simple interventions. extraordinary outcomes....iad risk factors:1 n fecal incontinence n frequency...
TRANSCRIPT
Sage Products LLC | 3909 Three Oaks Road | Cary, Illinois USA 60013 | www.sageproducts.com | 0808-189-045623587 © Sage Products LLC 2016
SIMPLE INTERVENTIONS.EXTRAORDINARY OUTCOMES.
Sage Products believes that evidence-based interventions lead to improved clinical outcomes. Our market-leading, innovative products solve real problems in the healthcare industry and are backed by proven clinical evidence. They make it easier for nurses to deliver essential
patient care, helping to prevent healthcare-acquired infections and skin breakdown.
Pressure Ulcer PreventionComfort Shield® Barrier Cream Cloths
Prevalon® Heel ProtectorPrevalon™ Turn & Position System
Prevalon™ Seated Positioning System
Simple Interventions. Extraordinary Outcomes.
REFERENCES: 1. Gray M, et al., J Wound Ostomy Continence Nurs. 2007 Jan-Feb;34(1):45-54. 2. Maklebust J, Magnan MA, Adv Wound Care. Nov 1994;7(6):25, 27-8, 31-4 passim. 3. Getting started kit: prevent pressure ulcers, how-to guide. Protecting 5 Million Lives From Harm Campaign, Institute for Healthcare Improvement. 2006 Dec. 4. Gray M, Lerner-Selekof J, Junkin J, CE symposium in conjunction with 2006 WOCN Conference, Minneapolis, MN, 2006 June. 5. Junkin J, Moore-Lisi G, Lerner-Selekof J, What we don’t know can hurt us: pilot prevalence survey of incontinence and related perineal skin injury in acute care. Poster presented at the Clinical Symposium on Advances in Skin and Wound Care (ASWC), Las Vegas, NV, 2005 Oct.
IAD is defined as “an inflammation of the skin that occurs
when urine or stool comes into contact with perineal
or perigenital skin.”1 IAD is also a major risk factor for
pressure ulcers.2
IAD is often grouped with pressure ulcers, but they are
not one and the same. A pressure ulcer is defined as “any
lesion caused by unrelieved pressure resulting in damage
of underlying tissue.”3 Essentially, skin damage from a
pressure ulcer occurs from the inside out, but IAD starts on
the surface and works inward. Therefore, “IAD should be
distinguished from wounds caused by differing etiologies,
such as full-thickness wounds (caused by pressure and
shear) or linear lesions (caused by a skin tear).”1
IAD risk factors:1
n Fecal incontinencen Frequency of incontinencen Poor skin conditionn Painn Poor skin oxygenation n Fevern Compromised mobility n Double (urinary and fecal) incontinence n Tissue tolerance impairmentsn Moisturen Alkaline pH
Incontinence-Associated Dermatitis (IAD): a risk factor for pressure ulcers
IAD risk factors:1
n Fecal incontinencen Frequency of incontinencen Poor skin conditionn Painn Poor skin oxygenation n Fevern Compromised mobility n Double (urinary and fecal) incontinence n Tissue tolerance impairmentsn Moisturen Alkaline pH
Studies at long-term care facilities show IAD
prevalence can range from 5.6% to 50%, while
incidence rates range from 3.4% to 25%.1 In acute
care, one 976-patient study found 20.3% of patients
were incontinent.4,5 IAD prevalence for incontinent
patients was 54% at three hospitals, affecting 11%
of the general patient population.4,5
IAD prevalence
“…Patients with fecal incontinence were 22 times more likely to have pressure ulcers than
patients without fecal incontinence.”2
“…The odds of having a pressure ulcer were 37.5 times greater in patients who had both
impaired mobility and fecal incontinence than in patients who had neither.”2
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Multiple steps associated with
traditional methods of incontinence
care often mean barrier application
is overlooked. Protecting the skin
of incontinent patients is just as
important as cleansing and
moisturizing,1 and failure to
apply a proper barrier can
lead to Incontinence-Associated
Dermatitis (IAD), a known risk factor for pressure ulcers.2
One study shows 54% of incontinent patients suffered from
IAD, while 21% had two or more peri-skin injuries.3,4
Inadequate barrier application: a gateway to Incontinence-Associated Dermatitis (IAD)
Barriers severely underutilizedCompliance to a comprehensive protocol can help prevent skin injuries.5,6 But tubed barriers can make compliance difficult.
n A study of 76 protocols found barriers should cost 23.5 cents for each application, but facilities actually spend only 10 cents per day per incontinent patient.7
REFERENCES: 1. Haugen V, Gastroenterology Nursing, 1997;20(3):87-90. 2. Maklebust J, Magnan MA, Adv Wound Care. Nov 1994;7(6):25, 27-8, 31-4 passim. 3. Gray M, Lerner-Selekof J, Junkin J, CE symposium in conjunction with 2006 WOCN Conference, Minneapolis, MN, 2006 June. 4. Junkin J, Moore-Lisi G, Lerner-Selekof J, What we don’t know can hurt us: pilot prevalence survey of incontinence and related perineal skin injury in acute care. Poster presented at the Clinical Symposium on Advances in Skin and Wound Care (ASWC), Las Vegas, NV, 2005 Oct. 5. Lyder CH, et al., Ost/Wound Mgmt Apr 2002;48(4):52-62. 6. Clever K, et al., Ost/Wound Mgmt Dec 2002;48(12):60-7. 7. Nix D, Ermer-Seltun, J Ost/Wound Mgmt Dec 2004;50(11):32-41.
REFERENCES: 1. Sluser S, Consistency the key for treating severe perineal dermatitis due to incontinence. Poster presented at Clinical Symposium on Advances in Skin and Wound Care (ASWC), Las Vegas, NV, 2005 Oct.
Comfort Shield Barrier Cream Cloths provide easy, all-in-one
incontinence care. Each premoistened, disposable cloth delivers
one-step perineal cleansing, moisturizing and deodorizing—
all while treating and protecting skin with 3% dimethicone.
