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Residents in aged care facilities are repositioned every two hours to prevent bedsores, but new Australian research has found this practice is ineffective and could be causing further problems for patients. What’s more is researchers from the UNSW believe this practice could constitute abuse.
The new study found that two-hourly repositioning was not only ineffective in preventing pressure ulcers from developing, but also caused a series of behavioural problems by disrupting the sleep patterns of residents. The research has been published in the Bioethical Enquiry Journal.
The study, released as the Royal Commission into Age Care Quality and Safety is underway, also claims regular two-hour repositioning could be a form of unintentional institutional abuse. The report analysed the medical and nursing records of 80 deceased residents across eight Registered Aged Care Facilities (RACFs) in Australia to determine the number of residents who were assessed as being at risk of developing pressure ulcers, how the two-hourly repositioning impacted them and whether the residents had these ulcers in the last week of life.
The report found that 91 per cent of residents were deemed at risk of developing pressure ulcers and were repositioned every two hours, but more than a third of them had the painful skin condition when they passed away.
“My first thought was that the practice of two-hourly repositioning would cause sleep deprivation and that it is simply torturous,” Study author Professor Mary-Louise McLaws said in a statement. “It wasn’t a surprise when residents were classified as having ‘behaviours of concern’ and then chemically or physically restrained.”
As such, authors of the study believe preventing bedsores could be as simple as using alternating pressure air mattresses (APAMs). The mattresses work by relieving pressure all over the body every few minutes. Unlike current measures, residents would not be woken up or disturbed by the continuous and gentle motions of the mattress.
Read more: Nursing homes drugging patients to decrease workload, AMA claims
At present, the issuing of APAMs to patients most at risk of developing bed sores has been minimal, with researchers claiming nurses and care staff simply don’t have the authority to order this kind of equipment. There’s a belief in the industry that the mattresses are expensive, but the study found the devices could cost around $1.40 a day and available on government contract.
“Alternating pressure air mattresses have limited published evidence for preventing pressure ulcers and are considered to be initially an expensive outlay,” McLaws said. “However, a study carried out decades ago showed that APAMs were more cost-effective than the practice of repositioning. And when you look at the costs of prevention, they are substantially lower than those required to treat severe pressure ulcers.”
The authors of the study have also called for changes to the legislation surrounding Coroners Court powers, noting just four cases have been referred to coroners regarding the possible role pressure ulcers played in the deaths of elderly people. At present, Coroners make very little recommendations when it comes to the best practice in aged care.
“Australian coroners could consider formulating recommendations which refer to section 3 of the Australian Quality of Care Principles [2014],” study co-author Dr Jennifer Schulz Moore said in a statement. “These principles recommend that RACFs provide APAMS to residents at risk of developing bedsores.”
Read full article in Assistive Technology Today. dated May9th 2017 entitled: "Could Treat-Eezi spell the end for pressure ulcers?"
Could Treat-Eezi spell the end for pressure ulcers? For over 20 years, the healthcare industry has relied on Alternating Air Beds, either as an overlay or a deep profiling bed system, as a means of preventing and tackling pressure ulcers. Derek Timm, Co-Director at Dan Medica South, discusses a revolutionary new solution that could effectively tackle the issue. The pressure care specialist highlights that traditional Alternating Air Beds that rely on different pumps and mediums such as sand and air can have inherent issues. The systems, designed to stimulate blood flow through a massaging effect as they pump air or sand in and out of plastic or cloth membranes, can be costly ranging in price and quality from £150 to £30,000. These electric systems also cost to operate and should the mattress be punctured or if the air being pumped to a cell escapes into the atmosphere – with the cells running flat then creating pressure on the contacting tissue- then the system would need to be replaced. Derek explains: “They also require massive contracts to be put in place for daily running to keep the pumps going, plus avoiding punctures in plastic mattresses. It has also been known some of these devices increase sweating, can cause sea sickness type effect and can have noisy pumps which do not help patients sleep.” Various methods of prevention and treatment have been explored for more than a decade and there has been significant growth in the world of fabric technology, with different healthcare departments investigating polyester fibres capable of supporting the body without the need for pumps as a possible solution.
Derek told us: “Medical papers from The Exogenous Dermatology Review dated as far back as September 2002 and written with findings of Chronic Wounds-Pressure Relief by the Department of Dermatology, Dresden University Hospital Germany, prove that single weave spacer fabrics were useful in treating chronic venous insufficiency. “With this in mind, we set about to create a fabric that could be pressure mapped below capillary blood flow at just 28mm Hg. This would avoid any arterial insufficiency and allow steady blood flow at even under the most direct pressure points of the body when laying in a supine position on a normal hospital bed.” The result was the Treat-Eezi fabric, a unique, patent-pending three weave polyester fabric that is vastly more complicated than the original one weave design. To the company’s knowledge, there is only one factory in the world that is able to weave a three-layer construction that collapses in a sideways motion when under body weight, enveloping the contact areas to offer support. “Treat-Eezi went one step further by adding a slippery surface interlayer under the first layer of fibres,” Derek explains. “When the body moves on the top surface, the underlayer glides to compensate for shearing forces and friction. Although at this moment in time it is impossible to measure shearing forces on a cushion or mattress surface, we know a good 95% of pressure ulcers are caused by this. To bring those down to little more than zero is another reason our Treat-Eezi static system has been able to help heal even stage four pressure ulcers.” The company says that now with the advantage of Vapour Permeable Covers designed to prevent cross-infection in the Acute Care sectors, there is no reason why TreatEezi technology cannot be used in any Community or Hospital setting.
Further work is also continuing using the Treat-Eezi fabric in between the skin and plaster casts, on stretchers in ambulances and for use with epilepsy monitors and more. Derek concluded: “It aids better sleep and offers the same high-risk protection but without the need for maintenance, lasting longer than nearly every alternating air bed plus proving more cost effective over a 4-year period.” The company owns the exclusive worldwide rights to the Treat-Eezi brand and has supplied over 4,000 clients with Treat Eezi in the UK, estimating savings to the NHS of well over £1 million+, as well as working with a range of manufacturers in the industry, including Simple Stuff Works.
“We have used the Treat-Eezi Pressure Care Overlay in our nursing home for at least 3 months. We have found it to be highly effective in providing pressure relief with the added benefit of no noisy pump and no need for a contingency plan should we have a power cut. Having trialled and carefully monitored this product we now feel confident in purchasing more, as and when we need to replace the old airflow units.”
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