Biggest pressure ulcer breakthrough since Florence Nightingale created patient turn protocols in 1859

Innovative, new, wearable, wireless sensor helps prevent pressure ulcers

By Dr. Margaret Doucette, DO

A new, wearable, wireless technology offers the first breakthrough in the prevention of pressure ulcers since Florence Nightingale introduced the concept of patient turns 156 years ago.

A recent Quality Improvement initiative we introduced at the Veterans Administration Boise Medical Center found the Leaf Patient Monitoring System to be the first practical technology that improves both patient care and system efficiency by monitoring and coordinating patient turning. 

In the absence of comprehensive studies to determine how relatively minor bedsores become life-threatening pressure ulcers, this new technology offers an enormous leap forward in patient care because it enables clinicians to monitor patients at all risk levels and stop relying on easily misinterpreted medical guidelines that healthcare has relied on since the Braden Scale was introduced in 1987. 

Studies i ii have repeatedly shown that patients perceived to be at lesser risk under the Braden Scale have, in fact, developed pressure ulcers that require significant care, including extended hospital stays.

The standard of treatment


It’s no exaggeration that the standard approach to pressure ulcer prevention has, for the last 156 years, been to turn patients every two hours. While that approach may have been practical in 1859, staffing costs today make it impossible to meet the two-hour standard. 

The Braden Scale’s introduction was important because it provided guidelines for assessing risk and, as a result, identifying patients who need more intensive staff attention. 

The Braden Scale – along with the Norton Scale commonly used in Europe – is really a tool to optimize staff deployment and workflow.  And these scales are deficient because, while they are based in science, they rely on the interpretations of individual clinicians to assess each patient’s risk.  That explains why so many “lesser risk” patients end up with prolonged hospital stays.

The scales’ underlying vagueness poses a significant problem.  In the U.S. alone, more than one million hospital patients will develop a pressure ulcer this year. Recent studies have shown that an estimated 3.5?percent to 4.5 percent of all hospitalized patients develop potentially preventable, hospital-acquired pressure ulcers.iii And those wounds can be deadly.  The Department of Health and Human Services says that up to 60,000 people a year die from pressure ulcers.iv

Pressure Ulcers: Serious, Costly Problem

Pressure ulcers form when sustained pressure on a given area of the body causes tissue compression and impairs blood flow to affected areas. If surface pressure is not relieved, the resulting shortage of blood flow can lead to localized tissue damage and cell death. Pressure ulcers initially appear as areas of reddened or discolored skin, but can quickly develop into large open wounds if interventions are not initiated.

Studies have shown that the development of a pressure ulcer independently increases the length of a patient’s hospital stay by four to 10 days.

This makes them expensive to treat. The cost of treating a pressure ulcer depends on its severity, with estimates ranging from $2,000 to $20,000 per ulcer. The Society of Actuaries has calculated that the overall incremental cost of treating an average pressure ulcer is $10,700.v

Federal studies show the nation’s healthcare system spends at least $10 billion a year to treat hospital-acquired pressure  Since virtually all of the nation’s 5,700 hospitals have the problem, the average hospital spends more than $1.7 million to treat pressure ulcers each year. And that is an expense hospitals must swallow completely.  

Because they are largely avoidable, the Centers for Medicare & Medicaid Services discontinued reimbursement for hospital-acquired pressure ulcers in 2008, thus increasing the demand for early-stage prevention.

The advantage of wireless technology

The Leaf system we deployed helps to increase staff efficiency because it identifies the individual patients who specifically need to be turned, enabling nurses to focus their time and energy on patients who are at greatest risk of developing pressure ulcers.  The side benefit is that the system also allows us to not disturb patients who are turning themselves and, therefore, are at lower risk.

Overall, the technology increased compliance with our own turn protocols to 90 percent and improved productivity. The system ensures that patients experience adequate tissue decompression time between repositionings so that patients who turn themselves back to their favored side do not over-pressurize a body area. 

By using the sensors on most or all patients, the Leaf System enables clinicians to overcome the problems that often result from the vagueness that is inherent in the Braden scale.  And it certainly allows healthcare providers to optimize their clinical staff workflow by allowing them to focus their attention on those patients who need it most, while at the same time ensuring that no patient is neglected.

This can help to eliminate pressure ulcers from the list of medical mistakes that commonly occur in American hospitals.

Dr. Doucette is chief of Physical Medicine and Rehabilitation and director for Wound Care at Boise VAMC.

i Jenkins ML, O’Neal E. Pressure ulcer prevalence and incidence in acute care. Adv Skin Wound Care. 2010;23(12):556-9.
ii Johnson J, Peterston D, Campbell B, Richardson R, Rutledge D. Hospital-acquired pressure ulcer prevalence – evaluating low-air loss beds. J Wound Ostomy Continence Nurse. 2011;38(1):55-60.
iii Hospital-acquired pressure ulcers: results from the national Medicare Patient Safety Monitoring System study.
Lyder, et al. J Am Geriatr Soc. 2012 Sep;60(9):1603-8.
v Society of Actuaries’ Health Section. Economic Measurement of Medical Errors. Schaumburg, IL: Society of
Actuaries; 2010.
vi Are We Ready for This Change? Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care.
April 2011. Agency for Healthcare Research and Quality, Rockville, MD.