Towards zero pressure injuries

An unobtrusive monitoring system is targeting pressure injuries with positive results in aged care, writes Natasha Egan.

Resident quality of life and staff satisfaction are up while pressure injuries and the unnecessary repositioning of residents have almost been eliminated at St Sergius Aged Care in Sydney. The 168-bed aged care facility has been using the sensor-based reposition management system PosiSense for 16 beds in its east wing since mid 2019.

PosiSense is an Australian innovation that aims to prevent pressure injuries. It is a big task as there were just over 12,000 pressure injuries in all residential aged care facilities in the first three months of 2020, according to the National Aged Care Mandatory Quality Indicator Program.

PosiSense involves a smoke-detector sized sensor on the ceiling above a resident’s bed that accurately detects when a resident has been repositioned or self-repositions.

The unobtrusive system shows the status of each resident on a monitor at the nursing station to indicate a resident’s most recent reposition and when their next reposition is due. It also highlights and sends an alert for any overdue repositions.

To try and prevent pressure injuries, residents are repositioned according to a schedule based on a risk assessment. The standard is every two hours and it is usually done during repositioning rounds in residential aged care.

In the east wing at St Sergius Aged Care, it is now done according to individual need, chief executive officer Helen Workman tells Australian Ageing Agenda.

“The east wing ward has the largest concentration of immobile residents with the highest pressure injury risk in the facility,” Workman says.

She says in the 12 months before the PosiSense system was installed, there were 13 cases of pressure injuries in the east wing. During the first 12 months of implementation, there were two cases of new pressure injuries, and both were stage 1 (see graph).

“The case developed in May 2020 was for a high-risk resident who refuses to be repositioned, and has demanded his repositioning schedule to be increased to four hours.”

The fully-automated system is used by registered nurses and the assistants in nursing in the wing daily. Workman says it has been well-received by all.

“RNs are supportive of the system because it contributes to residents’ wellbeing. As for AINs, the response is positive as well, as the system has improved transparency and has reduced stress.”

She says there were some privacy-related concerns from some AINs in the first month after installation, but they were addressed through staff meetings early on.

“Once it was demonstrated that the system is completely depersonalised, there have been no further complaints,” she says. “We’ve also witnessed a surge of support among AINs after PosiSense records were used to assist us in a false claim against an AIN. The PosiSense records could disprove the accusation.”

Due to the results and ease of use, Workman says they have applied for funding to install PosiSense into two more wings.

“We would certainly recommend PosiSense. Not only has it helped us prevent pressure injuries, but it also required virtually no effort from us. Installation was simple, took a few days and required no rewiring. Training was needed only in the first few days, after which the caregivers began to learn from more experienced team members,” she says.

“Another important aspect is that the system enables us to reposition residents in accordance with their individual repositioning schedules. This has become an essential component of our individual-focused care model.”

A new repositioning standard

PosiSense, The Prince Charles Hospital in Brisbane and CSIRO are preparing a project that will use the data gathered by PosiSense to develop a new repositioning standard.

It aims to replace the current pressure injury prevention standard that requires patients to be repositioned every two hours.  

PosiSense has already been installed at The Prince Charles Hospital, where researchers have been looking into what repositioning actually goes on.

Professor Paul Fulbrook, who is nursing director at The Prince Charles Hospital, says until now there has been a lack of evidence on repositioning.

“The mainstay of nursing care particularly for patients who are immobile or confined to beds for a long period of time is to reposition them on a regular basis.

“In the past we have done this in nursing on a clinically intuitive basis of changing a patient’s position every two or more hours. But the reality of that is there is not any research evidence that tells us how long it is between repositioning,” Fulbrook tells AAA.

He says nurses generally identify a patient’s risk level and determine when to change their position somewhere between every two and four hours.

“The reality of that is – and we found this out in our research in the hospital setting – what nurses say they do and what they actually do is not one and the same.”

He suspects the situation would be similar or even magnified in aged care settings where there are fewer nurses and care workers to each care recipient than in hospitals.

Dr Sandra Miles, an experienced nurse and senior lecturer and research fellow at The Prince Charles Hospital, says PosiSense has provided the first opportunity to see and log what actually happens in practice.

“In real-time we are able to see what nurses are doing but also very importantly what patients themselves are doing. We are able to see if a patient self-repositions,” Miles tells AAA.

Knowing that a hospital patient or aged care resident has turned or re-arranged themselves could save nurses and care workers time and eliminate doing something unnecessary, she says.

“But if we know a person has repositioned themselves partly or wholly then we won’t need to do such a reposition.”

Miles says they are keen to find out how often on average patients are being repositioned and contributing to their own repositioning.

Fulbrook says the more they learn, the more sophisticated they can make the system.

“The data we are collecting will enable us to develop much more specific algorithms for individual patients’ schedules. At the moment we are applying repositioning regime a bit like a broad brush approach. But we want to be able to say this is what we want to do for this patient.”

The project is planning to start collecting data in February 2021. It has applied for funding to also include residential aged care settings. Aged care facilities interested in participating should email research@posisense.com.

Main image: St. Sergius Aged Care registered nurse Susanna Maguire sitting in front of the PosiSense dashboard.

This article first appeared in Australian Ageing Agenda magazine (Sep-Oct 2020).

Postscript: PosiSense and St Serigus Aged Care won the increasing care and service productivity award for this implementation at the 2020 innovAGEING National Awards in November.

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