Question 1

Warning Signs and Symptoms of Pressure Ulcers

Accepted Answer

Pressure ulcers often develop slowly but can develop in just a few hours with the right conditions.
Pressure ulcers are likely to develop faster when there is higher pressure on a smaller area, and more slowly when there is lower pressure over a wider area.
What are the Early Signs of Pressure Ulcer Development?
Early signs of pressure ulcer development include:

A change in the colour of the skin. People with pale skin are more likely to see red patches on the skin, and people with darker skin area more likely to see purple or blue patches.
Reddening of the skin that does NOT turn white when you press it. This is called a ‘non-blanching erythema’.
Any unusual changes in skin texture may be related to pressure damage. Common changes include skin feeling spongy or ‘boggy’.
A patch of skin that feels cooler or warmer to the touch than others.
A sore or itchy patch of skin.

Bedsores fall into one of several stages based on their depth, severity and other characteristics. The degree of skin and tissue damage ranges from red, unbroken skin to a deep injury involving muscle and bone. Skin showing these signs of pressure ulcer development may be referred to as ‘category one’.
See our related article for more information on the staging of pressure ulcers.
What are the Later Signs of Pressure Ulcer Development?
As pressure ulcers worsen, they may break the skin. Signs of worsening pressure ulcers include:

An open wound or
A deep wound that reaches the deeper layers of the skin.
A very deep wound that may reach the muscle and bone.

When should I get help for a Pressure Ulcer?
The NHS website says that if you&#8217;re in hospital or a care home, you should tell your healthcare team as soon as possible if you develop symptoms of a pressure ulcer as it will probably continue to get worse if nothing is done about it.
If you&#8217;re recovering from illness or surgery at home, or are caring for someone confined to bed or a wheelchair, contact your GP surgery if you think you or the person you&#8217;re caring for might have a pressure ulcer.
Get medical advice immediately if there is:

Red, swollen skin
Pus coming from the pressure ulcer or wound
Cold skin and a fast heartbeat
Severe or worsening pain
A high temperature (fever) of 38C (100.4F) or above

These symptoms could be a sign of a serious infection that needs to be treated as soon as possible.

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Question 2

Staging / Grading of Pressure Ulcers

Accepted Answer

Pressure ulcers vary in size and severity of the tissue affected, ranging from reddening of the skin to damage to muscle and underlying bone.
How are Pressure Ulcers Staged / Graded / Classified?
According to the international classification system pressure ulcers can be staged as one of six categories.
Superficial
Stage 1: Intact skin with persistent reddening, known as ‘non-blanching erythema’. For more information on non-blanching erythema, click here.
Stage 2: An abrasion or a blister can be seen, without bruising. There is some skin loss or damage affecting the top skin layers.
Superficial ulcers are more difficult to spot than deep ulcers. For information on the warning signs of pressure ulcer development click here.
Deep
Stage 3: Full thickness skin loss which can expose fat in areas where this exists. Damage is limited to the skin and fat layers.
Stage 4: Full thickness skin loss with damage to the underlying structures, such as tendons or bone, which may be exposed.
Other
Deep tissue injury: Tissue injury hidden under intact skin. These appear as deep bruises and can quickly deteriorate into a high-stage pressure ulcer. For more information on why deep tissue injuries occur, click here.
Unstageable Pressure Injury: Pressure ulcer with an undetermined level of tissue injury because the entire base of the wound is covered by slough tissue.

Figure 1 Staging of pressure injury, NPUAP resources
The grading of a pressure ulcer is a critical part of the process of caring for a person with pressure ulcers.
While treatment is tailored to the individual, as may factors can impact the development of a pressure injury, the grade of pressure sore is an important part of creating a treatment/management plan.
For more information on what the risk factors are for developing a pressure injury, click here.

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Question 3

Shear and Friction in Pressure Ulcer Development

Accepted Answer

While the major factor in the development of pressure injury is pressure itself, shear forces also play a part.
What causes shear and friction?
When you move over a surface and the body remains in contact with it, the skin can be pulled along that surface. You can feel this ‘drag’ effect if you run your hand over something.
This ‘drag’ is caused by friction and leads to a difference in the direction of movement of the skin and the deeper tissues. This difference is called “shear” and is an important factor in pressure ulcer development.
How can shear forces lead to the development of a pressure ulcer?
Shear causes stretching and tearing of blood vessels which reduce blood flow increase blood pooling and can lead to cell damage.
Shearing stops or reduces blood flow more easily than pressure alone (for example, it is easier to cut off flow in a water hose by bending than by pinching it).
Although shear causes tissue damage slightly differently to pressure, the damage produced is the same as with pressure.
Importantly, it is difficult to create pressure without shear, and shear without pressure, so the two usually go hand-in-hand.
For information on how pressure leads to pressure injury, see our article How Pressure Ulcers Develop?
How can repeated friction cause a pressure ulcer?
As well as being a key element of making shear force, friction between the skin and the stationary surfaces such as bedclothes can result in the loss of the top layer of the skin (the stratum corneum).
Think about repeatedly rubbing your skin against a surface – after a time, the skin would start to become red and sore. This is due to friction.
This inflammation can lead to deeper injury or could be the initial damage needed to start pressure ulcer formation.
When there is a loss of the top skin layer, there is also a breach in the barrier against infection.
How can friction and shear be reduced?
There are several strategies to reduce shear and friction forces:

Use low-friction clothing such as Parafricta undergarments and socks to reduce friction on the vulnerable heel and pelvic areas. These can be especially useful for people who push themselves back up the bed using their heels, or who have involuntary leg movement, for example, those with Parkinson&#8217;s.
Use positioning aids such as slides sheets under the person’s body and feet and heels when repositioning to reduce the risk of friction and shear.
Use a profiling bed with an in-built knee break. When the person has been repositioned in bed, elevate the knee break first to prevent the person from sliding down the bed.

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Question 4

Risk Factors for Pressure Ulcer Development

Accepted Answer

Who is at Risk of Developing Pressure Ulcers?
The risk of developing a pressure ulcer is affected by many health and environment-associated factors.
In fact, more than 100 risk factors for pressure ulcers have been identified.
This means that anyone can get a pressure ulcer, although the following factors can make them more likely to develop:

Being elderly – older people are more likely to have mobility problems and may also have thin skin that is more easily damaged.
Being confined to bed or a chair with an acute illness, for example a urine infection, diarrhoea and vomiting, or after recent surgery.
Full or partial paralysis, reducing the ability to move independently.
Incontinence leading to wet and irritated skin.
Poor nutrition, which may be due to a lack of adequate nutrients or insufficient calories.
Medical conditions such as kidney disease or heart failure, or those that affect the blood supply, such as diabetes or peripheral arterial disease, or conditions that affect the ability to move independently, such as a stroke (CVA), multiple sclerosis (MS) or Parkinson’s disease.
History of previous pressure damage, where scar tissue may be present, as this will be less resilient than normal skin.

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Question 5

Preventing Pressure Ulcer Development

Accepted Answer

Pressure ulcers can develop rapidly given the right conditions.
Not all risk factors can be controlled. However, the key risk factors affecting the individual should be taken into account as part of a pressure ulcer prevention strategy.
Preventive measures should include:

Risk assessment to identify key risk factors that put the individual at higher risk of pressure ulcer development

Risk assessment may involve the use of a scoring system eg. Waterlow, Braden, or Glamorgan scales or a system for colour (RAG) rating risk eg. Purpose T.
Whichever system is in use, it is important to ensure that it is not used in isolation but supports clinical & holistic assessment of the person and their needs and preferences.

Frequently assessing skin for early signs of damage

People who are able to do so should be shown how to check their skin for any signs of damage
Carers can also be shown how to inspect the skin and what to look for
Early signs of skin damage may include discomfort, redness, or a change in colour to the skin. This may be more difficult to assess in dark skin tones

Use of equipment that reduces pressure

Inflate and deflate to redistribute pressure
Static Viscoelastic (memory-foam) mattresses/cushions which conform to the shape of the body to distribute pressure evenly.
Positioning devices – these may include slide sheets for repositioning, and devices suitable for heels, etc. to remove all pressure from the heel and facilitate healing

Keep the person moving as much as possible. Regular movement helps redistribute pressure

For those at risk of pressure damage, changes in position should be made at least every 4 hours
For those at high risk of pressure damage changes in position should be made at least every 6 hours
Even small changes in position are really important to reduce the risk of damage
This should be discussed with each person on an individual basis, and agreement on the frequency of repositioning should be recorded
Repositioning frequency may need to be increased if skin assessment shows any increased vulnerability
People who cannot reposition themselves need assistance to do so.
This repositioning should be done throughout the day and night.

Use barrier creams and appropriate containment products (eg. Continence pads) for those with bladder or bowel issues that lead to frequent episodes of wet or soiled skin

Barrier creams should be dimethicone based products rather than oil-based products
A thorough continence assessment should be undertaken to establish the most appropriate containment products for the person.

