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Pressure Ulcers

Jan 06 2023

Balmoral Mattress / Harvest 2 Pump

View PDF

Balmoral Mattress Post-Market Clinical Performance Review

 

1.0 Background

Harvest supplies pressure-reducing mattresses (static and dynamic) to the health and social care sector within the UK. The company is committed to ensuring that the equipment it manufactures is subjected to post-market clinical follow-up (PMCF). Audits undertaken within the care provision sectors have sought to establish how the equipment functions in the real-world setting compared to laboratory/on-site testing. This document provides results and findings from audits undertaken between August and December 2022 in the Care Home Sector where the Balmoral Active Mattress is in use and has been compiled by an Independent Nurse Advisor / Educator on behalf of Harvest Health Care.

2.0 Findings

Data is provided for 82 residents in 11 independent care homes, however, it should be noted that not all data elements are available for all 82 residents due to the complexities of collecting audit data within the care home environment.

2.1 Age, Waterlow Score, and Weight

The age of the resident was available for 67 of the residents for whom audit data was available. The average age of residents nursed on the Harvest Balmoral mattress was 78 years, with the oldest resident at 103 years and the youngest resident was 39 years old. Waterlow scores for those who were managed on the Balmoral mattress ranged from WS 7 (not at risk) to WS42 (Very High Risk), with the average Waterlow score being 21 (Very High Risk). For the Waterlow data set, data was available for 78 of the 82 residents included in the audits. Weight ranges of those using the Balmoral mattress ranged from 38kg to 114.7 kg with an average weight of 63.3kg. Those with a weight of 38kg would usually be deemed to be extremely frail, and those with a weight of > 100kg in such an elderly population are likely to have high BMI and are most likely to be overweight or obese.

Figure 1 – Descriptive statistics for Age, Waterlow and Weight

2.2 Resident Mobility and Comorbidities

The audits undertaken by the independent clinical advisor also reviewed the mobility levels and comorbidities for each resident who was using the Harvest Balmoral. Findings are shown in Figures 1 and 2. Figure 1 shows that 92% of residents who were nursed on the Balmoral mattress had either poor mobility (required hoist or wheelchair, but were able to make some independent movements in bed) or were completely immobile (reliant on staff for all repositioning), with the remaining 8% able to mobilise with some assistance. The most common comorbidities (Figure 2) for those residents who were nursed on the Balmoral mattress, included (a) a history of Cerebral Vascular Accident (CVA 20%), (b) Dementia and/ or cognitive impairment (38%) and (c) Diabetes (33%).

Fig 1                                                               Fig 2

2.3 Development of Pressure Ulcers

In total, during the audit period there were 8 residents who were being nursed on the Balmoral pressure mattress who had existing pressure ulcers.

• One resident had developed a category 2 pressure ulcer to their elbow, but the care home staff believed that this had developed due to the resident leaning on the chair and was therefore not associated with use of the mattress.

• Another resident had 2 category 2 pressure ulcers to their heels, but these had developed due to direct contact between the resident’s heels and a specialist chair footplate, so again this was not deemed to be associated with use of the Harvest Balmoral mattress.

• A further 6 residents with pressure ulcers; Category II (1 resident); Category III (2 residents) and Category IV (2 residents) had been admitted to the care home with pressure ulcers and were being nursed on the Harvest Balmoral mattress as part of a package of care to prevent further pressure ulcers and to expedite healing of these existing pressure ulcers. In all of these cases, the resident’s wounds were showing signs of ongoing improvement.

• Those with a history of pressure ulceration (3 residents) but were now ulcer free had healed whilst using the Balmoral mattress and had remained healed and ulcer free during their time using the mattress

3.0 Summary

Post-market clinical follow-up on the Harvest Balmoral Alternating Mattress was undertaken between August and December 2022 using an independent clinical advisor to undertake the audit and collate the data. A Total of 12 Independent Care Homes which used Harvest pressure-reducing mattresses were visited by the Independent Clinical Advisor (11 of these Care Homes had a total of 82 residents who were using the Balmoral alternating mattress) and a review of equipment in use within the care home was undertaken at each site. Whilst on site the Independent Nurse Advisor was provided with anonymised information for each of the residents to enable the collation of real-world PMCF performance data for the Harvest Balmoral Mattress.

Data collected so far suggests that the Harvest Balmoral Mattress performs well for prevention of pressure ulcers in the 24-hour care home provider environment for elderly residents (where regular repositioning and continuous support via carers is available), with low, medium or high weights, those who are at very high risk of pressure ulceration and those with comorbidities such as Diabetes, CVA and Dementia or Cognitive impairment.

It also suggests that the mattress performs well for those with pressure ulcers of Category II, III or IV and can also be used for those with a history of previous pressure ulceration to prevent further ulceration, although the numbers of residents where this was observed during the audit was small (n=3).

Harvest Healthcare aims to continue to collect this PMCF data via collaborative working with care home providers to increase the number of residents audited and to provide robust post-market clinical follow-up data.

Report compiled by:

N Morton
Independent Nurse Advisor / Educator
RGN, BSc Hons Nursing, MSc Wound Healing and Tissue Repair, PG Cert HE

04/01/2023

 

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Written by James Hunt · Categorized: Harvest Healthcare · Tagged: Care Home, Harvest Healthcare, Pressure Ulcers

Feb 26 2020

Warning Signs and Symptoms of Pressure Ulcers

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’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’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’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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Written by Marjan Hakami · Categorized: Harvest Healthcare · Tagged: Care Home, Harvest Healthcare, Pressure Ulcers

Feb 26 2020

Staging / Grading of Pressure Ulcers

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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Written by Marjan Hakami · Categorized: Harvest Healthcare · Tagged: Care Home, Harvest Healthcare, Pressure Ulcers

Feb 26 2020

Shear and Friction in Pressure Ulcer Development

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’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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Written by Marjan Hakami · Categorized: Harvest Healthcare · Tagged: Care Home, Harvest Healthcare, Pressure Ulcers, Shear and Friction

Feb 26 2020

Risk Factors for Pressure Ulcer Development

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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Written by Marjan Hakami · Categorized: Harvest Healthcare · Tagged: Harvest Healthcare, Pressure Ulcers, Risk Factors

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