The barrier is in the cloth, so you can be assured it is applied
every time. Plus, our Peri Check™ Guide helps promote early
identification of IAD through increased communication with staff.
Comfort Shield® Barrier Cream Cloths deliver proven IAD prevention and treatment
Shield Barrier Cream Cloths are soft, skin-friendly and
guarantee barrier application every time they’re used.
Keeping the skin protected means IAD and other skin
problems can be prevented.
72-year-old patient with severely denuded, blistered skin and
extreme pain from incontinence.
After only 3 days using Shield Barrier Cream Cloths, patient’s skin
vastly improved; no discomfort.
DAY 1 DAY 4
PROVEN IAD TREATMENT—SEE THE DIFFERENCE!1
One-step:Clean + treat + protect
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PROFESSIONAL GUIDELINES
2010 WOCN GUIDELINE FOR PREVENTION AND MANAGEMENT OF PRESSURE ULCERS MANAGING INCONTINENCE3
“Combined products can be used to save time and make providing perineal care easier for the care giver. Combined products include moisturizing cleansers, moisturizer skin protectant creams, and disposable washcloths that incorporate cleansers, moisturizers, and skin protectants into a single product.” (Beeckman, et al., 2009)
2009 EUROPEAN PRESSURE ULCER ADVISORY PANEL AND NATIONAL PRESSURE ULCER ADVISORY PANEL1 Prevention and Treatment of Pressure Ulcers
Skin Care12. “Protect the skin from exposure to excessive moisture
with a barrier product in order to reduce the risk of pressure damage.”
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Control Group Intervention Group
30%
25%
20%
15%
10%
5%
0%
83% of patients whodeveloped IAD wenton to develop HAPU
6/24 5/24
Pati
ents
who
dev
elop
ed IA
D a
nd H
APU
0/25 0/25
Developed IADDeveloped HAPU
DEVELOPMENT OF IAD AND HAPU
n Randomized controlled trial proves effectiveness A 4-month study of 464 nursing home residents evaluated use of Shield
Barrier Cream Cloths versus water and pH neutral soap. Residents using Shield saw a reduction in the prevalence of IAD from 22% to 8%, while residents using soap and water saw IAD prevalence increase from 23% to 27%. The study also found a decrease in IAD severity in residents using Shield, while no improvement was seen with soap and water.4
n In a study on a high-risk patient population, patients receiving an intervention that included Shield Barrier Cream Cloths following each incontinence episode had an IAD rate of zero versus patients using multiple products who had an IAD rate of 25%. Patients using Shield had a rate of zero hospital-acquired pressure ulcers versus a rate of 83% for those using multiple products.7
GLOBAL IAD EXPERT PANEL2 Prevention and Management of IAD
“After cleansing, skin should be protected to prevent IAD”.
“The performance of an individual product is determined by the total formulation and not just the skin protecting ingredient(s)”.
“Continence care wipes (i.e. 3-in-1 products) may have the advantage of simplifying care by combining products to reduce the number of steps involved, saving clinician/caregiver time and potentially encouraging adherence to the regimen”.
“A skin cleanser with a pH range similar to normal skin is preferred over traditional soaps”.
REFERENCES: 1. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009. 2. Beeckman, D et al., “Evidence-based Practice in Wound Care: Toward Addressing Our Knowledge Gaps.” The Journal of Rehabilitation Research and Development JRRD 48.3 (2011): Vii. Incontinence-Associated Dermatitis: Moving Prevention Forward. Wounds International. Web. 21 Jan. 2015. 3. Wound Ostomy and Continence Nurses Society. Guideline for Prevention and Management of Pressure Ulcers; June 2010. 4. Beeckman D, et al., A 3-in-1 perineal care washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis. Journal of Wound, Ostomy and Continence Nursing, Nov/Dec 2011; 38(6). 5. Pukiova I. Clean, Moisturise and Protect! A Standardization Approach to Preventing Incontinence-Associated Dermatitis. Poster presented at EWMA 2015; London, UK; 13-15 May, 2015. 6. Heinemann K. Effectiveness of a clinically proven 3-in-1 perineal care washcloth in the prevention of IAD on a geriatric unit. Poster presented at EPUAP 2015; Ghent, Belgium; 16-18 September. 7. Hall K, Clark R, Henderson K, Implementing nurse-driven interventions to improve incontinence-associated dermatitis and hospital-acquired pressure ulcers. Poster presented at Clinical Symposium on Advances in Skin & Wound Care, Sept 2011.
Proven clinical outcomes
A UK study found a 54% reduction in IAD after implementing the Shield Barrier Cream Cloths.5
A German study found a 57% reduction in IAD after implementing the Shield Barrier Cream Cloths.6
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REFERENCES: 1. West D, Northwestern Univ Dept of Dermatology, Chicago, IL, Feb 2000. 2. West D, Comparison of Skin Barrier Effectiveness for Products Containing Dimethicone. Poster presented at: Symposium on Advanced Wound Care, Fall 2014, Oct. 16-18; Las Vegas, NV.
Clinically proven to help prevent IAD and HAPU when used as part of a standardized incontinence cleanup intervention/protocol.
The all-in-one skin cleansing, moisturizing, deodorizing, treatment and barrier protection with ever use that helps maximize compliance to incontinence care protocols.
n Proven barrier protection. 3% dimethicone formula was proven equivalent to traditional tube barrier creams by Northwestern University’s Department of Dermatology.1
n Hypoallergenic, gentle and non-irritating.
n Breathable, transparent dimethicone barrier makes skin assessment easy.
n Allows the use of other products such as anti-fungals without removing dimethicone barrier.
n Helps eliminate mess of standard zinc oxide and petroleum-based barriers; makes each cleanup easier.
n Helps treat and prevent perineal dermatitis; helps seal out wetness.
n Convenient tubs contain 24 cloths for extended use.
OURS THEIRS
Comfort Comfort Shield Barrier Cream Cloths are strong and absorbent. They gently cleanse while delivering a proven layer of barrier protection.
