aderma case studies - smith & nephew...detailed in the case study an evaluation of aderma strips...

ADERMA Case studies

ADERMA™

An evaluation of ADERMA™ strips under nasal cannula tubing and the impact on patient wellbeing

Page 6 An evaluation of ADERMA sacrum over the shoulder and the impact on patient wellbeing

Page 8 An evaluation of ADERMA sheet with hand contracture and the impact on patient wellbeing

Page 10 An evaluation of ADERMA sheet between contracted knees and the impact on patient wellbeing

Contents

An evaluation of ADERMA™ strips and the impact on patient wellbeing

Background -78-year-old gentleman (Mr. A) -Lives alone -Receiving End Of Life care for COPD -Requiring home oxygen -Broken areas acquired to tops of both ears due to friction and pressure from nasal cannula tubing -Braden score was 16 indicating at risk of pressure damage

Implications for the patient• Mr. A was in pain and reported both areas were sore due to

the pain of the pressure ulcers and therefore not using home oxygen therapy effectively; resulting in occasional shortness of breath

• Mr. A did not wish to use a face mask as an alternative

Implications for clinician• Unsure how to manage treatment due to the anatomical area

and difficulties for dressing choices• Unsure how to prevent recurrence for this patient and other

patients in same / similar situation• Unsure how to enhance the wellbeing of this patient as this

was having a significant impact on his quality of life• Increased financial cost to local NHS

Amy Pierrepont - Community Staff Nurse, Nottinghamshire County Health Partnerships

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ADERMA in-situ under nasal cannula tubing*

Management of wounds - Treated with conservative hydrocolloid dressing to aid wound healing - Both pressure ulcers healed within 17 days - ADERMA strips were used following re-epithelialization of tissue

* image for illustrative purposes only, does not represent the actual patient

detailed in the case study

An evaluation of ADERMA™ strips and the impact on patient wellbeing

Implications for physical wellbeing• Pain and discomfort expressed • Patient also stated he felt some discomfort prior to

presentation of wounds• Sleep disturbance due to pain, discomfort and

shortness of breath as patient was not using home oxygen therapy effectively as a result of the pressure ulcers

• Lack of appetite due to pain and discomfort

How using ADERMA™ strips aided physical wellbeing

• Mr. A reported nasal cannula was now more comfortable • No further complaints of pain• Mr. A was now able to tolerate the nasal cannula,

allowing him to receive home oxygen therapy effectively thus resulting in less shortness of breath

• Mr. A reported sleeping much better• Mr. A was able to wash ADERMA under warm water

aiding good hygiene• Mood was enhanced and patient reported feeling

relieved and reassured that through using ADERMA strips the risk of deterioration or recurrence was reduced

Patient:• Mr. A was more comfortable and reported he

was now free from pain• He was now able to use home oxygen and

nasal cannula effectively• Maintained skin integrity and prevented any

further recurrence of pressure damage• Aided patient physical, psychological, spiritual

and social wellbeing• Mr. A liked the product and was easy to apply

/ change by self• Mr. A was able to clean the product with

warm water aiding hygiene

Clinician: • As a clinician I would recommend using ADERMA strips

for patients with a nasal cannula as a first line measure to prevent risk of pressure damage; and on recently healed wounds in these areas

• ADERMA strips were easy to use • Able to cut ADERMA strips to ideal size was very useful• ADERMA strips were inexpensive• Easy to secure to nasal cannula with secondary fixation tape• Aided regular and easy removal for skin inspection• ADERMA strips were available on FP10 • Available in different sizes aiding appropriate ordering and

choice dependent on individual needs

Outcomes of using ADERMA strips on newly healed wounds

Implications on social wellbeing• Patient reported laying in bed more that sitting out as

he felt pressure pulling from nasal cannual was causing more damage

• Symptoms interfering with activities of daily living contributing to risk of social isolation

• Desire and struggle for control and independence • Family reported when visiting that patient wasn’t

interacting; patient reported this was due to pain and frustration leading to a risk of social isolation

• Alternative option of face mask was offered, however patient refused reporting feeling worried it would feel invasive, would impact on cleanliness on face and would further hinder social interaction when family and friends came to visit

Implications on spiritual and cultural wellbeing

• Mr. A reported no spiritual or cultural beliefs specifically • Mr. A was anxious about pain and wanted to be free

from any pain nearing End of Life• It was important to Mr. A to maintain his independence • Mr. A wished to be able to socialize with family and

friends when they visited: a oxygen face mask would have been too restrictive for Mr. A

• Mr. A wanted to be cared for at home for as long as possible

How using ADERMA strips aided social wellbeing

• Mr. A sat out of bed more with home oxygen and ADERMA strips in situ

• Family reported more social interaction and increased mood

• Both Mr. A and his family reported feeling relieved• Able to maintain independence

