Danielle Base
Danielle is a Specialist Occupational Therapist and Moving and Handling Practitioner, and leads the team of Bristol-based Pearce Brothers Mobility.
A Qualified Occupational Therapist (BSc Hons.) with 20 years’ experience in the profession, Danielle is a registered OT with the Health and Care Professions Council (HCPC). Danielle has worked in both health and social care, supporting people with complex needs in hospital and community care settings.
As well as OT work for Pearce Brothers Mobility, Danielle provides moving and handling training to the NHS and Local Authority Community Care and Therapy Services, as well as for Families, Personal Assistants, Care Agencies, Care Homes and Hospices.
Danielle has a special interest in research and strategies for pressure care management and works with Gel Ovations Europe on the development of Medical Silicone Gel protection solutions for the prevention and treatment of pressure ulcers. She also provides training to health care professionals on 24 hour preventative pressure care strategies and equipment, working closely with tissue viability and therapy teams on finding solutions for complex pressure care cases.
Danielle believes that pressure care management should have a multidisciplinary team approach, and that both nurses and therapists working jointly together can significantly reduce the risk of pressure injuries and improve a person’s quality of life and well-being.
Poster Presentation (Research category) at The Society of Tissue Viability 2023 Conference
The 3 P’s when prescribing Medical Grade Silicone Gel; Pressure, Posture and Positioning
Abstract
Summary – When prescribing pressure care products to prevent or manage skin integrity for individuals who are at risk, there are a range of solutions. This project was set up to collect quantitative and qualitative data on shear, pressure, comfort, and stability when using Dimensional medical grade silicone gel, in comparison to foam and static air products.
Aims and Objectives – The aim was to record how dimensional gel manages pressure and shear, when seated in a standard armchair compared to other pressure care products. In addition, the personal views and thoughts captured would be able to add the voice of the person into this trial.
The objective of the project was to provide evidence and guidance to practitioners to support them with their clinical decisions when prescribing dimensional gel, and with developing a pressure care plan for individuals. In addition, offering the company valuable evidence and data to further develop the product.
Background – Pressure care in the UK costs the NHS 3.8 million pounds a day (NHS England 2018) (1) not to mention the cost to the individual whose lives are greatly changed in the process of being treated (Mervis and Philips.) (2)
Every day, Clinicians face having to manage and treat individuals relying on their own knowledge and ability to identify, prevent and treat pressure. In addition, organisations play a large part in ensuring an approach, policies, procedures, tools and accessibility to equipment or products to ensure good practice. (J keen – et all) (3)
Medical grade silicone gel provides a soft cooling, comforting layer of protection for the prevention of pressure ulcers, that is widely prescribed worldwide and is effective in its application. Dimensional gel whilst being both versatile and unique in a variety of settings offers limited clinical evidence or guidance, to fully understand and describe its impact and scope in practice.
Technique ‘The Comfort Research Pod’ – An invitation shared via Eventbrite and social media provided 30 individuals whose skin was not compromised, to participate in this randomised trial called “The Comfort Research Pod”.
Volunteers provided information, including height, weight, BMI, health, and level of mobility, before testing their response to sitting on a height adjustable chair, without a cushion, foam, dimensional gel, and a static air cushion.
To gather quantitative objective evidence, the FSA Pressure Map System and “I Shear” device were used to measure the impact on each surface.
A Likert scale questionnaire was used to collect qualitative data. Permitting this research to consider the subjective view of each solution and what factors may be key with prescribing specialist pressure cushions, including temperature comfort and stability.
Recognising that in practice often cushions are issued, chairs not adjusted, each cushion was assessed at the correct and incorrect height, to understand if height is a contributing factor in the performance of the cushion and a key factor when choosing and prescribing pressure cushions.
Two Occupational Therapists completed the testing gathering comparable data, cross referencing and checking that the trial was set up identically for each volunteer adopting the basic principles as listed in the Code of practice for research (UK Rio) (4)
Results – All three cushions when correctly fitted to the volunteer’s seated height, offered additional comfort, and decreased pressure and shear.
Medical grade dimensional gel reduces pressure and shear and scored highly in both the quantitative data and the qualitative feedback. Volunteers stating that it is, cooler, and offered increased stability without adapting the height of the chair.
Personal preferences of the volunteer generally supported the formal data demonstrating they were experiencing less pressure or shear, and were personally aware that they were more stable, and comfortable.