OthersComfort Shield thick emulsion Vs.
A study designed to test the effectiveness of incontinence barriers found that Comfort Shield “significantly outperformed all other products.” Comfort Shield allowed 3-5 times less artificial urine to pass through than the leading competitors.2
Barrier effectiveness and product performance characteristics should be considered when choosing skin protectant products designed for barrier effect.
Comfort Shield® Barrier Cream Clothswith Dimethicone
Not all skin barrier cloths are equal
Proven clinical outcomes
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Implementing Shield Barrier Cream Cloths and providing bedside access enhanced staff compliance to an incontinence care protocol and resulted in a near-zero rate of HAPUs. The rate was maintained over time and resulted in significant cost savings.2
n Point-of-use access. 24-packs, 8-pack, and 3-pack all compatible with Shield Barrier Station.
Maximize compliance Help meet IHI recommendations to keep supplies at the bedside of at-risk incontinent patients1
Help meet IHI recommendations
to keep supplies
at the bedside of at-risk incontinent patients1
REFERENCES: 1. Getting started kit: prevent pressure ulcers, how-to guide. Protecting 5 Million Lives from Harm Campaign, Institute for Healthcare Improvement, 2006 Dec. 2. Krapfl L, Improved access to incontinence care products leads to a reduction in facility acquired pressure ulcers. Poster presented at 42nd Annual WOCN Conference, June 12-16, 2010.
REDUCE IAD, IMPROVE COMPLIANCEAdding Shield Barrier Station reduced one facility’s IAD incidence to 0% and boosted compliance to 97%!*
*Schmitz T, Location, location, location: incontinence care supplies at the bedside. Nursing Management, Dec 2010, 45-49. CE available.
Peri Check™ Guide Promote early identification of a major pressure ulcer risk factor
REFERENCES: 1. Federal Register, Vol. 72 No. 162, 2007 Aug; 47201-47205. 2. Carr D, Benoit R, The role of interventional patient hygiene in improving clinical and economic outcomes. Advances in Skin and Wound Care, Feb 2009 22 (2): 74-78 3. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009. 4. 2009 Hospital/Critical Access Hospital National Patient Safety Goals. Joint Commission, 2009. 5. Getting started kit: prevent pressure ulcers, how-to guide. Protecting 5 Million Lives from Harm Campaign, Institute for Healthcare Improvement, 2006 Dec.
Comfort Shield® Barrier Cream Cloths feature Peri Check Guide peel-and-stick labels to facilitate daily skin inspection. They empower staff to observe and report skin issues to the patient’s nurse, and promote rapid response through early identification of skin breakdown and Incontinence-Associated Dermatitis (IAD), a known risk factor for pressure ulcers.
JOINT COMMISSION 2009National Patient Safety Goals4
Improve Staff Communication “Create steps for staff to follow when
sending patients to the next caregiver. The steps should help staff tell about the patient’s care. Make sure there is time to ask and answer questions.”
* Excerpts from the Joint Commission 2009 Hosp Nat Pt Safety Goals.
IHI 5 MILLION LIVES CAMPAIGN5
2. Reassess Risk for All Patients Daily “Adapt documentation tools to prompt daily
risk assessment, documentation of findings, and initiation of prevention strategies as needed.”*
3. Inspect Skin Daily “Educate all levels of staff to inspect the skin any
time they are assisting the patient … Upon recognition of any change in skin integrity, notify staff so that appropriate interventions can be put in place.”
*Processes that “can be put in place to ensure daily inspection of the skin.”
2009 EUROPEAN PRESSURE ULCER ADVISORY PANEL AND NATIONAL PRESSURE ULCER ADVISORY PANEL3
Prevention and Treatment of Pressure Ulcers
Skin Assessment 3. “Inspect skin regularly for signs of redness in
individuals identified as being at risk of pressure ulceration.”
7. “Document all skin assessments, noting details
of any pain possibly related to pressure damage.”
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In one study, Peri Check helped reduce pressure ulcers to zero in a facility.2 The same study found that Peri Check improved non-licensed staff’s knowledge about pressure ulcer development and “resulted in enhanced communication between non-licensed staff and RNs.”
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LET US HELP YOU VALIDATE YOUR SUCCESS!
Create awareness of patient skin condition and facilitate clinical intervention.Damage from moisture and pressure ulcers are among the most common skin injuries. However, a large percentage of these injuries can be avoided.
Your Sage Representative will provide a a brief, yet thorough Incontinence- Associated Dermatitis (IAD) Assessment in your facility to help you:
n Identify skin issues at the two most common sites for pressure ulcers: the heels and the sacrum.
n Track your facility’s prevalence rate of IAD, a risk factor for pressure ulcers.
n Improve awareness of your facility’s compliance to protocol.
n Target effective interventions, which may improve patient outcomes.
n Illustrate the benefits of using Sage’s skin-protecting interventions both clinically and financially.
IAD Assessment ToolFor monitoring and evaluatingpatient skin injury
n Incontinence is a significant risk factor for skin breakdown1, such as pressure ulcers and incontinence-associated dermatitis (IAD). Applying a barrier after each episode with Comfort Shield® Barrier Cream Cloths can help prevent these conditions.
Protect YOUR patients’ skin before skin injury develops into a pressure ulcer.
REFERENCES: 1. Maklebust J, Magnan MA, Adv Wound Care. Nov 1994;7(6):25,27-8,31-4 passim. 2. MacPherson SAWC 2011
n One facility saw a 53% decrease in IAD over a 10-month period after implementing an IAD Prevention Strategy including the use of Comfort Shield® Barrier Cream Cleansing Cloths at the bedside.2
n Ask your Sage Representative to provide you with additional
clinical outcomes.
Clinically significant published outcomes.
INCONTINENCE-ASSOCIATED DERMATITIS INTERVENTION TOOL (IAD-IT)
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Skin Care for Incontinent Persons
1. Cleanse incontinence ASAP and apply barrier.
2. Document condition of skin at least once every shift in nurse’s notes or per organization’s policy for documenting skin breakdown.
