PRACTICAL PRACTICAL PRESSURE PRESSURE MAPPINGMAPPING

Presented by: Andrew Frank

October 2008

Copyright 2008

PRACTICAL PRESSURE PRACTICAL PRESSURE MAPPINGMAPPING

Much appreciated input from folks like

Jeannie Minkel, PT

Kim Davis, PT

Stephen Sprigle, PhD.

Jan Miller-Polgar, OT

Allen Siekman

Our GoalOur Goal

The ProblemThe Problem

Wound measurement using VEV MD

Some Sobering NumbersSome Sobering Numbers

39% of SCI Veterans in Houston in the 3 39% of SCI Veterans in Houston in the 3 Years studied were treated for a PUYears studied were treated for a PU

150 day average in Hospital150 day average in Hospital $150,000 per Hospitalization. $150,000 per Hospitalization. Total cost estimated up to $3.6 Billion Total cost estimated up to $3.6 Billion

in 1999. in 1999.–Garber, Rintala Journal of Rehabilitation Research Garber, Rintala Journal of Rehabilitation Research and Development, Sept/Oct. 2003and Development, Sept/Oct. 2003

SCI Skin ChangesSCI Skin Changes Collagen catabolismCollagen catabolism Decreased amino acid concentrationDecreased amino acid concentration Decrease in enzymes of biosynthesisDecrease in enzymes of biosynthesis Decrease in proportion of Type I to Type II collagenDecrease in proportion of Type I to Type II collagen Decrease in density of adrenergic receptorsDecrease in density of adrenergic receptors Poor collagen synthesisPoor collagen synthesis Abnormal vascular reactionsAbnormal vascular reactions Decreased blood flowDecreased blood flow Decreased PO2 – 5X less than in innervated skinDecreased PO2 – 5X less than in innervated skin Decreased fibronectin, glycoproteins for fibroblast activityDecreased fibronectin, glycoproteins for fibroblast activity

The skin below the injury is not the same The skin below the injury is not the same as the skin aboveas the skin above..

Courtesy of LAURIE M. RAPPL, PT, CWS

Wounds Are Not All The SameWounds Are Not All The Same

Courtesy of LAURIE M. RAPPL, PT, CWS

Deep Pressure Ulcer Stage IVDeep Pressure Ulcer Stage IV

Wound measurement using VEV MD

Shear Ulcer Stage IIIShear Ulcer Stage III

Courtesy of D. Keast

Summary of CausesSummary of Causes

ImmobilityImmobility IncontinenceIncontinence PressurePressure FrictionFriction ShearShear Maceration a.k.a. Heat and MoistureMaceration a.k.a. Heat and Moisture

NPUAP

Evidence Based Practice Or Why Evidence Based Practice Or Why Use Tools?Use Tools?

We used to say outcomes We used to say outcomes measuresmeasures

Now evidence based practiceNow evidence based practice X-ray for a broken wrist is routine X-ray for a broken wrist is routine

before casting yet we will provide before casting yet we will provide AT often with no objective AT often with no objective measurement.measurement.

Orthopedics gets paid because Orthopedics gets paid because they use objective tools like they use objective tools like Biodex, Cybex, etc.Biodex, Cybex, etc.

Preventing harm and Preventing harm and improving patient outcomesimproving patient outcomes

Evidence Based Practice: It’s HereEvidence Based Practice: It’s Here

Veteran SCI patient guidelines are that Veteran SCI patient guidelines are that they be assessed with pressure mapping they be assessed with pressure mapping annually.annually.

FL Medicaid reviewers frustrated. FL Medicaid reviewers frustrated. State of FL purchases 11 pressure State of FL purchases 11 pressure

mapping for their SCI and Brain Injury mapping for their SCI and Brain Injury centers. centers.

