Applications / Pressure Ulcer Detection
The Use of the EPISCAN for early detection of
Pressure Ulcers
It is recommended that the use of the EPISCAN be incorporated into existing facility skin care protocols. Each patient should be evaluated by standard indices (Braden, etc.) to determine their propensity to pressure ulcer formation. Patients that are documented to be “at risk” should have a careful skin evaluation including ultrasound scanning.
Depending upon the patient’s mobility and continence status, high risk anatomical sites are identified, evaluated, and scanned. The ultrasound examination can be completed while performing a thorough skin assessment, adding approximately twenty minutes to the standard exam. This time spent will be more than made up if the incidence of pressure ulcers is reduced.
Each scan is evaluated for tissue changes occurring beneath the skin’s surface which is indicative that a pressure ulcer may be forming. Clinical signs such as non-blanching erythema and bogginess may or may not be present. Any site that has either ultrasound changes and/or clinical signs of a pressure ulcer is immediately targeted for treatment.
A registered nurse is trained to perform the scans and can interpret the images as either normal or abnormal. Areas that have demonstrated ultrasound changes indicative of pressure ulcer formation should be scanned on a regular basis. All images are saved to a patient’s record within a database which allows the clinician the ability to compare saved images from previous weeks to determine effectiveness of treatment.
With existing pressure ulcers, the ulcer should be scanned to help determine the extent of damage to underlying tissue. Scans can be repeated as necessary to determine treatment effectiveness. Digital photographs can also be recorded for each wound. The EPISCAN software allows for accurate measurement of wounds.
The EPISCAN is an additional assessment tool that can become an integral part of the care plan for pressure ulcer prevention and treatment in acute and long term care.
The advantages of the EPISCAN in the prevention of pressure ulcers are as follows:
- Detection of pressure ulcers before clinical signs are apparent
- Documentation of existence of pressure ulcers on admission
- Targeting treatments to specific anatomical areas
- Distinguishing between pressure ulcers and friction ulcers
- Following pre-pressure ulcers to see if treatments are effective
- Increasing awareness and compliance of staff
Detection of pressure ulcers before clinical signs are apparent:
High resolution ultrasound has the ability to detect subtle changes in the fluid content of tissue. It has been demonstrated that the first ultrasound change that occurs in the formation of a pressure ulcer is edema in the subcutaneous tissue. This is followed by dermal and sub-epidermal edema. This information alerts the healthcare provider of tissue changes occurring before the clinical signs of a pressure ulcer are seen. Pressure relief and skin care can then be targeted before the ulcer has developed further.
Documentation of existence of pressure ulcers on admission:
There has always been a conflict over who is responsible for the formation of a pressure ulcer. Very often patients are transferred from one facility to another with a pressure ulcer already forming. By adding an ultrasound exam to your standard skin assessment upon admission, the receiving facility can document if a pressure ulcer is already forming. This documentation could be your defense when trying to determine where the pressure ulcer originated and who should pay for it. This could also reduce liability, regulatory sanctions, and fines.
“Due in part to the decrease in the incidence of pressure ulcers; liability insurance rates were decreased upon renewal.” (Provider)
Targeting of treatments to specific anatomical areas:
Providing pressure relief and skin care to all patients and anatomical parts is costly, time consuming, and often not practical. The EPISCAN exam allows for the treatments to target the patient and areas that need them the most. This can result in better outcomes and more efficient use of staff and materials.
“The scanner utility has already been realized through reduced treatment costs and the nurses’ treatment time has been utilized in other direct-care patient issues such as teaching, documentation and assessment-related procedures.”(Provider)
“We conclude that EPISCAN, in extended care rehabilitation units, is a cost-benefit to providers for preventing costly pressure ulcers. The expected cost savings for the at-risk patient is approximately $5,300.00 per resident over a 1 year period. The decision to use the EPISCAN was very robust and changed only when the incidence of pressure ulceration was below 3.0% in the standard evidence-based group. When used routinely, the EPISCAN skin ultrasound diagnosis will be cost-effective approximately 74% of the time.” (Referenced from a poster presented at SAWC. Principal Investigator: Ronald Shannon, MPH)
Distinguishing between pressure ulcers and friction ulcers:
Often, there is no distinction made between pressure ulcers and friction and incontinence ulcers, although the treatment regime can be different. The EPISCAN exam can distinguish between types of ulcers. This allows for more effective treatments of the ulcer.
Following pre-pressure ulcers to see if treatments are effective:
Once a pressure ulcer is seen developing on ultrasound, appropriate care is initiated to reverse the process. Up until now there has been no effective way to measure the effectiveness of these modalities. Follow-up exams can document the effectiveness of the treatment given.
Increasing awareness and compliance of staff:
There was a study performed at Yale University utilizing the EPISCAN in the treatment and prevention of pressure ulcers. One of the conclusions of this study is that it increased the awareness and compliance of the staff. By demonstrating ultrasound evidence of pressure ulcer formation staff members are more likely to take clinically appropriate action. Also, by showing the results of their efforts with improved scans, the outcomes of their actions are reinforced.