Today, we welcome Patricia (“Tricia”) Lipschultz RN, BSN, CWOCN, Arjo Clinical Consultant Wound Care, to discuss Arjo’s newly launched Provizio SEM Scanner for early pressure injury risk assessment.
Tricia is a certified Wound, Ostomy, Continence Nurse through the WOCN Certification Board. She has been an RN for over 30 years and has over 20 years of wound care experience. Practice settings have reached across the continuum including acute cute, home care, and wound care clinics, functioning in both staff and management roles. Tricia has been on the WOCNCB exam committee for the past 6 years, has worked with the California Board of Registered Nursing, and provided consulting services for private attorneys regarding pressure injury litigation.
What are the current trends being seen in hospital-acquired pressure injury (HAPI) incidence and other healthcare settings?
Despite the fact that most hospital-acquired conditions have decreased in number, the incidence of HAPI’s have increased over the last several years. In the US alone, more than a million patients in acute care will develop a pressure injury (PI) and several thousand will die from PI complications. International pressure injury prevalence rates are estimated to be between 5-27% in acute care, ~27% in long term acute care, and 3.4-32.4% in long-term care.1 HAPI’s are challenging for healthcare providers as clinicians strive to provide best care and are costly to treat. Patients that are affected often suffer emotional, physical, and financial burdens. Pressure injuries are considered one of the largest unsolved challenges in healthcare today.
As clinicians, preventing pressure injuries is always a priority. What role do commonly used assessment tools & methods play in pressure injury prevention?
Prevention of pressure injury remains a key component in increasing quality of life, and reducing unnecessary hospital and patient costs. Risk Assessment Tools (RAT), such as the Braden scale and Norton scale, are utilized frequently to determine a patient’s risk for the development of a pressure injury. These tools rely on subjective data based upon observation of a patient, and can be limited by the clinician’s interpretation and knowledge of the assessment tool. Visual skin assessment (VSA), used in conjunction with the RAT, provides additional information including skin color, temperature, induration, and blanchability.
What are the recommendations for sub-epidermal moisture assessment and its role in prevention?
In the International Pressure Injury Prevention and Treatment Guidelines (2019), the use of sub-epidermal moisture (SEM) measurement is recommended to assist with assessing patient risk for PI development prior to the presence of a visible PI.2 The manifestation of moisture in sub-epidermal tissue is a biophysical marker for possible pressure injury formation in at-risk patients. Inflammatory changes in the skin and underlying tissue may precede VSA changes by as early as 3-10 days. Early identification of skin changes prior to cell death, ischemia, and tissue death increases the likelihood of effective PI prevention. Interventions can be implemented earlier and targeted to at-risk areas before visible damage is seen.
The Provizio SEM Scanner objectively alerts clinicians to early PI risk in the sacrum and heels. Can you explain the significance of incorporating the Provizio SEM Scanner into a PI prevention protocol?
The innovative Provizio SEM Scanner is a hand-held wireless, noninvasive device used in adjunct with a hospital’s current prevention protocol. The device objectively alerts clinicians to specific anatomical areas (sacrum and heels) of a patient’s body at increased risk of PI before visible damage manifests at the skin surface. This is done by providing an increased Delta reading which signifies the presence of sub-epidermal moisture and is an early indicator of pressure injury risk. The SEM scanner identifies possible pressure injury development in these areas as early as 5 days (median) prior to visual assessment allowing for earlier intervention.3
What clinical impact has Provizio SEM Scanner implementation had on PI incidence rates in healthcare settings?
Implementation of the Provizio SEM Scanner as an adjunct to RAT, VSA, and PI prevention strategies has shown reductions in pressure injuries: 90% reduction in acute care settings, 47% reduction in hospice settings, and 27% reduction in community care.4 These are significant reductions among many care settings gathered from real-world evidence.
Where can we learn more about the Provizio SEM Scanner and this technology?
- Salomeja Garolis, MS, RN, CNS, NEA-BC; Natalie Martin, RN,CWOCN; Hillary Ryan, BSN, RN, CWOCN; Jennifer Ruppel, RN; Lauren Logan, RN, Anne Van Dueson, MSN, RN, CWOCN; and Clinical Research Department of Providence Portland Medical Center.
- European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: The International Guideline 2019.Emily Haesler (Ed.). EPUAP/NPIAP/PPIA:2019.Section 5:Skin and Tissue Assessment. Recommendation 2.6 Conducting Skin and Tissue Assessment. Page 78-79.
- Okonkwo H, Bryant R, Milne J et al. A blinded clinical study using subepidermal moisture biocapacitance measurement device for early detection of pressure injuries. Wound Repair & Reg 2020;1-11.
- Burns M (2020). Real World Evidence. Accepted and presented at EWMA conference.