Skin is not erythematous or warmerthan nearby skin but may show scars or color changes from previous IAD episodes and/or healed pressure ulcer(s).
Person not able to adequately care forself or communicate need and isincontinent of liquid stool at least 3 times in 24 hours.1
Skin exposed to stool and/or urine is dry, intact, and not blistered, but is pink or red with diffuse (not sharply defined), often irregular borders. In darker skin tones, it might be more difficult to visualize color changes (white or yellow color) and palpation may be more useful.
Palpation may reveal a warmer temperature compared to skin not exposed. People with adequate sensation and the ability to communicate may complain of burning, stinging, or other pain.
Affected skin is bright or angry red –in darker skin tones, it may appearwhite, yellow, or very dark red/purple.
Skin usually appears shiny and moistwith weeping or pinpoint areas ofbleeding. Raised areas or small blisters may be noted.
Small areas of skin loss (dime size)if any.
This is painful whether or not theperson can communicate the pain.
This may occur in addition to any level of IAD skin injury.
Usually spots are noted near edges of red areas (white or yellow areas in dark skinned patients) that may appear as pimples or just flat red (white or yellow) spots.
Person may report itching which may be intense.
HIGH-RISK
EARLY IAD
MODERATE IAD
1. Use a disposable barrier cloth containing cleanser, moisturizer and protectant.2
2. If barrier cloths not available, use acidic cleanser (6.5 or lower), not soap (soap is too alkaline); cleanse gently (soak for a minute or two – no scrubbing); and apply a protectant (ie: dimethicone, liquid skin barrier or petrolatum).
3. If briefs or underpads are used, allow skin to be exposed to air. Use containment briefs only for sitting in chair or ambulating – not while in bed.
4. Manage the cause of incontinence: a) Determine why the patient is incontinent. Check for urinary tract infection, b) Consider timed toileting or a bladder or bowel program, c) Refer to incontinence specialist if no success.3
Ask primary care provider to order an anti-fungal powder or ointment.Avoid creams in the case of IAD because they add moisture to a moisturedamaged area (main ingredient is water). In order to avoid resistantfungus, use zinc oxide and exposure to air as the first intervention forfungal-appearing rashes. If this is not successful after a few days, or if theperson is severely immunocompromised, then proceed with the following:
1. If using powder, lightly dust powder to affected areas. Seal with ointment or liquid skin barrier to prevent caking.
2. Continue the treatments based on the level of IAD.
3. Assess for thrush (oral fungal infection) and ask for treatment if present.
4. For women with fungal rash, ask health care provider to evaluate for vaginal fungal infection and ask for treatment if needed.
5. Assess skin folds, including under breasts, under pannus, and in groin.
6. If no improvement, culture area for possible bacterial infection.
DEFINITION INTERVENTION
FUNGAL APPEARING RASH
↑ Include treatments from box above plus:
5. Consider applying a zinc oxide-based product for weepy or bleeding areas 3 times a day and whenever stooling occurs.
6. Apply the ointment to a non-adherent dressing (such as anorectal dressing for cleft, Telfa for flat areas, or ABD pad for larger areas) and gently place on injured skin to avoid rubbing. Do not use tape or other adhesive dressings.
7. If using zinc oxide paste, do not scrub the paste completely off with the next cleaning. Gently soak stool off top then apply new paste covered dressing to area.
8. If denuded areas remain to be healed after inflammation is reduced, consider BTC ointment (balsam of peru, trypsin, castor oil) but remember balsam of peru is pro-inflammatory.
9. Consult WOCN if available.
Affected skin is red with areas ofdenudement (partial-thickness skin loss)and oozing/bleeding. In dark-skinnedpersons, the skin tones may be white,yellow, or very dark red/purple.
Skin layers may be stripped off as the oozing protein is sticky and adheres to any dry surface.
SEVERE IAD ↑ Include treatments from box above plus:
10. Position the person semiprone for 30 minutes twice a day to expose affected skin to air.
11. Consider treatments that reduce moisture: low air loss mattress/overlay, more frequent turning, astringents such as Domeboro soaks.
12. Consider the air flow type underpads (without plastic backing).
3. Notify primary care provider when skin injury occurs and collaborate on the plan of care.
4. Consider use of external catheter or fecal collector.
5. Consider short term use of urinary catheter only in cases of IAD complicated by secondary infection.
The #1 priority is to address the cause of incontinence. Use this tool until incontinence is resolved.
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REFERENCES: 1. Amlung SR, Miller WL, Bosley LM, Adv Skin Wound Care. Nov/Dec 2001;14(6):297-301. 2. Walsh J, DeOcampo M, Waggoner D, Keeping heels intact: evaluation of a protocol for prevention of facility-acquired heel pressure ulcers. Poster presented at the Symposium on Advanced Wound Care, San Antonio, TX, Apr 2006. 3. Beckrich K, Aronovitch SA, Nursing Economic. Sep/Oct 1999;17(5):263-71. 4. Fowler E, Scott-Williams S, McGuire J. Practice recommendations for preventing heel pressure ulcers. Ostomy Wound Management 2008;54(10):42-57. 5. Russo, AC, at al., Hospitalizations Related to Pressure Ulcers Among Adults 18 years and Older, 2006, Heath Care Cost and Utilization Project, Agency for Health Care Research and Quality Statistical Brief #64, Dec 2008. 6. Mannari, at al Successful Treatment of Recalcitrant Diabetic Heel Ulcers with Topical Becaplermin (rh PDGF-BB) Gel, Wounds. 2002;14(3). 7. NHS Department of Health Pressure Ulcer productivity calculator. First published 10 June 2010. Available at www.gov.uk/government/publications/pressure-ulces-productivity-calculator. Accessed January 12, 2016. 8. Cuddigan JE, Ayello EA, Black J. Saving heels in critically ill patients. WCET Journal. 2008;28(2):2-8. 9. Wound, Ostomy, and Continence Nurses Society (WOCN). Guideline for prevention and management of pressure ulcers. Mount Laurel (NJ): June 2010. 96 p. (WOCN clinical practice guideline; no. 2).
