Everyone has a role to play in preventing pressure injuries. Caregivers ensure that the patients with the greatest risk are attended to in the most proactive, strategic way to minimize the risk of pressure injury development. Administrators work ceaselessly to find and fund innovative solutions such as advanced mattresses that will promote healing while simultaneously minimizing staff time and resources. Patients and their families cooperate with the facilities to ensure that the needs of the patients are addressed as personally as possible.
Even given all these efforts, however, reinforcements may be needed. In the case of Sitting Acquired Pressure Ulcers (SAPU), there is no mattress to help lower the risk. In such cases, the best prevention is to seek a helping hand from an occupational therapist.
And, increasingly, technology is providing support that can help nurses and occupational therapists make more informed decisions about treatment. It is also providing patients with more tools to monitor their own situations, leading to more independence and greater health, which is everyone’s combined goal.
The Risk of Extended Sitting
Sitting for an extended period of time in a particular position could be just as risky as lying in bed without changing position. People who spend much of their day in wheelchairs, or those with movement impairment who spend large parts of their day working at computers are highly susceptible to SAPUs.
That's because sitting puts pressure on the small bony region of the back known as the sacrum and prolonged sitting could result in tissue damage.
Those at the highest risk for SAPUs are:
- Spinal cord injury victims
- The elderly
- Those in orthopedic settings
Individuals with spinal cord injuries are particularly vulnerable for tissue damage because of lack of sensation in the sacrum and reduced mobility as a result of the injury.
According to Dr. Alison Porter-Armstrong, a senior lecturer in rehabilitation sciences at Ulster University in the UK, an occupational therapist can help prevent pressure injuries acquired in the sitting position through a number of important interventions.
The Role of Occupational Therapists in Pressure Injury Prevention
Occupational therapists help fight the war on pressure injuries acquired via sitting through:
- Seating evaluation - occupational therapists design the optimal seating arrangement for patients specifically suited to their unique needs.
- Provision of equipment - the therapists set the guidelines for the most appropriate equipment. That means that pressure injury risk will be taken into account in all equipment used by the patient and the care provider.
- Positioning - different sitting positions place different amounts of pressure on tissue that could be sensitive to a pressure injury. The goal is to find the most comfortable position that avoids placing the patient in greater risk.
- Education of clients and their caretakers – the therapist works directly with the patients and their families, helping ensure that all of the key team members are on the same page and pulling in the same direction with similar goals and methodology.
- Transfers and repositioning maneuvers - the therapist determines how and how often a patient must be repositioned, or reposition him or herself.
According to Dr. Porter-Armstrong, the last point may be the most important. Repositioning, she said, is one of the most effective methods for reducing the duration and magnitude of pressure on vulnerable tissues.
"Healthy, able-bodied individuals automatically change position 6-9 times per hour," Dr. Porter-Armstrong comments. "Each posture change increases oxygen saturation by 2.2%."
The goal is to create the same effect for patients. "We try to teach our clients to weight-shift every 15 minutes – to lean forward, move side to side or even to lean or completely lift off the chair," she says.
Technology to the Rescue
Dr. Porter-Armstrong mentions that very few clinical studies have been carried out on the use of technology to help prevent SAPUs. She noted that Interface pressure mapping technology already exists, and it can to play a key role in providing vital biofeedback to patients.
Most studies, she says, show that outside of therapy sessions, patients are unlikely to follow the repositioning guidelines set by their occupational therapists. But with tracking from technology, the patients can be alerted when they need to change their positions so that they do not need to rely on their own memory.
href="http://www.sciencedirect.com/science/article/pii/S2095254616000259">Monitors can also be placed on or near body parts so that medical professionals can see when pressure is accumulating. This allows a level of advanced warning that an intervention is needed, and does not rely exclusively on observation from a nurse.
The Need for Movement
There are many health benefits, both physical and mental, associated with increasing a patient's level of movement. But according to Dr. Porter-Armstrong, many of the patients she has monitored fall far short of movement goals set for them by occupational therapists.
"Pressure mapping has shown that although patients BELIEVE they are performing weight shifts to prevent PUs, they are actually NOT. This is of great concern," she shares.
With that knowledge in hand, occupational therapists can operate with a better idea of what they can expect patients to do and what they are unlikely to do. It isn't likely to start a revolution in treatment, but with the help of technology, improvements may be on the way.