Pressure MappingPressure Mapping

Shear SensorsShear Sensors

Temperature MappingTemperature Mapping

HumidityHumidity

Calibration at Calibration at 75.3 % RH75.3 % RH

Calibration at Calibration at 23° C 23° C

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20

40

60

80

100

0 1 2 3 4 5 6 7

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FSA 32.8 ISO 32.8 ECS 32.8 23 deg

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20

40

60

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FSA 75.3 ISO 75.3 ECS 75.3 75.3%

Courtesy of: Allen R. Siekman

Pressure mapping; Its Not Pressure mapping; Its Not Mystical WizardryMystical Wizardry

Pressure mapping; Its Not Pressure mapping; Its Not Rocket ScienceRocket Science

An IPM Shares A Spot An IPM Shares A Spot In Your Toolbox With A:In Your Toolbox With A:

GoniometerGoniometer InclinometerInclinometer Tape measureTape measure

– MetalMetal

CaliperCaliper Digital cameraDigital camera

How Do We Make Sense Of How Do We Make Sense Of Pressure mapping?Pressure mapping?

What can we really do?What can we really do?

What do the numbers mean?What do the numbers mean?

How can we make good decisions?How can we make good decisions?

We Can Only Redistribute: We Can Only Redistribute:

We Can’tWe Can’t

Relieve pressure

Or Reduce pressure

Star Trek anti gravity boots

Redistribution Redistribution

How Do We Decide?How Do We Decide? Keep in mind that we are doing a case Keep in mind that we are doing a case

study of one, n=1. study of one, n=1. No normative data is available yet to guide No normative data is available yet to guide

our decisions for a particular patient type.our decisions for a particular patient type. The numbers are only bench marks to The numbers are only bench marks to

refer to as we seek a better solution.refer to as we seek a better solution.– Is a proposed position or product affording a Is a proposed position or product affording a

better pressure distribution, functional better pressure distribution, functional capability and or comfort than another?capability and or comfort than another?

What About The Numbers???What About The Numbers???

A particular number at a particular location does A particular number at a particular location does not = success or safety.not = success or safety.

Key numbers to watch areKey numbers to watch are– Highest pressure-Where is the potential trouble?Highest pressure-Where is the potential trouble?

Focuses attention on key at risk areasFocuses attention on key at risk areas

– Sensing Area- More is better! (Quantity of distribution)Sensing Area- More is better! (Quantity of distribution) Are we expanding or contracting the area of the pressure Are we expanding or contracting the area of the pressure

distribution on the surface?distribution on the surface?

– Coefficient of Variation - Lower the % the Better! Coefficient of Variation - Lower the % the Better! (Quality of distribution)(Quality of distribution) How evenly is the pressure distributed over the surface?How evenly is the pressure distributed over the surface?

Smaller Area Higher CoVSmaller Area Higher CoV

Larger Area Much Lower CoVLarger Area Much Lower CoV

How Long To Wait?How Long To Wait? Research indicates 6-8 minutes is a good Research indicates 6-8 minutes is a good

practical time (Stinson 2002). practical time (Stinson 2002). Be consistent so you can make valid comparisonsBe consistent so you can make valid comparisons You need to be observant as it depends on the You need to be observant as it depends on the

solution you choose, i.e.. air vs. foam. solution you choose, i.e.. air vs. foam. Some advocate up to 45 minutes-not usually Some advocate up to 45 minutes-not usually

practical-but you could use remote scanning to practical-but you could use remote scanning to confirm a solution’s effectiveness over time.confirm a solution’s effectiveness over time.

ImmersionImmersion

How Long To Wait?How Long To Wait?

Foam cushion initial sitting and after a few minutes

Peak Pressure IndexPeak Pressure Index

The highest pressure within a 9-10 cm2 in the ischial region or The highest pressure within a 9-10 cm2 in the ischial region or other bony prominence. Try to achieve the lowest possible PPI. other bony prominence. Try to achieve the lowest possible PPI. Single sensor peak values are not recommended to rate maps, Single sensor peak values are not recommended to rate maps, as they are not reliable (repeatable)as they are not reliable (repeatable)

Dispersion IndexDispersion Index

Percentage of the pressure from the total rectangular sensing area compared Percentage of the pressure from the total rectangular sensing area compared to the combined area under the ischial and sacro-coccygeal region.to the combined area under the ischial and sacro-coccygeal region. Evidence Evidence supports that a DI > 50% indicates high pressure ulcer risk (Drummond 1985)supports that a DI > 50% indicates high pressure ulcer risk (Drummond 1985)

Pressure GradientPressure Gradient

Change in pressures per inch or cm (how close the high pressures are to the low pressures). Try to get the lowest possible gradient.