Discussion – Individuals that require stability with no seat height alteration, those who are at risk of pressure and shear, require cooling, dimensional gel should be considered during the assessment and prescription of pressure care.
Development of the 3 Ps; It is important that clinicians consider the individuals Pressure, Posture and Positioning in seating. The statistics demonstrated that only offering a cushion and not considering the change to a person’s posture or positioning, reduced the effectiveness and ability to relieve pressure and shear.
The research has instigated further development into a new product to offer additional immersive support.
References
- NHS England – Pressure Ulcers: revised definition and measurement summary and recommendations. June 2018 NHS Improvement 2018 Publication code CG 73/18.
- J S Mervis and TJ Philips – Pressure ulcers: Pathophysiology, epidemiology, risk factors and presentation. . Journal of the American Academy of Dermatology. October 2019 Volume 81 Issue 4 Pages 881 -890
- L Pinkney, J Nixon, L Wilson, S Coleman , E McGinnis, N Stubbs, C Dealey, A Nelson , M Patterson, J Keen. – Why do patients develop pressure ulcers? A retrospective case study. British Medical Journal JAN 2014 Volume 4 Issue 1
- UK RIO – Code of practice for Research – Promoting good practice and preventing misconduct. 2019-2021 UK Integrity Office.
Poster Presentation (Case study category) at The Society of Tissue Viability 2022 Conference
Preventative strategies for reducing interface pressure on sling users during hoist transfers
Abstract
Background: This paper explores the development of a care strategy for the prevention and treatment of pressure ulcers when transferring patients using slings. In care facilities, hospitals and the community, immobile patients are transferred using a hoist and sling. This can compromise a patient’s skin in contact with sling edges and seams, due to the concentration of forces on the body.
Soft tissue damage can occur around the posterior upper and lower thigh areas, which can lead to pressure ulcers. Studies have shown that force concentration on a patient’s skin can increase by 300% [1] over natural body weight force, when using a sling.
Transfers should be seen as part of 24-hour pressure care management; Across Europe approximately 18% of in-patients have pressure ulcers[1]. They are more likely to occur in people with the inability to reposition themselves[2]. Yet we found limited academic research or statistics to show the effects on a patient’s skin of the heightened interface pressure during transfers.
Method: The project looked at solutions to decrease interface pressure to reduce potential pressure injuries and improve patient comfort. This included using different moving and handling techniques and applying low-profile silicone gel padding to the sling.
Two case studies of transfers were undertaken: Pressure mapping of a 74-year-old (Joe) and a clinical case study of a 78-year-old client in the community (Edith) with pre-existing pressure issues. These demonstrate how improvements to patient pressure care and well-being can be made.
Results: The pressure mapping test of Joe indicated pressure hotspots impacting on his skin, at the front and rear edges of the sling, showing an average interface pressure of 29.96mmHg. Following insertion of the silicone gel, these hotspots were reduced to an average interface pressure of 13.94mmHg. Average interface pressure overall was reduced by 53.5%.
Joe was also asked to rate his pain level, using the Likert Scale [2] (a rating between 1-10, with 1 being very uncomfortable, and 10 being very comfortable). Without the gel, Joe gave a rating on the Likert Scale of 3. After application of the gel padding, Joe reported a rating of 8.
In the clinical case study, Edith had been experiencing discomfort, skin-marking, and agitation during sling transfers. After two weeks of using improved moving and handling techniques, along with silicone gel inserts, the redness and marking completely cleared and Edith was less agitated, enabling safer transfers.
Conclusion: To reduce the risk of pressure injuries during transfers, the following need to be considered:
Education and training within the health and social care sector of skin protection during transfers using a hoist and sling. The use of low-profile silicone pads to protect the skin, reduce the risk of shear, friction and pressure; type of hoist and sling, moving and handling techniques and the duration and frequency of hoisting during a 24hr period.
[1] Katrien Vanderwee, Michael Clark, Carol Dealey, Lena Gunningberg L. Pressure ulcer prevalence in Europe: a pilot study. J Eval Clin Pract. 2007 Apr;13(2):227-35. doi: 10.1111/j.1365-2753.2006.00684.x.
[2] National Institute of Clinical Excellence (NICE). Pressure ulcers: prevention and management of pressure ulcers [GG 179]. London: NICE: 2014
