Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Lai CM(1), Chan KK(1), Lee HS(1), Hui N(1)
Affiliation :
(1) Occupational Therapy Department, United Christian Hospital
Introduction :
Acute ischemic stroke patients are a group at high risk of pressure injuries (PI). Functional deficits including sensory loss, hemiplegia, and paralysis are the common complications in stroke causing immobility and dependence in activities of daily living.
Immobilization could yield to pressure injury (PI) over heels due to constant pressure and shearing force. Being susceptible to mechanical forces such as shearing stress and friction (National Institute for Health and Care Excellence, 2014), heels were often reported as the second most common anatomical location of hospital-acquired pressure damage with prevalence rate from 2% to 41% (Kerstein, 2002; VanGilder et al, 2008; Salcido et al, 2011), serving as one of the complications during hospitalization and stroke. According to a global systematic review and meta-analysis, PI accounts for a prevalence rate of 8.4% in hospitalized patients (Li, Lin, Thalib, and Chaboyer, 2020) and 22% after onset of stroke patients in an UK study (Sackley, et al., 2008). Given that stroke was also associated with heel PI development (Rajpaul & Acton, 2016), it is therefore important to identify risk factors for PI in acute ischemic stroke patients in view of its prevalence and vulnerability, in order to facilitate early adoption of appropriate preventive and treatment measures.
Subepidermal moisture (SEM) has been recognized as a potential indicator of early stage PI development. By assessing SEM levels, occupational therapists can stratify patients with high risks of PI and implement appropriate preventive measures.
Prescription of commercially available pressure relieving devices such as fleece padded and foam filled heel protectors is a common intervention of OT to prevent and alleviate PI by offloading pressure and proper heel positioning. Optimal selection becomes crucial when it comes to achieving a balance between effectiveness and efficiency. The incorporation of the conventional intervention with smart technology consisted a new pilot program of heel pressure injury prevention program in the Acute Stroke Unit (ASU) designed with the application of a SEM scanner.
Objectives :
To investigate the effectiveness of reducing risk of PI in terms of SEM-delta using SEM scanner and with the use of appropriate heel pressure relieving devices.
Methodology :
A prospective cohort study was adopted. All patients with stroke newly admitted to the ASU with Braden Scale below 13 were recruited to this program from September to December 2023. Initial assessment was done by occupational therapists within 72 hours with SEM-Delta scanning. Different levels of heel pressure relieving devices will be provided with risk stratification according to the protocol (SEM delta < 0.6 = heel protectors; SEM ≥ 0.6 = heel suspension device). SEM-Delta value was then re-assessed after 1 week.
SEM-Delta value and the incidence rate of heel pressure injuries would be the primary outcome measures.
Result & Outcome :
10 stroke cases (age mean=77.8, SD=16.57) were recruited and completed 1-week review. 9 (90%) of them were prescribed heel suspension devices while 1 was given heel protectors. SEM-Delta values of left (Pre-test mean=0.678, SD=0.393, Post-test mean=0.589, SD=0.197) and right heel (Pre-test mean=0.7, SD=0.309, Post-test mean=0.61, SD=0.218) before and after the programme were normally distributed, demonstrated in the Shapiro-Wilk test (p>0.05). Data was analyzed with SPSS.
Results from paired t-test showed no statistically significant difference in SEM-Delta before and after 1-week follow-up for both left (p=0.426) and right heel (p=0.434). No subject was documented with developed PI during their hospitalization period in ASU.
Conclusion:
Despite the fact that there was no statistically significant difference in SEM-Delta before and after 1 week, both mean of SEM-Delta of left and right heel decreased and no subjects were recorded newly developed pressure injuries during their hospitalization period, indicating their risk of PI was reduced or maintained with appropriate pressure relieve devices prescribed according to the designated protocol. There was a limited length of stay among subjects (mean=20.7 days, SD=12.8) which may not be able to reflect the long-term effect in this study. In this regard, future studies were suggested in UCH with randomization, larger sample size and long-term review with SEM-scanning technology in ASU stroke patients.
In conclusion, SEM scanner is a convenient device and can serve as an adjunct assessment tool with new technology for occupational therapists in clinical assessment with respect to reducing risk of PI development and facilitating triage decision on appropriate selection of pressure relieving devices in ASU.