Where is Potential Shear?Where is Potential Shear?

•You can’t have high shear without high normal forces.

•Where is the pressure gradient changing fastest?

Don’t Forget Asymmetry!Don’t Forget Asymmetry!

Make sure that it’s the client not a misplaced sensing mat?

That’s More Like It!That’s More Like It!

While this looks symmetric the person still loads 7% heavier on the right.

Be Confident In Your Data-OrBe Confident In Your Data-OrCalibration Is ImportantCalibration Is Important

Soft interface pressure mapping systems Soft interface pressure mapping systems need to be recalibrated!need to be recalibrated!

Do you have the equipment to do it?Do you have the equipment to do it? Do you have a protocol governing when, Do you have a protocol governing when,

where and who does the calibration?where and who does the calibration? Does the system help you confirm the Does the system help you confirm the

calibration was successful?calibration was successful?

Calibration Interval?Calibration Interval?

Follow the manufacturersFollow the manufacturers recommendationrecommendation

What is the use cycle?What is the use cycle? Whenever the readings look strangeWhenever the readings look strange Practical clinical calibration check-Practical clinical calibration check-

chair checkchair check Monthly or quarterly seems to be a Monthly or quarterly seems to be a

common default common default

Be Be PreparedPrepared!! !! Are the Tools Ready?Are the Tools Ready?

Don’t keep the IPM system in the Don’t keep the IPM system in the closet.closet.– No one wants to wait 30 minutes while you No one wants to wait 30 minutes while you

set up.set up.

Have it up and running ready to useHave it up and running ready to use Install it on all the computers you useInstall it on all the computers you use Know when was it last calibratedKnow when was it last calibrated

IPM System Preflight CheckIPM System Preflight Check

Check blinking lightsCheck blinking lights Sit on a firm surfaceSit on a firm surface Check for rows or columns out Check for rows or columns out Irregular peaksIrregular peaks Pop cornPop corn Red or white blocks Red or white blocks

Infection ControlInfection Control

Wash your hands! For your sake and theirs, Wash your hands! For your sake and theirs, before and after the evaluation! before and after the evaluation! Gloves??Gloves?? – Don’t touch the computer or camera unless you clean Don’t touch the computer or camera unless you clean

your hands or remove the gloves.your hands or remove the gloves.

Make sure you use an isolation bag! Comply with Make sure you use an isolation bag! Comply with Universal Precaution GuidelinesUniversal Precaution Guidelines– Mats contaminated with urine or fecal material might be Mats contaminated with urine or fecal material might be

cleaned with disinfectant wipes. But blood or tissue cleaned with disinfectant wipes. But blood or tissue fluids usually results in the mat being disposed.fluids usually results in the mat being disposed.

Mat Storage & MaintenanceMat Storage & Maintenance Follow manufacturers recommendationsFollow manufacturers recommendations Store mat flat or in case from manufacturerStore mat flat or in case from manufacturer Clean with medical grade disinfectant-spray Clean with medical grade disinfectant-spray

or wipesor wipes– Don’t soak the matDon’t soak the mat– If you get it wet air dry or gently blow dryIf you get it wet air dry or gently blow dry

OK Take A Big BreatheOK Take A Big Breathe

Thankfully using IPMs is Thankfully using IPMs is relatively easy. relatively easy.

Two Classic Questions Two Classic Questions Of New IPM UsersOf New IPM Users

What is the best number? What is the best number?

What is the best cushion?What is the best cushion?

Where Does Pressure Fit In Where Does Pressure Fit In The Assessment Hierarchy?The Assessment Hierarchy?

PatientPatient Position Position PressurePressure

– Client and O’Malley’sClient and O’Malley’s Beautiful seating solution in clinic but a Beautiful seating solution in clinic but a

wood stool at the bar defeats the wood stool at the bar defeats the benefitsbenefits

– Teenager gets a Nintendo and a woundTeenager gets a Nintendo and a wound– Breaking down doing the brakesBreaking down doing the brakes– Caregiver impact on Vet with repetitive Caregiver impact on Vet with repetitive

injuryinjury Why five years of sacral pressure ulcers Why five years of sacral pressure ulcers

only in August?only in August?

