Teledermatology and Severity of Pressure Ulcers
Teledermatology and Severity of Pressure Ulcers
Eighty-three patients (39 males, 44 females) who had developed pressure ulcers before being admitted to the author's medical center (Nagasaki Medical Center, Nagasaki, Japan) were treated from January 2009 through December 2010. They ranged in age from 12–94 years (mean age 75.9 ± 12.3 years), with 63% over 70 years old (Figure 1). The settings where patients developed their pressure ulcers are shown in Figure 2. The most pressure ulcers (66%) developed at home. Patients' degrees of self-help are presented in Figure 3. Eighty-four percent of them were bedridden. All patients were evaluated and classified using the OH scale for preventive measures against pressure ulcers, as described by Ohura and Horita. Patients' physical status, including spontaneous body turning, sacral bony prominences, and edema and joint contraction, were checked and evaluated numerically. This risk-assessment scale indicates pressure ulcers will develop in less than 25% of patients with a low risk (risk score: 1–3 points), 26%-65% of patients with a moderate risk (risk score: 4–6 points), and more than 66% of patients with a high risk (risk score: 7–10 points).
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Figure 1.
Age of patients who developed pressure ulcers before being admitted to the hospital (n = 83).
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Figure 2.
Setting where patients developed pressure ulcers (n = 83).
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Figure 3.
Degree of self-help of patients who developed pressure ulcers before being admitted to the hospital (n = 83).
Risk-assessment scale scores in patients who developed pressure ulcers before being admitted to the hospital are shown in Figure 4. Although more than half of patients were classified into the moderate or high-risk groups, 89% of patients who developed pressure ulcers did not use a body pressure dispersion mattress as a preventive measure.
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Figure 4.
Risk assessment scale scores in patients who developed pressure ulcers before being admitted to the hospital (n = 83).
According to companions, friends, or family members of patients who developed pressure ulcers while at home and were then admitted to the National Hospital Organization Nagasazki Medical Center, 74% of those patients lived alone or with an elderly spouse. Conferees of patients who developed pressure ulcers at home are shown in Figure 5. Only 19% of them consulted in-person with a wound specialist (ie, wound ostomy and continence nurse, dermatologist, or plastic surgeon). The authors felt these survey results supported the need for a teledermatology service.
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Figure 5.
Conferees of patients who developed pressure ulcers at home (n = 53).
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Figure 6.
Concerns of home care nurses and managers regarding the care and treatment of pressure ulcers (n = 529).
Questionnaires were provided to home care nurses and home care managers at the Fifth Nagasaki Pressure Ulcer and Management Congress, and 321 persons replied. According to survey results, home care nurses have difficulties with wound management because of a shortage of dressing materials as well as difficulty in doing a debridement procedure in the home setting, due to possible complications from localized anesthesia or postsurgical bleeding. The home care practitioners also indicated they did not receive proper training in debridement techniques.
In addition, the survey respondents indicated they struggle with consulting specialists, either because of the absence of a wound care specialist or the unreliability of the specialist, and disagreements with the home care doctor. Their complaints against doctors accounted for 70% of all answers.
Seventeen consultations were sent to the authors' teledermatology system, and all cases were responded to. Fourteen (82%) of the 17 teledermatological consultations were requested by patients, family members, or home care nurses and managers. Physician-requested consultations comprised only 3 cases. Eight (47%) of the 17 patients were bedridden, and 14 (82%) were in home care. Three consultations were directed from a far district (more than 1,000 km from the authors' medical center), and 2 consultations were directed from isolated islands. Another 12 cases (70.6%) were from relatively nearby urban areas in the same prefecture, within 100 km of the authors' medical center).
