Nurses at the first hospice in the UK to trial a ground-breaking scanner designed to detect pressure damage say the device has helped them act sooner to stop ulcers developing and raises questions about the value of traditional skin assessments.
Staff at the Marie Curie Hospice in Newcastle are the first in the UK to test the SEM (Sub-epidural moisture) Scanner with patients who have a palliative care needs and say it has helped them put appropriate measures in place earlier to help prevent painful and distressing ulcers.
“The scanner has helped us intervene at the right time and earlier than we could have done”
Before the six-month trial had even finished, the setting had invested in a scanner of its own and has since purchased another scanner, which cost £5,835 each.
Staff decided to trial the device after the hospice’s manager saw a presentation and demonstration at a patient safety conference, said lead nurse Gillian Raine. The device has been piloted at a number of settings, as previously reported by Nursing Times.
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Ms Raine said: “We were already looking at whether there was anything we could do regarding tissue viability [and] were we doing everything possible to minimise the risk of pressure damage to our patients.
“It was something I had been involved with in a previous role within the NHS so it was something I was keen to explore more,” she told Nursing Times.
“We’re going to look at drawing up some guidelines around who we scan and the frequency of scans”
The trial, which started in November, saw all staff on the 22-bed unit – including staff nurses, healthcare assistants and sisters – trained on how to use the hand-held battery operated device.
All patients were scanned on admission – with their consent – as part of the normal SSKIN assessment and then daily after that.
The SEM Scanner is able to detect skin damage up to five days before it is visible to the naked eye, according to its manufacturers Bruin Biometrics.
Ms Raine said the unit did not have a big problem with hospice-acquired ulcers but patients often had skin damage when they arrived or it became apparent very soon after admission.
“We see a lot of patients who come in from other areas with pressure damage on admission,” she said. “Also, we noticed we had patients who developed pressure damage within the first 24/48 hours of coming, so we were looking at that.”
She said the scanner had helped detect the early warning signs of skin damage and meant pressure-relieving measures could be put in place at the right time – and generally sooner than if they had relied on more traditional skin assessments such as the widely-used Waterlow score.
“As part of our daily assessment, one of the questions staff were asked after they had scanned a patient was whether there was any skin damage evident – could they actually see any damage – and a lot of the time the scanner was picking up that there were changes but staff were noting there was no redness to be seen,” she said.
“When we used scanner results, rather than visual assessment, to implement pressure-relieving equipment at that stage, then those patients didn’t go on to develop pressure damage,” she said. “The scanner has helped us intervene at the right time and earlier than we could have done if we had just been reacting to red or using Waterlow.”
Those involved in the trial are currently collating and analysing the data but Ms Raine said she was fairly confident it would demonstrate an overall reduction in pressure ulcers over the trial period.
She said she believed the scanner had the potential to ensure limited, high cost equipment was used at the right time for the right patients and ensure best value for money.
“In a hospice setting and the NHS more generally, you have a limited number of resources, so if you can use those resources on the people who actually need them then that has to be of benefit,” she said. “And if this scanner can help make that judgement earlier – before the skin is red and you’re already starting to get damage – then it has to have a use somewhere.”
“We see a lot of patients who come in from other areas with pressure damage on admission”
Meanwhile, the fact it could detect changes in the skin before they were visible raised questions about the value of more traditional risk assessments.
“One thing we would consider looking at when we are taking this forward is whether or not the scanner could replace the use of Waterlow or other risk assessments – whether or not the scanner actually makes them irrelevant,” she said.
During the trial, the hospice was offered a donation to buy a new piece of equipment and decided to use that money to buy an SEM Scanner. Managers also agreed to the purchase of a second scanner.
Ms Raine confirmed the hospice would definitely continue using the technology but that it would change how it was deployed.
“As part of the trial, we were scanning all patients who agreed every day. Now we’re going into implementation across the unit, we’re going to look at drawing up some guidelines around who we scan and the frequency of scans,” she said.
“On admission, we will scan all patients and we’ll probably scan them the second day as well just to get a second reading,” she said. “We’ll then make a decision whether or not we scan them on alternate days or every three days or carry on with every day scans.”
“I guess some nurses felt that was removing some of their clinical judgement”
Ms Raine admitted that introducing a new piece of kit had been challenging for nurses and others, as it went against ingrained training and long-established skin assessment procedures, and involved “a completely different mindset”.
“It was something different and we were challenging what they had known in the past, which was to use the Waterlow scoring system and to ‘react to red’,” she noted.
“We were asking them to implement pressure relieving pads and pumps when they weren’t seeing any damage on the skin so they were purely doing it based on what this machine said numberwise,” she said. “I guess some nurses felt that was removing some of their clinical judgement, because actually now we were relying on a number rather than what they were observing on the skin.”
However, she said that when staff understood the technology and started to see results “they came round to it a lot more”.
“Actually, when we then went back and said, ‘we introduced this piece of equipment on this patient then we didn’t see any redness, we didn’t develop any pressure – did we catch this one earlier than we would have done? We have to assume we did’.”
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The unit cares for patients aged 18 and over with palliative care needs who may be admitted for a temporary stay for specialist palliative care symptom control before returning home or may be nearing the end of life.
Given the nature of the setting, Ms Raine stressed that using the scanner was not always appropriate.
“At any point during the trial patients could refuse to be scanned and sometimes that did happen, especially in the very late stages,” she said. “Sometimes it was a clinical or staff decision not to scan a patient when they were coming to the end of life – there was some discretion used.”
“I personally think it could be adapted to be used in the community”
She told Nursing Times that she could also envisage wider use of the scanners beyond hospital and hospice care settings.
“I personally think it could be adapted to be used in the community – the thing is how frequently you have to do it,” she said.
“We did look at introducing it to our day therapy unit patients but because they are only seen once a week that wouldn’t necessarily work very well,” she added.
The results of the trial will be shared with other Marie Curie sites and Ms Raine. “Certainly, I will be speaking to other staff about our experience of using it,” she said.