Focusing On The Wrong P Focusing On The Wrong P Can Cost You!Can Cost You!

Learn About the PatientLearn About the Patient Gather any background Gather any background

information you deem information you deem pertinent and record in the pertinent and record in the client information tab.client information tab.– General, equipment related General, equipment related

for future reference.for future reference.– Don’t rewrite the patient file Don’t rewrite the patient file

but do include the “Cliff but do include the “Cliff Notes” of what is relevant to Notes” of what is relevant to what you are doing.what you are doing.

– Learn about their lifestyle Learn about their lifestyle and goals. Lifestyle can and goals. Lifestyle can trump good seating.trump good seating.

Multi-System AnalysisMulti-System Analysis

Braden Scale Braden Scale

for Predicting Pressure Sore Riskfor Predicting Pressure Sore Risk

– Validated Long term care Geriatric toolValidated Long term care Geriatric tool– Useful to expand areas of investigation Useful to expand areas of investigation – Nutrition, incontinence and out of chair Nutrition, incontinence and out of chair

activitiesactivities

Client Positioning Issues?Client Positioning Issues?

Mat table evaluation is a good ideaMat table evaluation is a good idea Client Information Check list-Client Information Check list-

– Jeannie Minkel’s for example.Jeannie Minkel’s for example. Use camera as part of documentationUse camera as part of documentation

– Illustrate the challenges at the beginningIllustrate the challenges at the beginning– Illustrate the recommended solution and Illustrate the recommended solution and

the good resultsthe good results

PM Clinical WizardPM Clinical Wizard

It’s Not Just The ScanIt’s Not Just The ScanGood Documentation Is Key!Good Documentation Is Key!

““The single most important thing when The single most important thing when taking pressure datataking pressure data are the notes on are the notes on the position, posture and circumstances the position, posture and circumstances existing when the data was taken. It is existing when the data was taken. It is easy to take lots of data but difficult to easy to take lots of data but difficult to remember the details of exactly what the remember the details of exactly what the conditions were when the data was conditions were when the data was taken.”taken.”

Picture the PosturePicture the Posture

A Practical ProtocolA Practical Protocol

1.1. Introduce pressure mapping to the clientIntroduce pressure mapping to the client2.2. Capture how they are currently doingCapture how they are currently doing3.3. Demonstrate the client’s challengesDemonstrate the client’s challenges4.4. Document usual/least costly solutionsDocument usual/least costly solutions5.5. Provide as necessary an appropriate Provide as necessary an appropriate

alternative alternative 6.6. Communicate our findings effectivelyCommunicate our findings effectively

1) Introduce Pressure Mapping1) Introduce Pressure Mapping

Explain the processExplain the process– To remove any To remove any

apprehensionsapprehensions– Involve client and/or Involve client and/or

caregivers in the processcaregivers in the process– Allow them to interact Allow them to interact

with the technology with the technology They won’t be able to They won’t be able to

while you do the while you do the assessment or they will assessment or they will confuse your workconfuse your work

Make sure you use your Make sure you use your hands to limit hands to limit hammockinghammocking

Practical RemindersPractical Reminders

Place the mat as close to the skin as possible and with what they normally sit on.

Consistently place the mat in the same orientation so there is no confusion later.

Position the mat square on the seat. Confirm with your hands that the sensing

mat is not hammocked. Make sure the client is in a “ normal” or

neutral position you can replicate with other surfaces.

Mat PlacementMat Placement

Left mat is placed to far right and back in Left mat is placed to far right and back in seat so we are missing information.seat so we are missing information.

Client’s InformationClient’s Information

45 year old SCI client – 25 year post injury C5 Quadriplegia45 year old SCI client – 25 year post injury C5 Quadriplegia Long standing history of right side Stage I ulcer (has been worse)Long standing history of right side Stage I ulcer (has been worse) Now problems with left side Stage I ulcer and NOT problems on right side. Now problems with left side Stage I ulcer and NOT problems on right side.

