Nursing teams at UK hospitals are trialling a hand-held scanner that could transform diagnosis and prevention of pressure ulcers, according to the US nurse behind the idea.
The device is designed to detect the early warning signs of pressure-related skin damage days before it is visible to the naked eye, allowing nurses to take swift preventative action.
“We still have a gold standard that looks at the redness of skin. It’s just crazy”
Its inventors claim it could reduce wider infection risk and slash costs associated with largely preventable ulcers.
The SEM – sub-epidermal moisture – Scanner was the brainchild of Barbara Bates-Jensen, professor of nursing and medicine at the University of California, Los Angeles.
In an exclusive interview with Nursing Times, she described it as a “game changer” in the field of tissue viability.
“It gives us an objective tool that allows us to look at damage that might be occurring beneath the skin’s surface long before that damage shows up on the surface of the skin. I think that completely changes things,” she said.
“Pressure ulcers are a major financial burden, not to mention the suffering of patients, and yet we still have a gold standard that looks at the redness of skin. It’s just crazy,” she said.
Professor Bates-Jensen worked with colleagues from her university’s engineering and computer science departments to create a prototype scanner. The device was then taken forward by a medical technology company, Bruin Biometrics.
The scanner, which works by measuring changes in moisture under the skin, is placed on areas where damage is most likely to occur, such as the heels and sacrum, providing an almost instant reading.
“I knew it had to be point of care and super easy, so couldn’t require a 45-page user manual, as nurses just don’t have the time to use something like that,” said Professor Bates-Jensen.
She said that it also produced consistent results for all skin types, so could reduce higher rates of pressure ulcers among black and minority ethnic patients and, therefore, help tackle health inequalities.
Professor Bates-Jensen said the ability to gather data over time was another major advantage of the technology that could help show the impact of prevention work and motivate nursing teams.
“Preventing pressure ulcers is about providing individualised care that has to be delivered consistently over a long period of time and there is no real easy way of measuring you are doing a good job,” she said.
“Something like the SEM Scanner allows us to gather objective data that shows nurses’ prevention interventions are working.”
She acknowledged that the device was not “perfect”, but said it was “so much better than what we have”.
A study, published recently in the Journal of Tissue Viability, found the scanner produced standard, consistent readings when used by different people with different levels of skills and experience.
“Now nursing assistants, who do most of the hands on care, can do the scanning as well”
The scanner has been available in the UK since last year, where it is currently being trialled by nurses at two trusts in the North.
Nurses at Wrightington, Wigan and Leigh Foundation Trust started using the technology in December. They have six scanners, which they have been using on four wards.
Tissue viability specialist nurse Lindsey Bullough said she was keen to test the scanner in order to improve on current pressure ulcer assessments.
“I thought it was a good idea because we haven’t got anything definitive to say there is underlying pressure damage,” she told Nursing Times. “We use the Waterlow assessment tool but there can be quite a lot of anomalies with that and variable reliability.”
The fact the scanner was so simple to use, meant that it could be used by healthcare assistants as well as registered nurses, said Ms Bullough.
“That’s one of the best things about it,” she said. “We would only allow trained members of staff do the Waterlow scoring but now nursing assistants, who do most of the hands on care, can do the scanning as well, reporting back to the nurses.”
She said the technology had helped raise awareness of the possibility of underlying damage that may not be immediately obvious. “It’s made people more aware,” she said.
“For example, if someone has had a fall at home you may not know how long that person has been lying on the floor and in what position,” she said. “But with this device you can say this person has got some underlying tissue damage, so we need specialised equipment such as a higher spec mattress from the outset.”
As well as enabling a swift assessment when people were admitted, Ms Bullough said the scanner was helping ensure patients did not develop pressure ulcers following discharge.
“Previously patients may have gone home with underlying tissue damage that emerged a few days after discharge. We can now say ‘we have scanned this patient and we are allowing them to go home free from pressure damage’,” she said.
There have been no hospital-acquired pressure ulcers on the four wards involved in the trial over the past few months and the pilot will now be extended to a surgical ward.
“Quite often we see a dark area on the body, yet nurses don’t really know what it is”
Since February, the scanner has also been trialled at Doncaster and Bassetlaw Hospitals Foundation Trust.
Tracy Vernon, lead nurse for tissue viability, told Nursing Times that the trust was exploring how the technology might fit in with a range of other measures to reduce pressure ulcers, including a new bespoke ward-based training programme for staff.
She said the scanners could be useful in differentiating between moisture lesions and pressure ulcers, and might also help identify a deep tissue injury from a bruise.
“Quite often we see a dark area on the body, yet nurses don’t really know what it is at that point so keep monitoring it,” she said.
Ms Vernon added that it was too early to gauge the impact of the scanner on patient care.
Meanwhile, a separate group of US engineers have created a “smart bandage” that uses electrical currents to detect early tissue damage, as reported last month by Nursing Times.
They hope their findings, published in the journal Nature Communications, could also provide a major boost to pressure ulcer prevention.