissue damage
15 subjects with no visible signs of damage 33% (n=5) had positive scan results indicative of underlying damage
SEM Scanning presents an exciting innovation... a method of objectively assessing tissue health before damage becomes visible
Delta readings prompted front line staff to implement targeted interventions
5 patients potentially receiving preventative measures that they may not have had otherwise
Rose Raizman. et al., Scarborough Health Network, Canada
International Wound Journal, 2018, 1-12
A two-phased study designed to evaluate the clinical utility of the SEM Scanner and to see if the Hawthorne effect played a part in the results
Phase 1 - patients provided with a standard of care risk assessment and interventions and scanning by SEM Scanner but the resulting SEM scores were not used to determine interventions
Phase 2 - identical to phase 1 except that the resulting SEM scores were used in conjunction with risk assessment to determine appropriate interventions and care planning
284 patients evaluated in the 2 phasesOn 3 inpatient wardsOver a 7-month period
Phase 1 results:
12/89 patients developed pressure injuries/ulcers (PI/PUs) (4 category 1, 6 Category 2, 1 Category 3 and 1 Deep Tissue Injury (DTI).
Phase 2 results:
2/195 patients developed PI/PUs (1 Category 1 and 1 Category 2).
This illustrated a 93% reduction in Hospital Acquired Pressure Injury/Ulcer (HAPI/PUs) compared to phase 1.
93% decrease in HAPI/U rate following interventions using the SEM Scanner scores
A strategic approach to PI/PU management with the use of SEM Scanner for identification of PI/PU improves patients outcomes
SEM Scanner made non-visible damage identifiable by providing a numerical readout, alerting clinicians to implement stronger prevention strategies.
No Hawthorne effect noted
Glenn Smith, Formerly Clinical Nurse Specialist, Nutrition & Tissue Viability, St Mary’s Hospital, Isle of White
Journal of Wound Care, 2019, Vol 28:5
Evaluation of a sub-epidermal moisture (SEM) Scanner to detect non visible pressure damage, allowing appropriately targeted pressure injury/ulcer (PI/PU) prevention interventions
Evaluation on a medical-surgical inpatient ward over a period of 2 months
35 patients included in the evaluation
Heels and sacrum scanned on admission and daily thereafter
91% of patients had delta values ≥0.6 indicating inflammatory changes that without intervention may have progressed to a PI/PU
Zero Hospital Acquired Pressure Injuries/Ulcers (HAPI/Us) developed during the evaluation in this patient group
The inclusion of SEM Scanner as part of the patient examination informed clinicians about early damage
Identification of pressure damage prior to it being visible would allow the most appropriate resource use
Ruth Ropper, Senior Nurse Project Support previously Lead Nurse Tissue Viability, NHS Lothian
Lothian Health Board conducted a Pressure Ulcer Reduction Program (PURP) in 2 clinical settings: Western General Hospital (WGH) & Royal Infirmary of Edinburgh (RIE) in 2019/2020
Primary Aim:
• RIE - to determine if the addition of the SEM Scanner in the Pressure Injury/Ulcer (PI/PU) care pathway could reduce the incidence of Hospital Acquired Pressure Injuries/Ulcers (HAPI/U) where other initiatives had not achieved the Health Board goals
• WGH - to determine if their low HAPI/U rates were linked to high use of equipment or if decision making could be improved without affecting outcomes.
Secondary Aim:
• To assess if this project could impact on potentially inappropriate and excessive use of high cost intervention products, specifically dynamic mattress surfaces.
This project was split into 2 parallel paths:
1. PURP path to evaluate the use of SEM Scanning in the reduction of PI/PUs
2. Parallel path to test a decision pathway for equipment selection in clinical areas where there was high reporting of HAPI/U or high use of equipment.
Pre PURP information for the prior year 2018-2019 recorded a (HAPI/U) incidence rate in the SEM assessment wards:
• WGH - 0%, 259 admissions • RIE - 2.4%, 792 admissions WGH - 48 patients scanned - total 1212 readings
• 0% HAPI/U maintained
• 33% reduction in the use of dynamic system usage achieved
• 75% of patients, healthcare practitioners reported that the SEM Delta had changed their clinical decision making
• 75% patients received additional interventions on the basis of SEM delta readings. RIE - 78 patients scanned - total 1999 readings
• 100% HAPI/U reduction
• 11% reduction in the use of dynamic system usage achieved
• 79% of patients, nurses reported that the SEM Delta had changed their clinical decision making
• 79% patients received additional interventions on the basis of SEM delta readings.
Addition of the SEM Scanner into the care pathway impacted positively on both the HAPI/U incidence rates and resource usage.
In contrast the parallel path whilst a reduction in HAPI/Us was achieved, dynamic system usage increased.
Given the outcomes achieved the economic value has been fully reviewed compared to the reported cost of treatment of HAPI/U within the Health Board.
The introduction of SEM Scanner technology has been recommended to the Health Board for implementation to relevant wards within acute hospitals initially, with a view to widening the remit to the post-acute setting in the future.
Raine G. (2021). Lead Nurse, Marie Curie Hospice, Newcastle upon Tyne
International Journal of Palliative Nursing, Vol 27, No 9
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Gillian Raine, Lead Nurse, Marie Curie, Newcastle upon Tyne, UK
Patient Safety Congress, Manchester, UK, 2018
A quality drive for improvement to prevent damage occurring
Hospice Acquired Pressure Injuries/Ulcers (HAPI/Us) data for 34 patients developed 36 PI/PUs from Nov 2016 - Nov 2017
Overall HAPI/Us incidence rate = 9% prior to using SEM Scanner
6 Month pilot period
Focus on sacrum, buttocks & heels
All patients
Baseline scan performed as part of admission protocol, including Waterlow Risk Assessment & SSKIN check
Daily scan thereafter
Evaluation period of pilot incidence rate 4.8%
Pre pilot period incidence rate 9%
Reduction HAPI/U incidence rate 47%
Move to full implementation of SEM Scanner with the creation of own tools and guidelines for use
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