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 Seating What is suspicious in this picture? Note the hexagon.
Use Your Hands!! 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?
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?
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 focused 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”?
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 Aftertherapist supported left PSIS area Stand-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 What We Just Did? 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
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.