Cannot stay up longer than 4 hours Cannot stay up longer than 4 hours

Current ComplaintCurrent Complaint Unable to be up for longer than 4 hours due Unable to be up for longer than 4 hours due

to redness in both Ischial Tuberosities, with to redness in both Ischial Tuberosities, with left being the worst. left being the worst.

Secondary is concern over the tail bone Secondary is concern over the tail bone pressure which occurs with current position pressure which occurs with current position and/or reclineand/or recline

Goal of assessment/intervention: able to be Goal of assessment/intervention: able to be up 6 hours min, but preferably 8 hours each up 6 hours min, but preferably 8 hours each day.day.

2) Capture Them in Their 2) Capture Them in Their Existing SeatingExisting Seating

Now that they have sat for a while in their existing mobility device Now that they have sat for a while in their existing mobility device scan, store and describescan, store and describe– Keep your comments related to the specific scan stored. Keep your comments related to the specific scan stored. – General information should be in client information tabGeneral information should be in client information tab– Confirm what you see with your hands! Don’t trust all you see on Confirm what you see with your hands! Don’t trust all you see on

the screen confirm it!the screen confirm it!– Make notes with the thought in mind that you need to understand Make notes with the thought in mind that you need to understand

them 3-6 months down the road.them 3-6 months down the road.– Make sure you turn the client away from the screen so they can no Make sure you turn the client away from the screen so they can no

longer interact with the pressure mapping system.longer interact with the pressure mapping system.

This will help answer the question: This will help answer the question: Why do we need to make changes Why do we need to make changes or or spend money?spend money?

Current SeatingCurrent Seating

What is suspicious in this picture? Note the hexagon.

Use Your Hands!!Use Your Hands!!

2 3 2 4

2 10 24 46 69 104 91 116 73 41 17

2 2 15 38 53 62 70 62 95 64 59 33 17

8 16 27 49 76 62 63 46 82 78 72 28 18 2

4 19 30 56 117 42 31 5 28 59 70 38 34

3 42 31 81 135 34 13 9 20 49 78 49 36 15

44 49 69 104 37 16 12 17 89 84 59 46 41

2 32 36 51 82 60 51 31 62 65 54 48 39 50

5 23 37 45 49 56 45 14 39 49 35 47 35 36

4 18 33 44 35 41 45 9 37 33 34 29 25 27

18 22 28 27 32 24 15 20 20 35 20 28 22

2 11 14 34 31 30 23 11 17 27 37 28 17 29

18 8 20 24 24 26 8 8 26 37 25 20 16

5 6 19 19 25 17 3 5 23 36 24 24 9

2 9 12 16 27 9 2 19 27 35 19 8

Sensing area (in²)

Coefficient of variation (%)

Average (mmHg)

Maximum (mmHg)

229.67

73.66

34.23

134.90

1

20.9

40.8

60.7

80.6

100.5

120.4

140.3

160.2

180.1

200

mmHg

What really is at the 135 mmHg location??

3) Demonstrate What Their 3) Demonstrate What Their Challenge IsChallenge Is

If possible have the client sit upright on a firmer If possible have the client sit upright on a firmer surface like a mat table or a foam cushion. This surface like a mat table or a foam cushion. This should be part of the larger mat evaluation.should be part of the larger mat evaluation.– Scan, store and describe where the boney prominences are. Scan, store and describe where the boney prominences are.

Confirming with hands and noting coordinates on screen.Confirming with hands and noting coordinates on screen.

This will help answer the questions: This will help answer the questions: What is the client’s boney architecture like? What is the client’s boney architecture like?

Is it all there? Flexible? How rotated is the Is it all there? Flexible? How rotated is the pelvis,etc.?pelvis,etc.?Why won’t a simple solution be sufficient?Why won’t a simple solution be sufficient?

On A Firm Flat SurfaceOn A Firm Flat Surface

Don’t put the client at risk doing this. A mat table, mini simulator or firmer foam cushion might be good choices.

4) Document the Most Commonly 4) Document the Most Commonly Used/Least Costly AlternativeUsed/Least Costly Alternative

Your years of experience or the typical funding Your years of experience or the typical funding parameters may lead you to a particular solutionparameters may lead you to a particular solution

Scan, Store and describe what you did.Scan, Store and describe what you did. This may take recording a number of scans as you This may take recording a number of scans as you

try a number of variables. You can use 4 scan view try a number of variables. You can use 4 scan view to compare your solutions head to head.to compare your solutions head to head.