How using ADERMA strips aided spiritual and cultural wellbeing

• No further complaints of pain• Mr. A was able to remain being cared for at home

with home oxygen therapy• Able to maintain independence • Mr. A was able to socialize with family and friends

An evaluation of ADERMA™ sacrum and the impact on patient wellbeing

Background- 89-year-old lady (Mrs. A)- Lives with daughter and son in law- Receiving End of life care (EOLC) for

Cancer- Bed bound, air mattress in place,

however due to how the patient wished to be positioned little pressure relief was obtainable

- Unable to communicate her needs clearly

- Due to receiving EOLC; risk factors also included reduced mobility and risk of malnutrition

- Unable to communicate pain or discomfort verbally only expressive

- Mrs. A would only tolerate laying on her left hand side

- Daughter and son in law anxious and worried about red area developing to left shoulder blade

- Area was red, non blanching (grade 1 pressure ulcer), unbroken skin, but vulnerable to further pressure damage


6

ADERMA sacrum in situ over shoulder* Implications for the patient

• Grade 1 pressure ulcer present • Expression of possibility of pain and discomfort impacting wellbeing• At risk of further pressure damage• May require additional nursing intervention and dependency on healthcare

professionals• Unable to tolerate repositioning onto other side or back• Dependent on family members

Implications for familiy• Anxious about further pressure damage occurring• Emotional concerns as they felt responsible for deterioration in skin condition

despite reassurance• Family concerned about pain / discomfort as Mrs. A had previously expressed

concerns about dying in pain• Concerned as unable to reposition appropriately due to pain and tolerance

levels• Dependency on family members to support strict repositioning regime for Mrs. A

as much as she was able to tolerate• Consideration needed to be given regarding increased nursing visits and

possible intrusion into family home, family were juggling caring for Mrs. A and their own day to day living however they wished to continue to care for Mrs. A themselves

Implications for clinician• Unsure how to manage treatment due to the anatomical area• Deterioration of patients general health causing possible difficulties with

preventing deterioration• Priority difficulties of balancing comfort care and possible risk of wound

deterioration which would cause increased pain / discomfort• Unsure how to prevent recurrence and deterioration for Mrs.A• Unsure how to enhance the wellbeing for Mrs. A as this was the main aim of

care as she was receiving EOLC• Vital to give support and provide sensitivity and empathy to family members

during this difficult time• Important to aid comfort and enhance wellbeing • Increased financial cost to local NHS



An evaluation of ADERMA™ sacrum and the impact on patient wellbeing

Management of Grade 1 pressure ulcer - ADERMA™ sacrum was used to manage a grade 1 pressure ulcer to prevent further deterioration - No further pressure damage occurred - Complete healing / none blanching of skin was unable to be obtained, possibly as Mrs. A was

receiving EOLC and her condition was deteriorating

Patient:• Maintained skin integrity and prevented any

further recurrence of pressure damage• Effective pressure relief was achieved• Aided patient physical, psychological, spiritual

and social wellbeing• Able to maintain good hygiene was able to wash

with warm water

Relatives:• Able to wash with warm water and dry• Easy to put back in situ• Easy to remove to aid skin inspection at regular

intervals to monitor for any deterioration • Family were happy as no further deterioration

occurred

• Family were supported during a difficult time with use of ADERMA effectively nursing intervention visits were reduced enabling family to care for Mrs. A as both she and they wished

Clinician: • As a clinician I would recommend using ADERMA

sacrum for patients at risk of pressure damage to shoulder blade area

• ADERMA sacrum was available on FP10 • ADERMA sacrum was easy to use • ADERMA sacrum was inexpensive• Aided regular and easy removal for skin inspection• Reduced nursing visits and associated costs effectively

Implications physical wellbeing• Grade 1 pressure ulcer sustained• Requirement for sleep and rest was being disturbed• At risk of deterioration • At risk of further pressure damage• Unable to tolerate repositioning onto other side or back• Expression of possibility of pain and discomfort

Implications psychological wellbeing• Distress caused for repositioning• Risk of anxiety caused by increased intervention• Sleep disturbances due to repositioning

Implications spiritual and cultural wellbeing

• Expression of pain and discomfort from area of pressure damage whilst receiving EOLC

• Mrs. A wished to die at home pain free• Concerns of emotional distress on repositioning to try

to provide effective pressure relief• Concerns leading to confusion as to whether agitation

was due to repositioning or other factors

Outcomes of using ADERMA sacrum on grade 1 pressure ulcer over shoulder

How using ADERMA sacrum aided physical wellbeing

• Mrs A was able to continue to be cared for without disturbance from un-tolerated repositioning