Ensure access to a healthy diet and adequate fluid intake to keep the skin nourished and hydrated

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Question 6

Common Sites for Pressure Ulcer Development

Accepted Answer

Pressure ulcers are damage caused by pressure and / or shear.
What are the common sites for pressure ulceration?
The areas that are particularly prone to pressure sores are those that cover the bony areas such as:

Heels
Ankles
Buttocks
Shoulders
Spine
Backs or sides of the knees
Toes and feet
Back of the head (occiput)

When describing where the tissue damage has occurred on the buttocks, clinical staff should ensure that the correct terminology is used to accurately describe the location – the following diagram may help.

Sacrum (see below)
Coccyx (Tailbone)
Trochanter (Hipbones)
Gluteal (buttock)
Ischial (often incorrectly described as lower buttock or upper thigh, but usually caused by unrelieved pressure from sitting)
Gluteal cleft (often see moisture damage rather than pressure damage in this area)
Perianal / perineal area (often due to moisture eg. From urine or faeces – rather than pressure)

Effective preventive measures reduce the risk of pressure ulcers developing.
Preventive measures should include:

Frequently assessing skin for early signs of damage
Use a high-quality static pressure-reducing mattress and cushion. Or, for those who require a higher level of protection use an alternating pressure air mattress and cushion
Keep the person moving as much as possible. Even small changes in position are really important to reduce risk of damage
Use barrier creams and appropriate containment products (eg. Continence pads) for those with bladder or bowel issues that lead to frequent episodes of wet or soiled skin
Ensure access to a healthy diet and adequate fluid intake to keep the skin nourished and hydrated

*&#8217;Surface Anatomy of Buttocks&#8217; image is taken from the ‘Visual Guide for Accurately Designating the Anatomic Location of Buttocks Lesions’ article.
J Wound Ostomy Continence Nurs. 2016;43(2):148-149. Published by Lippincott Williams & Wilkins
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Question 7

How Pressure Ulcers Develop

Accepted Answer

What are pressure ulcers?
Pressure ulcers – also referred to as pressure damage, pressure injuries, bedsores or decubitus ulcers – are usually seen on the skin as red, purple or discoloured areas, which may progress into blistering or open wounds. These can develop on bony areas of the body such as the back, bottom or heels or in areas where the blood supply to the tissues has been reduced due to prolonged pressure.
They can happen to anyone, but usually affect people who spend more time in bed or those who sit in a chair or wheelchair for long periods of time. If you are at risk of pressure damage you should be offered advice on how to reduce your risk and this will usually include information on:

How to assess your skin for early signs of damage
What type of mattresses, cushions or special devices may help to relieve pressure from vulnerable areas
How to keep moving. Even small changes in position are really important to reduce the risk of damage
If you have problems with your bladder or bowels that mean that your skin is wet or soiled, there may be creams and products that will help to prevent skin damage
How to make sure that you eat a healthy diet and take sufficient fluid to keep the skin nourished and hydrated.

While pressure ulcers can appear anywhere on the body, they are most commonly seen over bony areas such as the heels, ankles, hips, spine and buttocks.
Why do pressure ulcers develop?
Pressure ulcers form when blood flow to the tissues of the skin and surrounding area is reduced.
Capillaries are the smallest blood vessels. They bring oxygenated blood from the arteries into the organs, skin and underlying tissue, as well as taking deoxygenated blood away from the skin and tissues back into the veins.
When a person is sitting or lying on a surface the pressure between the seat/mattress and the body compresses the capillaries in this area. This is especially noticeable over bony areas, like your heels, buttocks and tailbone (coccyx). Just like squeezing a hosepipe if this pressure is high enough it can reduce blood flow through these capillaries or even stop it altogether.
Pressure is not the only issue. Shear forces (such as sliding down the bed or slouching in a chair) also play a part in the development of pressure.
For more information on these forces, see our article Shear and Friction in Pressure Ulcer Development.
How do we naturally prevent pressure ulcers?
If someone’s blood vessels are closed or compressed due to pressure, then the oxygen supply to the surrounding tissues falls.
Interestingly, in healthy people, this fall in oxygen prompts a reflex to move; this is the reason you cross and uncross your legs or roll over in bed at night without really thinking about it! Ignore this reflex and you will start to feel pain and discomfort, a sign from your body that it’s time to get moving again.
If the pressure is relieved, and the circulation is restored, the capillaries open up again and blood flow increases to the area again. For those with pale skin, this may be observed as the pink patch that is visible if you have had your legs crossed for a sustained period. This pink patch is called ‘blanching erythema’. Blanching erythema is identifiable by the pale spot you can see when you press on it with a finger on Caucasian skin. In dark skin tones, this may not be visible, therefore when checking the skin, any change in skin colour or appearance should be checked carefully in case it is a sign of increased vulnerability.
To see strategies to support pressure ulcer prevention click here.
What happens if the skin remains under pressure?
If pressure continues, then reduced oxygen levels starts to cause damage to the capillaries and surrounding cells.
The first sign in the skin is often a change in colour. For those with light skin tones, non-blanching erythema may be visible, where the skin colour is a persistent red and the skin colour does not change when lightly pressed with a finger.
For those with dark skin tones, a change in skin colour may be observed, but is unlikely to present as redness. It is therefore important to compare any changes in colour observed with areas of unaffected skin to determine if early signs of pressure damage are developing.
It is also important to understand that damage may occur deep within the tissues, presenting as a Deep Tissue Injury. This may present as a purple or dark discoloured area, a thin blistered area over an area of dark discolouration or an area of thin dark eschar. The affected area may be painful and may be harder or softer, or warmer or sometimes cooler than the surrounding areas.
 