Be sure to describe what you did as you scan and Be sure to describe what you did as you scan and storestore

This will help answer the question: This will help answer the question: How well did the usual or least costly solution How well did the usual or least costly solution

performed for the client?performed for the client?

A “Usual” SolutionA “Usual” Solution

Foam cushion: pressures still unacceptably high, and highly focusedFoam cushion: pressures still unacceptably high, and highly focused

5) Provide an Alternative Solution 5) Provide an Alternative Solution

if Necessaryif Necessary If you’re not satisfied with the “normal” If you’re not satisfied with the “normal”

solution try another and validate or challenge.solution try another and validate or challenge. Again this may take recording a number of Again this may take recording a number of

scans as you try a number of variables.scans as you try a number of variables. Be sure to describe what you did as you scan Be sure to describe what you did as you scan

and store and store

This will help answer the question: This will help answer the question: Why are we recommending a solution Why are we recommending a solution

different than the least costly or “usual”?different than the least costly or “usual”?

An Alternate SolutionAn Alternate Solution

8 by 9 air insert in foam: good pressure distribution not as good though as the 8 by 9 air insert in foam: good pressure distribution not as good though as the full air cushion: up only 4 hoursfull air cushion: up only 4 hours

Proposed SolutionProposed Solution

On properly adjusted air cushion. F9 is right IT: Good pressure distributionOn properly adjusted air cushion. F9 is right IT: Good pressure distributionUp 6 hours am + 4 hours evening - meeting goalUp 6 hours am + 4 hours evening - meeting goal

Before Before therapist therapist

correctioncorrection

AfterAftertherapist therapist

supported leftsupported leftPSIS areaPSIS area

Change In Posture?Change In Posture?

6) Develop a Simple Four6) Develop a Simple FourStep ReportStep Report

Use comparison view to choose and tag the Use comparison view to choose and tag the frames that tell the story frames that tell the story

Print off the report with client information, in color Print off the report with client information, in color or in grey scale for faxing. or in grey scale for faxing.

Or copy and paste it into a new or existing Word Or copy and paste it into a new or existing Word documentdocument you use.you use.

Compare and ChooseCompare and Choose

Print Your ChoicesPrint Your Choices

Print Your ChoicesPrint Your Choices

PDF Makes It Easy To Share!PDF Makes It Easy To Share!

Don’t Forget Remote!Don’t Forget Remote!

Use Remote to monitor the performance of the Use Remote to monitor the performance of the proposed solution in real world use or over an proposed solution in real world use or over an extended period of time.extended period of time.– Remote can evaluate real time activities, e.g. Remote can evaluate real time activities, e.g.

bouncing down stairs.bouncing down stairs.– Monitor with Remote to see if the client does weight Monitor with Remote to see if the client does weight

shifts or tilts over time. Or, if they tilt, did the go far shifts or tilts over time. Or, if they tilt, did the go far enough to get the hoped for benefit.enough to get the hoped for benefit.

Use Pressure Mapping As Visual Use Pressure Mapping As Visual Feed BackFeed Back

Client and caregiver buy in and complianceClient and caregiver buy in and compliance– No that solution your buddy has will not work for you…No that solution your buddy has will not work for you…

See for yourself. Better client and caregiver buy in.See for yourself. Better client and caregiver buy in.– Don’t over-inflate that air cushion!! Use it wisely.Don’t over-inflate that air cushion!! Use it wisely.– How far do they have to go for adequate weight shift How far do they have to go for adequate weight shift

using tilt or other means. using tilt or other means. – Demonstrate appropriate positioning in bed or seat so Demonstrate appropriate positioning in bed or seat so

the caregiver doesn’t defeat your work.the caregiver doesn’t defeat your work.

Some Common MistakesSome Common Mistakes

You stop using your hands and let technology make decisions for you.

You try every choice available. You may have a mountain of cushions to try but go with your experience first.

Time is precious and trying everything can be confusing.

