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

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?

Patient Position 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

To remove any apprehensions

Involve client and/or caregivers in the process

Allow them to interact with the technology

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

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 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 Seating2 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 is suspicious in this picture? Note the hexagon.

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??

Ah The Numbers… A particular number at a particular site does not

= success or safety. Key numbers to watch are

Highest pressure-Where is the potential trouble? Focuses attention on key at risk areas

Sensing Area- More is better! Are we expanding or contracting the area of the pressure

distribution on the surface? Coefficient 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. Is a proposed position or product affording a

better pressure distribution than another?

Don’t Forget AsymmetryOr Lack Of It!

That’s More Like It!

Demonstrate What Their Challenge Is

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

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

Foam cushion: pressures still unacceptably high, and highly focusedFoam 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”?

Standing Chair: After Adjustments

F9 is right IT: Good pressure distributionF9 is right IT: Good pressure distributionUp 6 hours am + 4 hours evening - meeting goalUp 6 hours am + 4 hours evening - meeting goal

Power Chair: After Adjustments

8 by 9 Roho insert in foam: good pressure distribution8 by 9 Roho insert in foam: good pressure distributionnot as good though as the Standing Chair: up only 4 hoursnot as good though as the Standing Chair: up only 4 hours

Before therapist

correction

AfterAftertherapist therapist

supported leftsupported leftPSIS areaPSIS area

Stand-up chairStand-up chair

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.

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.

Training and testing for caregiver and client compliance 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

Sometimes you overdrive the solution and have to back up

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 Bad?

What Do You Do When It

All Looks Good? 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 WhatWe Just Did?

To help ensure it benefits the clientthat they get what they need

And to get your good work acknowledged and paid for

Develop a Simple FourStep 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

Pressure Mapping Reports Enhance Decision Making in the

Care Team With objective information better

decisions are made, e.g.. 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

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:

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

For more information on:Product

Applications Technical specifications

Clinical use Research bibliography

THANK YOU!