FINANCIAL COST:
The heel and ankle bone are the second and fifth most common sites for pressure ulcer development.1 One study found 43% of hospital-acquired pressure ulcers (HAPUs) developed on the heel.2 But, HAPUs are largely preventable.3
PREVALENCE AND COST
NPUAP/EPUAP Prevention Guidelines“ Ensure that the heels are free of the surface of the bed…
Heel-protection devices should elevate the heel completely (offload them) in such a way as to distribute the weight of the leg along the calf without putting pressure on the Achilles tendon.”8
Wound Ostomy and Continence Nurses Society Guidelines“ Maintaining alignment [with a pillow] may be difficult if the
patient moves. In addition, pillows do not prevent plantar flexion contracture or lateral leg and foot rotation.”9
Professional guidelines and recommendationsHEEL ULCER PREVENTION
A published study recommended patients be treated with a heel-suspending
device after a minimum of 6 hours of immobility and within 24 hours of immobility
to prevent plantar-flexion contractures.8
HUMAN COST4,5,6
n Painn Length of stayn Infection riskn Amputation
PU Stage Treatment Cost7
I £ 1,000II £ 6,000III £ 10,000IV £ 14,000
PREVALON® HEEL PROTECTOR
Uniquely designed to prevent heel pressure ulcers while keeping the foot and leg in a neutral position.
REFERENCES: 1. Lyder C. Never Events: Can The Congressional Mandate Be Met? Poster Presented at the Institute of Health Care Improvement (IHI), Orlando, FL December 6-8, 2010. 2. Rajpaul K., The use of heel protectors in the prevention, treatment and management of pressure ulcers. Poster presented at EWMA 2015; London, UK; May 13-15, 2015. 3. Loehne H. Limited Mobility and the Foot: Plantar Flexion Contractures, Heel and Malleoli Pressure Ulcers, Peroneal NerveDamage How Can We Prevent Them? What Happens If We Don’t? Poster presented at the 26th Annual Symposium on Advanced Wound Care (SAWC); May 1-5, 2013.
The experts suggest the optimal heel protector should: 3 Elevate the heel off underlying support surface.1
3 Prevent foot-drop and rotation of the leg.1
3 Maintain “grip” on the foot while in place as patients may be moving the leg.1
3 Decrease friction and/or shear.1
3 Heel is visible when the device is in place.3
3 No pressure on the Achilles tendon.3
3 Ability to accomodate sequential compression devices, negative pressure wound therapy, tubing, traction and other essential devices.3
3 Has straps that do not damage skin and are loosely applied to avoid pressure on dorsum and lateral edge of foot and the lower leg.3
3 Remains in place without causing pressure to other foot surfaces.2
3 A device with an anti-rotation wedge maintaining neutral position of the lower extremity to prevent hip external rotation and subsequent lateral knee and/or malleoli pressure ulcers and/or peroneal nerve compression.3
Presented at EWMA 2015 • London, UK • 13-15 May, 2015
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The foundation of an effective heel protector: its ability to grip the limb
Prevalon’s dermasuede fabric contours to and gently cradles the leg, calf, ankle and foot to maintain effective heel offloading.
Prevalon® Heel Protector was specifically designed to address the problem of patient movement and its negative effect on heel offloading. Prevalon’s unique dermasuede fabric interior gently grips the limb so it remains fully offloaded, even when the patient is moving.
Our specialized fabric and coating creates maximum grip control with the texture of fine velvet. This soft fabric contours to and cradles the leg, calf, ankle and foot to help prevent them from rotating within the boot or sliding out of the boot—maintaining effective heel offloading.
Dermasuede fabric holds the limb securely in place while preserving patient comfort. It’s also a breathable material, so the limb remains cool while inside the heel protector.
Testing shows significantly more force is required to dislodge the Prevalon® Heel Protector from the limb than with other heel protectors.3
PREVALON HEEL PROTECTORS’ ENHANCED ABILITY TO GRIP THE LIMB3
Prevalon’s unique dermasuede interior gently grips the foot
Several published studies show that a heel protector must stay in place on the foot and maintain offloading for effective prevention of heel pressure ulcers.
n A recent poster presented at the Symposium on Advanced Wound Care concluded “as patients shift, the ability of a heel protecting boot to grip the limb and retain optimal off-loading positioning is vital to the function of the device.” Furthermore, the study found evaluation of the heel protector’s grip is necessary for determining effectiveness in reducing risk of heel pressure ulcers.1
n One article found that a heel protector was “more effective in reducing heel PrU incidence if it did not dislodge during patient movement.”2
n According to another article, clinical considerations in selecting an optimal heel protector should include the device’s ability to remain in place while the patient is moving the leg.3
PUBLISHED STUDIES
REFERENCES: 1. Bill B, Pedersen J, Call E, Human cadaver testing to determine the reliability of heel boot positioning or “grip” of eight commercially available pressure relieving heel protector boots. Poster presented at SAWC, April 2012, Atlanta, GA. 2. Salcido R, Lee A, Ahn C, Heel pressure ulcers: purple heel and deep tissue injury. Advances in Skin & Wound Care, Aug 2011;24(8):374-80. 3. Lyder C, Getting serious about preventing heel pressure ulcers in hospitals. WCET Journal, Oct/Dec 2011;31(4)6-13.
THREE HEEL PROTECTORS THAT EFFECTIVELY GRIP THE LIMB
IPREVALON® HEEL PROTECTOR
IIPREVALON® HEEL PROTECTOR
IIIPREVALON® HEEL PROTECTOR
nOffloads the heel.
nOffloads the heel.
nReduces plantar flexion contracture risk.
nOffloads the heel.
nReduces plantar flexion contracture risk.
nHelps prevent lateral rotation, reducing risk of peroneal nerve damage.