• Less need for repositioning which ensured she was able to have undisturbed sleep and rest

• Prevented possible deterioration of further pressure damage• Reduced expression of pain / discomfort

How using ADERMA sacrum aided psychological wellbeing

• Reduced distress as ADERMA sacrum aided effective pressure relief to prevent further deterioration

• Risk of anxiety related to this aspect of care was reduced• Enabled less interruption, allowing for sleep and rest

How using ADERMA sacrum aided spiritual and cultural wellbeing

• Reduced expression of pain / discomfort • ADERMA Sacrum aided effective pressure relief which

enabled Mrs.A to be repositioned as she was most comfortable

• Enabled Mrs. A to be cared for with dignity at end of life stage of care

• Made more comfortable• Mrs. A was able to die at home as she wished

An evaluation of ADERMA™ sheet and the impact on patient wellbeing

Background- 79 year old lady (Mrs. B)- Lives in a residential care home- Receiving care for a previous stroke and dupuytren’s

contracture of both hands- Pain, soreness and redness were present on palms of both

hands upon assessment- Grade 1 pressure damage present to both palms of hands- Mrs. B able to communicate her needs clearly


8

ADERMA in situ between fingers and palm of hand*

Implications for the patient• Mrs. B reported pain and soreness to both palms of her hands from

pressure of contractions• Mrs. B reported feeling increasingly low in mood as it ‘ was another

thing ‘ to add to complaints

Implications for clinician• Unsure how to manage treatment due to the anatomical area and

difficulties for dressing choices• Unsure how to prevent recurrence for this patient and other patients in

same / similar situation• Unsure how to enhance the wellbeing of this patient as this was

having a significant impact on her quality of life• Increased financial cost to local NHS

Implications for carers• Carers unable to prevent pressure due to anatomical area• Carers concerned and anxious about how to manage the situation• Carers wanted Mrs. B to be comfortable and pain free

Management of Grade 1 pressure ulcer - ADERMA Sheet placed in situ between fingers and palm of hand to

prevent pressure damage occurring - Washed and placed back in situ at each personal care intervention /

when required - No further pressure damage occurred




9

Patient:• Mrs B more comfortable• Grade 1 pressure sore subsided aiding

blanching of skin and redness diminished• Appropriate and effective pressure relief

achieved• Maintained skin integrity and prevented any

further recurrence of pressure damage• Aided patient physical, psychological, spiritual

and social wellbeing• Able to maintain good hygiene was able to wash

with warm water

Carers:• Carers able to remove and wash with warm

water

• Easy to replace• Able to maintain effective pressure relief• ADERMA Sheet aided easy inspection of skin at regular

intervals• Carers were happy as no further deterioration occurred


sheet for patients at risk of pressure damage to areas of contraction such as between palms of hands

• ADERMA sheet was available on FP10 • ADERMA sheet was easy to use • ADERMA sheet was inexpensive• Aided regular and easy removal for skin inspection• Reduced nursing visits and associated costs effectively

Implications physical wellbeing• Pain and discomfort expressed • Sleep disturbance due to pain and discomfort• Lack of appetite due to pain and discomfort• Risk of deterioration and further pressure damage

Implications psychological wellbeing• At risk of depression, presented with low mood• Anxiety due to pain and discomfort• Sleep disturbance due to pain and discomfort• Fear of further deterioration

Implications on patients spiritual and cultural wellbeing

• Mrs. B’s carers took her to church on a Sunday however since pain and discomfort started Mrs. B ‘didn’t feel like going.’

Implications on social wellbeing• Patient reported sitting in bedroom more as she didn’t

feel like socialising with other residence or attending Church due to discomfort and fear of being judged due to altered body image

• Symptoms interfering with activities of daily living contributing to risk of social isolation

• Desire and struggle for control and independence • Family reported when visiting that patient wasn’t

interacting; patient reported this was due to pain and frustration leading to a risk of social isolation

Outcomes of using ADERMA sheet on Grade 1 pressure damage

How using ADERMA sheet aided physical wellbeing

• Mrs. B reported ADERMA was more comfortable• No further complaints of pain, reported sleeping much better• Carers were able to wash ADERMA under warm water aiding

good hygiene• Mood was enhanced and patient reported feeling relieved

and reassured that through using ADERMA sheet the risk of deterioration or recurrence was reduced

How using ADERMA sheet aided psychological wellbeing

• Mood was enhanced and patient reported feeling relieved and reassured that through using ADERMA strips the risk of deterioration or recurrence had been reduced