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Question 8

We Are Part of the Prism Group

Accepted Answer

We are delighted to inform you that on 18th December 2019, Harvest Healthcare Limited became part of the Prism Group. This exciting move will further improve our ability to serve our customers and will provide financial strength and investment to continue our successful growth. Harvest will operate as a standalone company within the Group, and will continue to be led by current Managing Director Neil Davis and his Senior Management Team. Read more here.
Should you have any queries, please do not hesitate to contact your Account Manager or any of the following:
Neil Davis – Managing Director
Tim Woods – Finance Director
Bruce McEwan – Key Account Director
Mario Gibbins – Purchasing Manager
Oskar Solvason – Operation Manager
Derek Scotton – HR Manager
Melissa Howle – Service Manager
Lauren Davis – Head of Clinical and Marketing
We are excited about the future and are looking forward to developing our relationship with you for many years to come.
Contact us on 01709 377172 or sales@harvesthealthcare.co.uk
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Question 9

Harvest Healthcare Ownership

Accepted Answer

We are delighted to inform you that as of 30th November 2018, our current Managing Director Neil Davis, has acquired all of the shares in the company from founders Phil and Jim Hutchinson. Both Phil and Jim have steadily reduced their involvement in the day to day running of the company over the last few years, and are very pleased to hand over the business to their existing management team.
Things will be very much business as usual, with the current team and all your regular contacts remaining unchanged.
Neil said “I am proud to have the opportunity to lead Harvest forward and to continue the positive development of our company. Our focus will always be to work in long-term partnerships with our customers, to support the delivery of exceptional resident and patient care, at an affordable price, and to try to make everyone’s lives a little easier. I really enjoy working with the fantastic people in this industry, and am very happy that our new ownership structure will help us to continue our successful growth, to the shared benefit of our customers, our own people, and our supply chain partners.”
Should you have any queries, please do not hesitate to contact your Account Manager or any of the following:
Neil Davis – Managing Director
Tim Woods – Finance Director
Bruce McEwan – Key Account Director
Mario Gibbins – Operations Manager
Derek Scotton – HR Manager
We are excited about the future and are looking forward to developing our relationship with you for many years to come.
Contact us on 01709 377172 or sales@harvesthealthcare.co.uk
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Question 10

New Community Mattresses

Accepted Answer

Introducing our new Community Mattresses.
Here at Harvest Healthcare we are always trying to find ways to make our customer&#8217;s lives easier. One way in which we do this is buy keeping our products at a high quality while making sure they are affordable.
Our new Community Mattresses maintain the high quality that customers expect from Harvest Healthcare with improved comfort and excellent pressure relief at a more cost-effective price.
HSMCOM &#8211; Community Mattress

Highly resilient and fire retardant foam
Can be turned two ways to extend life of the mattress
Medium Risk
Maximum patient weight: 25 Stone / 159kg
Dimensions: 2000 x 900 x 125mm
Available in other sizes upon request
Comes with 2-way stretch, waterproof cover

HSMCOMP &#8211; Community Plus Mattress

Built on the Community mattress with thicker foam
Can be turned two ways to extend life of the mattress
High Risk
Maximum patient weight: 30 Stone / 190kg
Dimensions: 2000 x 900 x 150mm
Available in other sizes upon request
Comes with 2-way stretch, waterproof cover

If you are interested in buying one of our fantastic new mattresses then please get in touch at sales@harvesthealthcare.co.uk or on 01709 377 172.
Take a look at our other Mattress Products
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Question 11

Team of the Month - Servicing

Accepted Answer

Our team of the month in September was our servicing team. From those in the office who get engineers out to you, to the mattress repair department who make sure you never go without a working mattress, they have worked their hardest to offer a great service for you.
Well done team!
Learn more about how Harvest Healthcare can help you with our servicing and maintenance packages.