PUBLISHED STUDIES
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VISIBLY FLOATS HEEL FOR EASY MONITORING
CLOSURE STRAPS• Secures Heel Protector I.
LOW-FRICTION OUTER SHELL• Slides easily over bed sheets.
• Helps maintain patients’ freedom of movement.
DERMASUEDE FABRIC INTERIOR • Gently grips limb so it
remains fully offloaded even when patient is moving.
SCD COMPATIBLE
PREVALON® HEEL PROTECTORFEATURES I
www.sageproducts.com
EXPANDABLE STRAPS• Stretches to accommodate
lower limb edema.
• No sharp edges or irritating surfaces.
RIP-STOP NYLON• Slides easily over
bed sheets.
• Helps maintain patients’ freedom of movement.
VISIBLY FLOATS HEEL FOR EASY MONITORING
CONTRACTURE STRAP• Helps prevent plantar
flexion contracture.
DERMASUEDE FABRIC INTERIOR• Gently grips limb so it
remains fully offloaded even when patient is moving.
SCD COMPATIBLE
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PREVALON® HEEL PROTECTORFEATURES II
PREVALON® HEEL PROTECTORFEATURES III
VISIBLY FLOATS HEEL FOR EASY MONITORING
DERMASUEDE FABRIC INTERIOR • Gently grips limb so it remains
fully offloaded even when patient is moving.
EXPANDABLE STRAPS• Stretches to accommodate
lower limb edema.
• No sharp edges or irritating surfaces.
6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Calf Circumference (in.)
Calf Circumference (cm.)
5
Prevalon® Heel Protector Petite
15 18 20 23 25 28 30 33 36 38 41 43 46 48 51 53 56 58 61 6313
Prevalon® Heel Protector Prevalon® Heel Protector XL
SIZING CHART:
SCD COMPATIBLE
CONTRACTURE STRAP• Helps prevent plantar
flexion contracture.
INTEGRATED ANTI-ROTATION WEDGE• Helps prevent lateral foot and
leg rotation, reducing the risk of peroneal nerve damage.
CLINICALLY VALIDATED Supported by more
peer-reviewed studies than all other
brands combined.1
RIP-STOP NYLON• Slides easily over
bed sheets.
• Helps maintain patients’ freedom of movement.
REFERENCES: 1. Data on file.
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REFERENCES: 1. GHX Trend Report (Dollars),4th Quarter, 2011 Hospital; Annualized markets based on last 4 quarters data. 2. Lyman V, Successful Heel Pressure Ulcer Prevention Program in a Long-Term Care Setting. J Wound Ostomy Continence Nurs. 2009 Nov-Dec;36(6):616-21. 3. Meyers T, Preventing Heel Pressure Ulcers and Plantar Flexion Contractures in High Risk Sedated Patients. J Wound Ostomy Continence Nurs. 2010 Jul-Aug;37(4):372-8. 4. Rajpaul K., The use of heel protectors in the prevention, treatment and management of pressure ulcers. Poster presented at EWMA 2015; London, UK; May 13-15, 2015. 5. Acton C. Heel pressure ulcers; How do we prevent them and evaluate practice? An example within an acute care hospital. Poster presented at EPUAP 2015; Ghent, Belgium; September 16-18, 2015. 6. Adapted from Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence-based medicine what it is and what it isn’t. BMJ. 1996;312(7023):71-2
PROVEN RESULTS: PREVENTION AND TREATMENT FROM THE #1 BRAND OF HEELP ROTECTION1
Prevalon® brings you more proven clinical studies and financial outcomes than any other brand.
Heel ulcer reductionn A study published in JWOCN found the use of Prevalon and a
heel ulcer prevention protocol led to a 95% decrease in heel pressure ulcers.2
n Another study published in JWOCN demonstrated a 100% prevention of both heel pressure ulcers and plantar flexion contracture over a seven month period when using the heel protector device.3
nA UK study found the early utilisation of heel protectors has shown a reduction in the number of acquired heel pressure ulcers over the twelve month period and has resulted in an overall return on investment of £ 55,965.4
nAnother UK study found a sustained 67% reduction in stage III and IV pressure ulcers to the heels. This sustained reduction was observed despite increases in patient acuity within the Trust according to a robust skin assessment conducted on all patients on admission and throughout9 their hospital stay. These findings suggest the use of a heel protector aid in the reduction of heel pressure ulcer incidence. Use of the heel protectors rose from 448 devices in 2009 to 3,008 in 2014, resulting in a total return on investment of £ 272,505.5
IN VITRO (’TEST TUBE’) RESEARCH
ANIMAL RESEARCH
IDEAS, EDITORIALS, OPINIONS
CASE REPORTS
CASE SERIES
CASE CONTROL STUDIES
COHORT STUDIES
RANDOMIZED CONTROLLEDDOUBLE BLIND STUDIES
2 Independent Laboratory Tests
1 Patient Case Study
29 Posters Presented
4 Peer-ReviewedPublications
SYSTEMATIC REVIEWS AND META-ANALYSES
PYRA
MID
OF
EVID
ENCE
6
PROVEN RESULTS: PREVENTION AND TREATMENT FROM THE #1 BRAND OF HEELP ROTECTION1
Prevalon® brings you more proven clinical studies and financial outcomes than any other brand.
2005Sage launches the first generation Prevalon Pressure-Relieving Heel Protector.
Sage Products has constantly improved and refined our line of Prevalon Heel Protector. From a simple engineered pillow, to the innovative and effective heel protector it is today, Prevalon has helped prevent and treat against heel pressure ulcers and plantar flexion contracture as well as increase protocol compliance.
2004Sage’s field-based research
finds pillows and other products don’t float the heel properly and don’t
effectively protect against heel pressure ulcers.
A history of innovation
Prevalon takes over as the
market leader in heel protection.1
2009Sage launches Prevalon with Integrated Foot and Leg Stabilizer Wedge.
2010Sage adds additional access ports to the Standard Size Prevalon to accommodate more Intermittent Compression Devices.