Sometimes you have to leave “well enough Sometimes you have to leave “well enough alone”alone”– Client’s trocanter is over 200 mmHg and has been for some time Client’s trocanter is over 200 mmHg and has been for some time

without incident only alternative is high pressure on proven risk without incident only alternative is high pressure on proven risk area of right I.T. Monitor it.area of right I.T. Monitor it.

Use the tool to teach movement-help the client Use the tool to teach movement-help the client find alternate pressure redistributing positions in find alternate pressure redistributing positions in their seating.their seating.– T3 and 2 wounds-use pressure mapping as a biofeedback tool to T3 and 2 wounds-use pressure mapping as a biofeedback tool to

help a nervous T3 discover how much(little) they have to move to help a nervous T3 discover how much(little) they have to move to achieve significant pressure reduction for at risk areas. achieve significant pressure reduction for at risk areas.

What Do You Do When It What Do You Do When It All Looks Bad?All Looks Bad?

Maybe it’s the Tool!Maybe it’s the Tool!

Wrinkles in matWrinkles in mat Poor placement of matPoor placement of mat Hammocking of matHammocking of mat Out of date calibrationOut of date calibration Damaged matDamaged mat

Get your hands in there and find outGet your hands in there and find out

What Do You Do When What Do You Do When It All Looks Good?It All Looks Good?

Sometimes everything you do in the seat looks good.Sometimes everything you do in the seat looks good. If it does, back up and take a good look at where the If it does, back up and take a good look at where the

wound is or what their history is. What is not obvious wound is or what their history is. What is not obvious and unseen during the assessment?and unseen during the assessment?

Some research and experience indicates that while the Some research and experience indicates that while the referral is for a perceived seating related pressure issue, referral is for a perceived seating related pressure issue, 50% of the time the problem is in the bed not the seat. 50% of the time the problem is in the bed not the seat. SoSo, go pressure map the bed even with a seat mat if you , go pressure map the bed even with a seat mat if you need to.need to.

Clinical BenefitsClinical Benefits

Objective evidence of needObjective evidence of need Focuses Resources-80/20 ruleFocuses Resources-80/20 rule Better solutions mean fewer visitsBetter solutions mean fewer visits Client information is organized over time Client information is organized over time

in an easy to use and share format.in an easy to use and share format.

Pressure Mapping Reports Pressure Mapping Reports Enhance Decision Making in the Enhance Decision Making in the

Care TeamCare Team With objective information better With objective information better

decisions are made, e.g..decisions are made, e.g..– Due to Sacral wound a physician orders Due to Sacral wound a physician orders

bed rest, but to you it looks a little high bed rest, but to you it looks a little high to be seating induced. to be seating induced.

– So you go check the bed with an IPM, So you go check the bed with an IPM, and you clearly identify the cause! and you clearly identify the cause!

– Now you have objective data to discuss Now you have objective data to discuss with the physician. Allowing more with the physician. Allowing more seating time and securing a better bed seating time and securing a better bed for the client. for the client.

Evidence Based PracticeEvidence Based Practice Many Have Come To Rely On Many Have Come To Rely On

HMOs are requiring pressure mapping for use as HMOs are requiring pressure mapping for use as a benchmark to become a contracted vendor with a benchmark to become a contracted vendor with them. them.

Those with the most success using pressure Those with the most success using pressure mapping take time to educate their Case mapping take time to educate their Case Managers and other payers.Managers and other payers.

It provides information that demonstrates why you It provides information that demonstrates why you did what you did and when you did it, a.k.a. Risk did what you did and when you did it, a.k.a. Risk ManagementManagement..

Conclusions:Conclusions:

Pressure mapping systems require intelligent Pressure mapping systems require intelligent interpretation and application of the data to make interpretation and application of the data to make good decisions.good decisions.

They are powerful tools to help maximize care for They are powerful tools to help maximize care for your clients and to help ensure they receive the your clients and to help ensure they receive the AT solutions they need.AT solutions they need.

They have also become standard of care for those They have also become standard of care for those needing rehabilitation seating. needing rehabilitation seating.

RememberRemember Our GoalOur Goal

More information at

ISO Working Group Clinical Use Guidelines

http://www.pressuremapping.com/index.cfm?pageID=4

Or you can e-mail me at

andrew@vista-medical.com