Transcript Best Practices for Using Pressure Mapping Systems

Our Goal
To Prevent This!
Wound measurement using VEV MD
Best Practices for Using FSA
Pressure Mapping Systems

Today’s Goal
 Why
use Pressure
Mapping?
 How to use it correctly?
Evidence Based Medicine
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We used to say
outcomes measures
Why do we insist on an
x-ray for a broken wrist
yet we will provide AT
with little objective
evidence.
Where Does Pressure Fit In
Our Assessment Hierarchy?
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Patient

Position
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Pressure
Pressure mapping systems help
you redistribute pressure they
do not:
 Relieve
pressure
Or
 Reduce pressure
So What Do We Actually Do
With The Client?
Introduce pressure mapping
 Capture how they are doing currently
 Demonstrate the client’s challenges
 Document commonly used solutions
 Provide as necessary an appropriate
alternative
 Communicate our findings effectively

But First Two Key Items
 Wash
your hands! For your sake and
theirs, before and after the evaluation!
Gloves??
 Make sure you use an isolation bag!
Ours our a thin dry cleaning type bag
Introduce Pressure Mapping

Explain the process
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To remove any
apprehensions
Involve client and/or
caregivers in the process
Allow them to interact
with the technology
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They won’t be able to
while you do the
assessment or they will
confuse your work
Make sure you use your
hands to limit
hammocking
Learn About the Patient

Gather any background
information you deem
pertinent and record in the
client information notebook.

General, equipment related
for future reference.
 Don’t rewrite the patient file
but do include the “Cliffs
Notes” of what is relevant to
what you are doing.
 Learn about their lifestyle and
goals. Lifestyle can trump
good seating.
Client’s Background
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SCI client – has C5 Quadriplegia
45 year old male – Diving accident at 20.
Long standing history of right side Stage I ulcer (has been worse)
Now problem with left side Stage I ulcer and NOT problems on right side.
Cannot stay up longer than 4 hours
Current Complaint
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Unable to be up for longer than 4 hours due
to redness in both Ischial Tuberosities, with
left being the worse.
Secondary is concern over the tail bone
pressure which occurs with current position
and/or recline
Goal of assessment/intervention: able to be
up 6 hours min, but preferably 8 hours each
day.
Capture Them in Their
Present Seating

Now that they have sat for a while in their existing mobility
device scan(F2), store(F2 again) and describe
 Keep your comments related to the specific scan stored.
 General information should be in client information tab
 Confirm what you see with your hands! Don’t trust all you
see on the screen confirm it!
 Make notes with the thought in mind that you need to
understand them 3-6 months down the road.
 Make sure you turn the client away from the screen so they
can no longer interact with the FSA system.
This will help answer the question:
Why do we need to make changes?
Some Reminders
•Make sure the ribbon cable is along the right leg
and mat is blue side up
•Make sure the mat is square on the seat
•Make sure the sensing mat is not hammocked
•Make sure the client is in a “ normal” or neutral
position you can replicate with other surfaces
Current Seating
2
2
3
2
200
4
2
10 24 46 69 104 91 116 73 41 17
2
15 38 53 62 70 62 95 64 59 33 17
180.1
8
16 27 49 76 62 63 46 82 78 72 28 18
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
160.2
2
140.3
120.4
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
100.5
80.6
37 33 34 29 25 27
60.7
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
40.8
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
Coefficient of variation (%)
73.66
2
9
12 16 27
2
19 27 35 19
8
Average (mmHg)
34.23
Maximum (mmHg)
134.90
9
Sensing area (in²)
What is suspicious in this picture? Note the hexagon.
229.67
20.9
1
mmHg
Use Your Hands!!
2
2
3
2
200
4
2
10 24 46 69 104 91 116 73 41 17
2
15 38 53 62 70 62 95 64 59 33 17
180.1
8
16 27 49 76 62 63 46 82 78 72 28 18
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
160.2
2
140.3
120.4
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
100.5
80.6
37 33 34 29 25 27
60.7
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
40.8
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
Coefficient of variation (%)
2
9
12 16 27
2
19 27 35 19
8
Average (mmHg)
34.23
Maximum (mmHg)
134.90
9
Sensing area (in²)
What really is at the 135 mmHg location??
229.67
20.9
73.66
1
mmHg
Ah The Numbers…
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A particular number at a particular site does not
= success or safety.
Key numbers to watch are
 Highest
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pressure-Where is the potential trouble?
Focuses attention on key at risk areas
 Sensing Area
Are we expanding or contracting the area of the pressure
distribution on the surface?
 Coefficient
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More is better!
of Variation - Lower the % the Better!
How evenly is the pressure distributed over the surface?
OK This Means What?
Keep in mind that we are doing a case
study of one.
 No normative data is available yet to guide
our decisions for a particular patient type.
 The numbers are only bench marks to
refer to as we seek a better solution.
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 Is
a proposed position or product affording a
better pressure distribution than another?
Don’t Forget Asymmetry
Or Lack Of It!
That’s More Like It!
Demonstrate What Their
Challenge Is
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If possible have the client sit upright on a firmer
surface like a mat table or a foam cushion. This
should be part of the larger mat evaluation.