2006Sage launches second generation Prevalon featuring ripstop nylon outer surface, tag to help visualize proper fit, bag with printed instructions, integrated stretch panels and the Foot and Leg Stabilizer Wedge to help prevent lateral rotation.
2009NPUAP/EPUAP releases updated Pressure Ulcer Prevention & Treatment
Clinical Practice Guideline.
2008 Sage launches Prevalon Petite for smaller patients.
2008Decision Tree
presented at 2008 SAWC Conference, clarifying when to
use a heel protector.
REFERENCES: 1. GHX Market Intelligence Trend Report (Dollars), 3rd Quarter, 2009 Hospital.Market; Annual market represents last 4 quarters of data.
2007Jill Walsh publishes Evaluation of a Protocol for Prevention of Facility-Acquired Heel Pressure Ulcers in JWOCN.
2008Tina Meyers poster
Successful Prevention of Heel Ulcers and Foot Drop in the
High Risk Ventilation Patient Population presented at World
Union of Wound Healing Societies in Toronto. Shows zero pressure ulcers and a $1.9 million
revenue preservation.
2014Sage diversifies the product line with Prevalon Heel Protector I to accommodate a variety of patient needs.
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THE PREVALON TURN & POSITION SYSTEM 2.0 REQUIRES 90% LESS EXERTION TO POSITION
PATIENTS VS. DRAW SHEETS.1
0
350
300
250
200
150
100
50
SAGE TAP 2.0
Exer
tion
(lbf
• s
ec)
SPH Exertion Test
Products tested
DRAW SHEETS
9.2x more
299.3
32.6
90% LESS
EXERTION
Prevent sacral pressure ulcers and healthcare worker injuryTurning and repositioning patients according to your facility’s turning schedule is crucial in preventing sacral pressure ulcers. Current methods including draw sheets and pillows have multiple challenges that present risks to patients and staff.
The Prevalon™ Turn & Position System 2.0 is is an evolution in turning and positioning safety. Unlike lift slings and plastic slide sheets, the Prevalon Turn & Position System 2.0 stays under the patient at all times. It’s always ready to assist with turning, repositioning, and boosting the patient. This makes it possible for nurses and staff to achieve compliance to a q2° turning protocol while providing the best care and minimizing additional stress on the patient.
PREVALONTM TURN & POSITION SYSTEM
Helps prevent sacral pressure ulcers and promotes safe patient handling.
Now with enhanced microturn, the system makes it easy to comply with turning schedules while protecting staff from injury. All that is necessary to position the patient at the appropriate angle is a quick microturn, which requires 90% less exertion than traditional methods using draw sheets.1
The newly designed Glide Sheet and Anchor Wedge System work together, creating a high-quality turn. Once placed under the patient, the wedges help to initiate patient turning.
REFERENCES: 1. Testing conducted by Sage Products LLC, data on file. 2. Powers J. A Comparative Study on Two Methods for Turning and Positioning and the Effect on Pressure Ulcer Development. Poster presented at the 27th Annual Symposium on Advances in Skin and Wound Care, Oct 2012. 3. Hall K, Clark R, Save the butts: preventing sacral pressure ulcers by utilizing an assistive device to turn and reposition critically ill patients. Poster presented at 25th Annual Symposium on Advanced Wound Care Spring/Wound Healing Society meeting, Apr 2012. 4. Way, H, Safe Patient Handling Initiative Results in Reduction in Injuries and Improved Patient Outcomes for Pressure Ulcer Prevention. Poster presented at 2014 Safe Patient Handling East Conference, March 27, 2014.
PROVEN RESULTS: PREVENTION AND COST SAVINGS
84%Sacral Pressure
Ulcer Reduction2
90% Less Exertion1
60% Less Time3
35% Less Staff3
Patient Benefits
nHelps prevent sacral pressure ulcers by offloading the sacrum.
nMaintains 30-degree side lying position.
nHelps prevent shear and friction forces on the patient’s skin.
nManages moisture due to incontinence and other conditions.
nCreates an optimal microclimate for the skin.
Staff Benefits
nNurse-friendly system helps staff more easily follow best practice prevention guidelines.
nRequires fewer nurses and less time to turn.
nReduces exertion needed to turn and boost patients. Decreases strain on staff’s hands, wrists, shoulders, and backs.
nProven compatibility with low air loss surfaces, meaning it can remain under the patient at all times, making it easier and more convenient for nurses to comply with a q2° turning protocol.
nMinimizes the frequency of boosting and other repetitive positioning tasks.
A study demonstrated that a safe patient handling initiative including the Prevalon® Heel Protector and PrevalonTM Turn & Position System can help ensure appropriate patient repositioning for HAPU prevention, prevent caregiver injuries, and save costs associated with HAPU and healthcare worker injury.
Reduction in Staff Injury and HAPUs4
28% reduction in HAPUs
= $184,720 savings
58% reduction in employee injury
= $247,500 savings
PREVALON™ TURN AND POSITION SYSTEM
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PrevalonTM Turn & Position System2.0
FEATURES The Low-Friction Glide Sheet works with the Anchor Wedge System to provide true friction and shear protection.
The top of the Glide Sheet has Dermasuede material, which grips the M2 Microclimate Body Pad and keeps it in place.
The boost straps promote proper body mechanics and reduce the reliance on grip strength.
A quick, gentle microturn positions the patient at the appropriate angle.
PROTECT STAFF
LESS EXERTION
MINIMIZE FRICTION AND SHEAR
REFERENCES: 1. Pedersen J, Bill B, Call E, In vitro Measurement of the Impact of Transfer and Positioning Devices on Microclimate when Left in Place Following Use. Poster presented at SAWC 2013.
The M2 Microclimate Body Pad protects the patient’s skin by effectively absorbing and locking in moisture while allowing air to flow through.
MANAGE MOISTURE
The only device proven
compatible with all low air loss mattresses1
The Body Wedge System reduces pressure by offloading the patient’s sacrum. The system significantly reduces the exertion needed to achieve proper side lying positioning.