Results
Evaluation of Conditions of Patients who had Developed Pressure Ulcers Before Being Admitted to the Hospital
Eighty-three patients (39 males, 44 females) who had developed pressure ulcers before being admitted to the author's medical center (Nagasaki Medical Center, Nagasaki, Japan) were treated from January 2009 through December 2010. They ranged in age from 12–94 years (mean age 75.9 ± 12.3 years), with 63% over 70 years old (Figure 1). The settings where patients developed their pressure ulcers are shown in Figure 2. The most pressure ulcers (66%) developed at home. Patients' degrees of self-help are presented in Figure 3. Eighty-four percent of them were bedridden. All patients were evaluated and classified using the OH scale for preventive measures against pressure ulcers, as described by Ohura and Horita. Patients' physical status, including spontaneous body turning, sacral bony prominences, and edema and joint contraction, were checked and evaluated numerically. This risk-assessment scale indicates pressure ulcers will develop in less than 25% of patients with a low risk (risk score: 1–3 points), 26%-65% of patients with a moderate risk (risk score: 4–6 points), and more than 66% of patients with a high risk (risk score: 7–10 points).
(Enlarge Image)
Figure 1.
Age of patients who developed pressure ulcers before being admitted to the hospital (n = 83).
(Enlarge Image)
Figure 2.
Setting where patients developed pressure ulcers (n = 83).
(Enlarge Image)
Figure 3.
Degree of self-help of patients who developed pressure ulcers before being admitted to the hospital (n = 83).
Risk-assessment scale scores in patients who developed pressure ulcers before being admitted to the hospital are shown in Figure 4. Although more than half of patients were classified into the moderate or high-risk groups, 89% of patients who developed pressure ulcers did not use a body pressure dispersion mattress as a preventive measure.
(Enlarge Image)
Figure 4.
Risk assessment scale scores in patients who developed pressure ulcers before being admitted to the hospital (n = 83).
Evaluation of Daily Life of 53 Patients who Received Home Care and Developed Pressure Ulcers
According to companions, friends, or family members of patients who developed pressure ulcers while at home and were then admitted to the National Hospital Organization Nagasazki Medical Center, 74% of those patients lived alone or with an elderly spouse. Conferees of patients who developed pressure ulcers at home are shown in Figure 5. Only 19% of them consulted in-person with a wound specialist (ie, wound ostomy and continence nurse, dermatologist, or plastic surgeon). The authors felt these survey results supported the need for a teledermatology service.
(Enlarge Image)
Figure 5.
Conferees of patients who developed pressure ulcers at home (n = 53).
Survey of 321 Home Care Nurses and Home Care Managers Regarding Their Concerns About the Care and Treatment of Pressure Ulcers (Figure 6)
(Enlarge Image)
Figure 6.
Concerns of home care nurses and managers regarding the care and treatment of pressure ulcers (n = 529).
Questionnaires were provided to home care nurses and home care managers at the Fifth Nagasaki Pressure Ulcer and Management Congress, and 321 persons replied. According to survey results, home care nurses have difficulties with wound management because of a shortage of dressing materials as well as difficulty in doing a debridement procedure in the home setting, due to possible complications from localized anesthesia or postsurgical bleeding. The home care practitioners also indicated they did not receive proper training in debridement techniques.
In addition, the survey respondents indicated they struggle with consulting specialists, either because of the absence of a wound care specialist or the unreliability of the specialist, and disagreements with the home care doctor. Their complaints against doctors accounted for 70% of all answers.
Results of a Teledermatology System Aiming at Early Intervention for Pressure Ulcer Treatment
Seventeen consultations were sent to the authors' teledermatology system, and all cases were responded to. Fourteen (82%) of the 17 teledermatological consultations were requested by patients, family members, or home care nurses and managers. Physician-requested consultations comprised only 3 cases. Eight (47%) of the 17 patients were bedridden, and 14 (82%) were in home care. Three consultations were directed from a far district (more than 1,000 km from the authors' medical center), and 2 consultations were directed from isolated islands. Another 12 cases (70.6%) were from relatively nearby urban areas in the same prefecture, within 100 km of the authors' medical center).