Scan(F2), store(F2) and describe where the boney
prominences are. Confirming with hands and noting
coordinates on screen.
This will help answer the questions:
What is the client’s boney architecture like?
Is it all there? How rotated is the pelvis,etc.?
Why will or won’t a simple solution be sufficient?
On A Firm Flat Surface
Document the Most Commonly
Used or Paid for Solution
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Your years of experience or the typical funding
parameters may lead you to a particular solution
Scan(F2), store(F2) and describe what you did.
This may take recording a number of scans as you
try a number of variables. You can use 4 scan view
to compare your solutions head to head.
Be sure to describe what you did as you scan and
store
This will help answer the question:
Why or how the most likely or commonly paid for
solution did or did not work?
A Standard Solution
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Foam cushion: pressures still unacceptably high,
and highly focused
Provide an Alternative Solution
if Necessary
If you’re not satisfied with the “normal”
solution try another and validate or
challenge.
 Again this may take recording a number of
scans as you try a number of variables.
 Be sure to describe what you did as you
scan and store
This will help answer the question:
Why are we recommending a solution
different than the “usual”?
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Standing Chair: After Adjustments
F9 is right IT: Good pressure distribution
Up 6 hours am + 4 hours evening - meeting goal
Power Chair: After Adjustments
8 by 9 Roho insert in foam: good pressure distribution
not as good though as the Standing Chair: up only 4 hours
Before
therapist
correction
Stand-up chair
After
therapist
supported left
PSIS area
Don’t Forget Remote!
Use Remote to monitor the performance of
the proposed solution over an extended
period of time.
 Remote can evaluate real time activities,
e.g. bouncing down stairs.
 Monitor with Remote to see if the client
does weight shifts or tilts. If they tilt did the
go far enough to get benefit.
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Some Common Mistakes
•We stop using our hands and let technology
make decisions for us.
•We try every choice in the clinic. Our time
evaporates and we don’t know what we have
by the time we’re done. Princess and the Pea
syndrome in reverse.
Pressure Mapping Is An
Excellent Teaching Tool.
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Training and testing for caregiver and client
compliance
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Caregiver and Vet in bed-demonstrate why lifting versus
sliding across a bed is necessary
No that solution your buddy has will not work for you…See!
Don’t over-inflate that ROHO!!
Use remote feature to check for weight shifts or tilts
Client lifestyle
 Beautiful seating solution in clinic but a wood stool at
the bar defeats the benefits
What Do You Do When It
All Looks Bad?
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Sometimes you overdrive the solution and
have to back up
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Client’s trocanter is over 200 mmHg and has been for some time without incident only
alternative is high pressure on proven risk area of right I.T. Monitor it.
Use the tool to teach movement-help the
client find alternate pressure redistributing
positions in their seating.

T3 and 2 wounds-use FSA as a biofeedback tool to help a nervous T3 discover how
much(little) they have to move to achieve pressure reductions for at risk areas.
What Do You Do When
It
All Looks Good?
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Sometimes everything you do in the seat looks good.
If it does, back up and take a good look at where the
wound is or what their history is. What is not obvious
and maybe lurking under the surface?
Some experience indicates that while the client maybe
referred for a seating related pressure issue, 50% of the
time the problem is in the bed not the seat.
How Do We Share What
We Just Did?
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To help ensure it benefits the client
 that

they get what they need
And to get your good work
acknowledged and paid for
Develop a Simple Four
Step Report
Use comparison view to choose and
tag the frames that tell the story
 Print off the report with client
information, in color or in grey scale for
faxing.
 Or copy and paste it into a new or
existing Word document

Compare and Choose
Print Your Choices
Other Tools In FSA 4D
Histograms
 Track pressure in multiple chosen areas
 Add pictures
 Add shear, temperature or any other FSA
sensing mat to the same client file
 Balance assessment
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Pressure Mapping Reports
Enhance Decision Making in the
Care Team
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With objective information better
decisions are made, e.g..
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Due to Sacral wound a physician
orders bed rest, but to you it looks a
little high to be seating induced.
So you go check the bed with FSA,
and you clearly identify the cause!
Now you have objective data to
discuss with the physician. Allowing
more seating time and securing a
better bed for the client.
Evidence Based Practice
Many Come To Rely On
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Kaiser requires PMs for use as a benchmark
to become a contracted vendor with them.
Those with the most success using PMs take
time to educate their Case Managers and
other payers.
It also provides information that
demonstrates why you did what you did,
a.k.a. Risk Management.
Conclusions:
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Pressure mapping systems are dumb. It takes intelligent
interpretation and application of the data to make good
decisions that benefit the client
They are powerful tools to help maximize care for your
clients and to help ensure they receive it.
They also have become standard of care for those
needing rehabilitation seating.
Remember Our Goal
www.pressuremapping.com
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For more information on:
 Product
Applications
 Technical specifications
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 Clinical
use
 Research bibliography
THANK YOU!