REDUCE PRESSUREThe Anchor Wedge helps the patient maintain a natural position when the head of the bed is raised. It also reduces the need for boosting and minimizes shear and friction.
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The larger size Glide Sheet and M2 Microclimate Body Pad accommodate bariatric patients.
The matress cover secures to most extra-wide hospital beds and can be used in place of a fitted/flat hospital sheet to help reduce friction.
PrevalonTM Turn & Position SystemXL/XXL
FEATURES
REDUCE PRESSURE
MINIMIZE FRICTION AND SHEAR
REFERENCES: 1. Pedersen J, Bill B, Call E, In vitro Measurement of the Impact of Transfer and Positioning Devices on Microclimate when Left in Place Following Use. Poster presented at SAWC 2013.
The larger size wedges redistribute pressure for bariatric patients.
Includes velcro strips that attach to Low-Friction Glide Sheet, locking Body Wedges in place under the patient.
REDUCE PRESSURE
The only device proven
compatible with all low air loss mattresses1
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REFERENCES: 1. Occupational Safety and Health Administration (OSHA), Guidelines for nursing homes: ergonomics for the prevention of musculoskeletal disorders, 2009. 2. Gomez-Cabrera MC, Domenech E, Viña J.Moderate exercise is an antioxidant: upregulation of antioxidant genes by training. Free Radic Biol Med. 2008:44:126-131. 3. Winkelman C, Higgins PA, Chen YJK, et al. Cytokines in chronically critically ill patients after activity and rest. Biol Res Nurs. 2007;8:261-271. 4. Herridge MS, Batt J, Hopkins RO. The pathophysiology of long-term outcomes following critical illness. Crit Care Clin. 2008;24:179-199.
Bedside chair challengesThe health benefits of sitting in a bedside chair are well documented. However, there are several challenges that make it difficult to achieve this goal. Positioning patients in the bedside chair can put clinicians and patients at risk for injury. Boosting and repositioning can put clinicians at risk for musculoskeletal disorders (MSDs) which include back pain, sciatica and rotator cuff injuries.1 Once patients are in the chair, they may become uncomfortable and lack the confidence to stay seated.
Safe & Secure SittingSlouching can lead to discomfort and falls. The PrevalonTM Seated Positioning System helps patients maintain a secure, seated posture. This provides stability and helps minimize the risks associated with slouched sitting.
PREVALONTM SEATED POSITIONING SYSTEM
Designed to improve compliance to the seated position and promote
patient and clinician safety.
Benefits of Mobility2-4
n Improved muscle strength
n Reduced oxidative stress
n Reduced inflammation
n Positive mood changes
n Less fatigue
Staff benefitsn Reduces Boosting
Innovative one-way glide resists forward movement, ensuring patients remain in the optimal position.
n Promotes Proper Ergonomics Multi-grip handles improve healthcare worker posture and body mechanics.
The PrevalonTM Seated Positioning System makes it easier for clinicians to safely glide patients to an optimal upright-seated position without lifting. It is uniquely engineered to keep the seated patient in place, minimizing the need for repetitive boosting and repositioning. It is also comfortable for patients, which may improve their confidence and compliance to chair sitting.
Safely glide patients to the upright position
Help Improve Safetyn FORCE—Patient is glided into position, not lifted
n REPETITION—Secures patient to minimize repetitive boosting and repositioning
n POSTURE—Promotes proper ergonomics and body mechanics while making it easy for nurses to reposition patient
Promote Comfort and ConfidenceA recently published study found that nurses were more likely to use the Seated Positioning System over traditional efforts of pulling patients upright in chairs. The use of the Seated Positioning System:1
n Enhanced nurses’ confidence in not hurting themselves
n Promoted greater compliance in following their facility’s repositioning and mobilizing patient protocols
n Provided a bundled approach that focused on preventing patient falls and pressure ulcers and reduced employee injuries
GLIDE PATIENTS WITHOUT LIFTING
Patient benefits n Redistributes Pressure
Multi-chamber air cushion provides comfort and security while allowing patient to shift in chair.
n Manages Moisture Microclimate Management Pad is effectively absorbant to protect patients’ skin while allowing air to flow through.
REFERENCES: 1. Kowal C, Enhancing Compliance to the Seated Position of a Hospital Mobility Bundle: A Mixed Method Case Study, Am J SPHM, 2014;4(1):8-14.
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Changing practice in healthcare involves significant effort and above all else—data. Evaluation is critical, but as a busy clinician or supply chain professional, you may not have resources to gather, analyze and report on your own.
We can help. CustomerOne is your expert resource for customized measurement and data analysis. Our exclusive team of professionals will generate comprehensive reports tailored to your specific requirements. Reports include:
Validate and celebrateyour success
n Executive Outcome Summary A true success story—it highlights a clinical intervention with a Sage product, including pre- and post-intervention data, clinical outcomes and return on investment.
n Return on Investment Report Measures the financial impact of positive clinical outcomes and the financial value in partnering with Sage.
n Cost Analysis Compares current process cost to a proposed Sage intervention while taking into account the cost of a hospital-acquired infection/wound. Includes a break even point or projected return on investment.
n Clinical Outcome Report Measures correlations of compliance to specific clinical protocols and the clinical outcomes achieved.
n Protocol Compliance Report Measures compliance to a specific clinical protocol.
CustomerOne professionals will support all of these areas and more. You’ll receive meaningful, actionable results that can be shared with core decision-makers across your facility—all to drive change.
0808-189-0456
Let us help validate your success! To learn more about CustomerOne call
Your Partners in Prevention
Help reduce SSIs by addressing multi-drug resistant organisms on your patient’s skin prior to surgery with 2% Chlorhexidine Gluconate Cloth
Provide comprehensive oral care with Q•Care® Oral Cleansing and Suctioning Systems
Help reduce the risk of staff injury with the Prevalon™ Liftaem® Mobile Patient Transfer System
Comfort Bath® Cleansing Washcloths eliminate the contamination risk from bath basins
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