Pressure Injury Strategy in Relation to Equipment Provision
Seating – Specifically Commodes
The international pressure injury guideline recommends a number of strategies to implement the guidelines. This includes specifics in relation to individualised pressure management within organisations.
Recommendations:
1. Assess barriers and facilitators for guideline implementation:
1.2.1 – At an organisational level, assess the availability quality and standards for the use of available equipment for the prevention and treatment of pressure injuries.
1.2.2 – At an organisational level, review the availability of and access to support surfaces and establish protocols for procurement that ensure timely access for individuals at risk of, or with an existing pressure injury.
2. Conduct regular evaluation of organisational performance in pressure injury prevention and treatment and provide feedback to the stakeholders.
International Pressure Injury Guidelines
These guidelines are now recommending individualised support surfaces that are chosen on an individualised basis. Pressure injury risk factors vary from person to person therefore proper assessment and equipment provision for pressure redistribution and management is a large part of their recommendations
General recommendations for seating support surfaces:
1. Individualise the selection and periodic re-evaluation of a seating support surface and associated equipment for posture and pressure redistribution with consideration to:
- Body size and configuration;
- The effects of posture and deformity on pressure distribution; and
- Mobility and lifestyle need.
Emerging therapies for the prevention of pressure injuries - Including micro climate manipulation and fabrics that are designed to reduce shear and friction.
Micro climate control:
1. Consider the need for additional features such as the ability to control moisture and temperature when selecting a support surface.
The use of specialised surfaces that come into contact with the skin may be able to alter the micro climate by changing the rate of evaporation of moisture and the rate at which heat dissipates from the skin.
New evidence now supports the consideration of equipment in the prevention and treatment of pressure injuries which is included in the international pressure injury guidelines. This consideration includes surfaces that support a healthy micro climate and also correct positioning of individual clients.
Repositioning:
Repositioning seated individuals:
1. Position the individual so as to maintain stability on his or her full range of activities.
2. Select a seated posture that is acceptable to the individual and minimizes the pressures and shear exerted on the skin and soft tissues. The ischia bear intense pressure when the individual is seated..
The Ischial tuberosity, greater trochanter, sacrum/ natal cleft coccyx need to be closely monitored when clients are in the seated position.
Commodes are considered high-pressure seating and need to be considered with clients who are at risk of or who have current pressure injury development in the prior mentioned locations. Commode seats that have torn vinyl or sealed plastic seams that are sharp increase the risk. Commode seats aperture may be the wrong size or badly placed to accept the ischial tuberosity. Standard commode seating offers minimal pressure relief with dense foam. If a client is at high risk and/ or spending a significant amount of time using a commode, more specialised seating needs to be considered.
Older Adults:
International guidelines promote correct assessment and care planning in special populations one of which includes older adults, which supplements their guidelines.
Care of vulnerable and aged skin:
1. Protect aged skin from skin injury associated with pressure and shear forces.
Case Study
An occupational therapist reviewed a client with a pressure injury on their coccyx approximately one year prior to their initial assessment. The area had developed since the client had been sitting on a replacement commode seat. Prior to this replacement seat the client had not had a pressure injury.
A Cubro team member went out on a joint visit to review the situation and it was found that the replacement seat specifications had changed from a high pressure redistributing visco-elastic foam covered in the soft, waterproof and flexible superflex fabric with a junior aperture to a regular foam and standard adult aperture. Since the change had occurred the client had developed a pressure injury that had needed treatment for the past year.
The pressure injury developed over time due to the change in commode seat. The replacement seat did not have the correct pressure relieving qualities both in the foam and fabric (pressure redistribution and microclimate considerations). As the client was frail with a low BMI, the standard aperture on the commode did not provide sufficient support for the ischial tuberosity placement and therefore increased the pressure and shearing forces and restricted blood flow to the soft tissues.
This example shows the importance of considering individual client requirements with showering and toileting equipment and the high costs associated with using standard features when a client is at risk of pressure area development.
How Cubro Products Can Help
At Cubro we understand the importance of individualised solutions that work with and for your clients. With our extensive mobile showering options we can attach one of our specially designed seamless handmade seats with high pressure relieving foam and customise seats to meet individual client needs. Also, check out our range of mobile showering solutions and as we have on site ability to customise we can work out a solution to even the most challenging situations.
For products to assist in pressure injury prevention and treatment please call Sharon Woodward on 0800 656 527. Please follow Cubro’s LinkedIn page for regular updates on this topic and other associated articles. Visit cubro.co.nz to view our product range.