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Question 12

Team Of the Month - Product Development & Quality

Accepted Answer

Our team of the month for June was our Product Development and Quality Team. John has won the award for all his hard work on our new active mattress range, and his work making sure our products are up to the high quality our customers expect. At Harvest we are proud of our quality products that enable a reduction in long term costs.

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Question 13

NAEP National Annual Conference 2018

Accepted Answer

We exhibited at NAEP National Annual Conference on 12th and 13 June 2018. it was a great opportunity to meet old customers, renew acquaintances and make new contacts. Above all, it was a successful attendance for Harvest Healthcare.
We had the opportunity to showcase our innovative product and we chose our Bed Wall Spacer for that purpose.  The Bed Wall Spacer kit is designed to reduce the risk of the bed being placed too close to the wall and colliding with power sockets or other features. It reduces damage within the care environment.
We would like to thank everyone who visited our stand and look forward to doing more business with all our old and new customers.
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Question 14

Tissue Viability Society Conference

Accepted Answer

Harvest Healthcare exhibited at the Tissue Viability Society conference on the 25th and 26th of April. It was great to meet so many people and show off our products.
The conference is a great chance for healthcare professionals to get together and discuss all areas of tissue viability including politics, research & innovation, leadership, clinical practice and multidisciplinary working.
We exhibited a selection of products on our stand that included:

Woburn Ultra-Low Bed
Sandringham Active Mattress
Active Seat Cushions
Viscoflex Plus Cushion
Reflect Cushion
A selection of our static cushions

We are delighted to announce that we won the award for Best Large Stand at the exhibition, judged on the appearance and delegate experience at the stand. We are very proud of our customer service and the quality experience that customers have when they choose to work with Harvest, this award recognises this.
Thank you to the Tissue Viability Society for putting on a great event and presenting us with the award.
Learn more about the Tissue Viability Society Conference on their website.
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Question 15

Team of the Month - Drivers

Accepted Answer

Our fantastic drivers have won the April Team of the Month Award
They have gone, literally, the extra mile for our customers.
Well done to you all and keep up the good work.

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Question 16

New Product - Bed Wall Spacer

Accepted Answer

Introducing our new Bed Wall Spacer!
These spacers are designed to reduce the risk of the bed being placed too close to the wall and colliding with power sockets or other features. This can be costly to fix and often requires an emergency callout, the Bed Wall Spacer can eliminate these costs.
It increases safety by reducing the risk of electric shock due to socket damage. The Bed Wall Spacer also protects the bed chassis from damage if being operated against window sills / skirting boards or other features, which can be expensive to fix.
The spacer is compatible with Harvest Healthcare’s Woburn bed and the Woburn Community Bed range and can be fitted to any corner of the bed within minutes without the use of tools. It is designed to be fitted to the bed at any point where the bed would come into contact with a wall and should be kept at a safe distance and reduce the possibility of collision.
If you would like more information please contact Lynne Buchanan on 01709 377 172 or email  sales@harvesthealthcare.co.uk.
See the webpage including specifications here.

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Question 17

Team of the Month - Servicing

Accepted Answer

Hardworking is rewarding here at Harvest Healthcare and we acknowledge it through our ‘Team of the Month Award’. Our February champions were the Servicing Team in the office!
They have put in the extra effort required to meet the challenges faced at the beginning of 2018.
With our nationwide team of engineers, we provide complete moving, handling and pressure care equipment services, with tailored packages to suit our valuable customers’ requirements. Learn more about the high quality sevicing we offer here.
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Question 18

New Range of Slings

Accepted Answer

We are introducing a new range of slings. The new range has been simplified to make it easier for you to make a right choice on what sling suits your needs.
The slings are very high quality and easier to use with instruction videos available on our website. They come with woven labels to extend the life of the slings as on printed labels the writing fades when washed meaning the sling has to be condemned. The slings are also back stitched so improve the strength of the sling. All of our new slings are manufactured in the UK.
See our full range of slings here.
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Question 19

Team of the Month - Customer Service

Accepted Answer

November&#8217;s team of the month is our very helpful Customer Service Team!
Jenny and Mel are always there on the phone to help out and direct our valuable customers. At Harvest, we are very proud of the second to none customer service we provide.
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Question 20

Stop the Pressure Day

Accepted Answer

We are supporting Stop the Pressure Day at the Thackray Medical Museum, Leeds.
Our comprehensive and innovative range of high-quality profiling beds, active and static mattresses and cushions as well as moving and handling equipment, provides supreme comfort and dramatically reduces the incidence of pressure ulcers.
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