For Willmar hospital, it's another step in advanced health care
WILLMAR -- It looks like a cushion but isn't. Embedded inside are dozens of tiny sensors that measure pressure from someone sitting.
On the electronic display screen, Karyn Loos can see red and orange areas light up where higher pressure is exerted on a patient's hip and tailbone.
The new technology is one of many tools Rice Memorial Hospital uses to prevent and reduce the incidence of pressure ulcers.
"It's a very advanced tool," said Loos, an occupational therapist at Rice. "It's just really beneficial."
Pressure ulcers, or bedsores, were the largest category of adverse events at Minnesota hospitals in 2010. Hospitals reported 118 serious or worsening pressure ulcers last year, down only slightly from 122 the year before.
There were none at Rice. In fact the city-owned hospital has a top track record of preventing and managing reportable pressure ulcers.
But pressure ulcers remain challenging to manage and prevent, say Suzanne Keuseman and Cathy Moe, advanced-practice nurses specializing in wound care at Rice Hospital.
Hospital staff have hit this area hard in the past few years. For instance, every patient who's admitted now undergoes a skin-risk evaluation.
"No matter how healthy or sick they are, everybody is assessed by the nurses for their risk of developing a pressure ulcer," Moe said.
It might lead to a special mattress for the patient, or heel or elbow protectors, or a care plan to ensure the patient is frequently turned in bed.
Guidelines using evidence-based best practices have been developed for what to do if a patient is admitted with an existing pressure sore or develops a pressure ulcer while in the hospital.
Quarterly surveys help the hospital stay on track and also allow staff to benchmark themselves against other hospitals.
This year Rice plans to strengthen coordination across the hospital, so that patients aren't unintentionally put at risk of pressure sores while undergoing surgery or medical imaging.
Increasingly, hospitals are being held accountable for the quality of care they provide -- including their ability to appropriately manage pressure ulcers, said Wendy Ulferts, chief nursing officer at Rice.
"Our reimbursement could in the future be affected. We need to be sure we're identifying (pressure ulcers) on admission and treating them from the get-go," she said.
It's thought that 6 to 12 percent of U.S. hospital patients develop a pressure ulcer during their hospital stay. People who are elderly or immobile are at highest risk, but pressure sores can also occur in younger, otherwise healthy patients.
They usually develop over bony protuberances such as the tailbone, hip, heel or shoulder blade. Medical devices such as oxygen tubing -- and even ordinary eyeglasses and shoes -- also can lead to pressure sores.
Left untreated, they can turn into deep, painful lesions, Moe and Keuseman said.
Complications such as infection can be costly. Some patients become so debilitated that they never truly recover, Keuseman said. "It can be a downward spiral."
Hospital leaders hope the newly acquired pressure mapping technology will be a significant step forward. The dark-blue mats are laid in a wheelchair or recliner or on a bed. When the patient sits or lies on the mat, sensors detect variations in pressure and relay the information digitally via color-coded images.
"Previously we would use our judgment. This gives evidence," Loos said.
She said the data remove the guesswork in selecting chair cushions, heel pads and other devices that ease pressure on sensitive areas. "It shows clinical outcomes. You can say it did help," she said.
Jenn Steinhaus, an occupational therapist at the Rice Care Center, said it has helped not only with properly outfitting and adjusting chairs and wheelchairs but also with educating patients.
"You can see it on here and it's like, wow. That visual information is so powerful," she said.
Gillette Children's Hospital in Minneapolis is the only other facility in Minnesota that currently has a pressure mapping system. Rice employees raised more than $52,000 through the annual Rice Health Foundation employee campaign to buy the technology, with enough money left over for other patient safety initiatives.
"Because of the employees stepping in, we were able to make a whole lot of things happen," said Jean Raatz, manager of the Rice Health Foundation.
Hospital leaders want to make the pressure mapping available not only in the hospital but in the community as well. It can be used at nursing homes, wheelchair clinics and even in the patient's home, said Lynn Stier, rehabilitation services director.
Indeed, the most likely place these days for people to acquire a pressure ulcer isn't in the hospital or in a nursing home -- it's in their home.
"They're coming to us with some very significant pressure ulcers that people didn't know about or didn't have the means to care for," Ulferts said.
Whether pressure sores are 100 percent preventable is open to debate. "That's the hard thing. If they have poor nutrition, if they're elderly and dehydrated and their skin is frail, you can do anything and everything and they can still get a pressure sore," Moe said.
But patients and families are almost uniformly happy when pressure sores are addressed, especially if it's a sore that developed at home, she said. "I've had family members say, 'I'm so glad you asked.' I think 100 percent of what we're doing here makes it better."