• Patient reported anxiety was relieved• Patient reported sleeping much better

How using ADERMA sheet aided patients spiritual and cultural wellbeing

• Since using ADERMA Sheet in between fingers and palm of hand. Mrs. B was more comfortable and started to attend Church with encouragement and support from carers and family members

How using ADERMA sheet aided social wellbeing

• Mrs. B came and sat in the day room more and was encouraged in activities with staff and residents

• Mrs. B started to attend Church again• Mrs. B reported feeling increase in mood and reduction in

pain and discomfort and felt more able to be in the company of others

• Able to maintain some independence


Background- 91 year old lady (Mrs. C)- Lives in residential care home- Receiving End of life care (EOLC)

for old age / frailty- Previous stroke- Bed bound, air mattress in situ- Unable to communicate

pain or discomfort verbally only expressive

- Mrs C suffered with contractions of legs causing knees to rub together

- Carers anxious about pressure damage- Red areas present but blanching- No evidence of pressure damage- Currently using pillow to prevent

knees rubbing together, however red area present, although blanching at

time of assessment


10

ADERMA in situ between knees*

Implications for the patient• Expression of pain and discomfort impacting on wellbeing• At risk of pressure damage • Additional nursing intervention and dependency on healthcare

professionals such as carer

Implications for clinician• Unsure how to manage treatment due to the anatomical area and

difficulties for dressing choices• Unsure how to prevent deterioration for this patient and other patients

in the same / similar situation • Unsure how to enhance the wellbeing of this patient as this was having

a significant impact on Mrs. C’s quality of life • Deterioration of patients general health leading to possible difficulties

with preventing deterioration of pressure damage• Priority difficulties of balancing comfort care and possible risk of wound

deterioration which would cause increased pain / discomfort• Unsure how to enhance the wellbeing for Mrs. C as this was the main

aim of intervention care as she was receiving EOLC • Increased financial cost to local NHS

Implications for carers• Carers unable to manage pressure areas due to anatomical area• Carers concerned and anxious about how to manage: they were

previously using pillows in between knees, however concerns of pillows not providing adequate pressure relief

• Carers wanted Mrs. C to be comfortable and pain free at the end of life.

Management of areas at risk of pressure damage - ADERMA Sheet placed in situ between knees to prevent pressure

damage occurring - Washed and placed back in situ at each personal care intervention/

when required - No further pressure damage occurred




11

Patient:• Mrs C more comfortable• No reports of red areas• Appropriate and effective pressure relief

achieved• Maintained skin integrity and prevented any

further recurrence of pressure damage• Aided patient physical, psychological and

spiritual wellbeing• Able to maintain good hygiene was able to

wash with warm water

Carers:• Carers able to take out and wash with warm

water • Easy to replace

• Able to maintain effective pressure relief• ADERMA Sheet aided easy inspection of skin at regular

intervals• Carers were happy as no further deterioration occurred


sheet for contractions between knees and other anatomical areas of limb contraction

• ADERMA sheet was easy to use • ADERMA sheet was inexpensive• Aided regular and easy removal for skin inspection• ADERMA sheet was available on FP10• Reduced nursing visits and associated costs effectively

Implications physical wellbeing• Requirement for sleep and rest was being

disturbed• At risk of pressure damage• Expression of pain and discomfort

Implications psychological wellbeing• Distress caused due to pain and discomfort• Risk of anxiety caused by increased intervention• Sleep disturbances due to repositioning

Implications on spiritual and cultural wellbeing

• Expression of pain / discomfort from area of redness whilst receiving EOLC

• Mrs. C wished to die pain free and this was clear in patients notes

• Concerns of emotional distress while repositioning to try to provide effective pressure relief

Outcomes of using ADERMA sheet between contracted knees

How using ADERMA sheet aided physical wellbeing

• Requirement for sleep and rest was achieved• No pressure damage occurred• Expression of pain and discomfort were reduced

How using ADERMA sheet aided psychological wellbeing

• Reduced distress as ADERMA sheet aided effective pressure relief to prevent further deterioration

• Risk of anxiety related to this aspect of care was reduced• Less interruption was achieved which enabled better

sleep and rest

How using ADERMA sheet aided spiritual and cultural wellbeing

• Reduced expression of pain and discomfort • ADERMA Sheet aided effective pressure relief which

enabled Mrs.C to be repositioned as she was most comfortable

• Enabled Mrs. C to be cared for with dignity whilst being care for at the end stage of life

• Made more comfortable

Wound Management Smith & Nephew Healthcare Ltd Healthcare House 101 Hessle Road Hull HU3 2BN

T 01482 222200F 01482 222211

www.smith-nephew.com/wound

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aderma case studies - smith & nephew...detailed in the case study an evaluation of aderma strips...

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