US-12622632-B2 - Method and system for pressure related skin injury risk assessment and treatment

Abstract

A system or method for pressure related skin injury risk assessment and treatment including measuring extrinsic and intrinsic pressure on skin of the patient through assigned ratings responsive to the pressure on skin measurement, measuring oxygenation of the patient and assigning a rating responsive to the oxygenation measurement, measuring perfusion of the patient and assigning a rating responsive to the perfusion measurement, summing the pressure on skin, oxygenation and perfusion ratings to obtain a POP Box score, determining a risk of pressure related skin injury for the patient in response to the POP Box score, and determining or selecting a recommended treatment from among a plurality of recommended treatments for the patient in response to the determined risk of pressure related skin injury.

Inventors

• Deborah C. Bly

Assignees

• Deborah C. Bly

Dates

Publication Date

20260512

Application Date

20211115

Claims (19)

1. 1 . A method of treatment of pressure related skin injury in a patient by a caregiver of the patient comprising: receiving a plurality of predefined weighted ratings for each of a plurality of factors including pressure on skin, tissue oxygenation, and perfusion factors, wherein the plurality of tissue oxygenation predefined weighted ratings is weighted in a different weighting range than the weighted rating range for pressure on skin and perfusion, each predefined weighted rating being associated with one or more different predefined measurement values for each factor; receiving a plurality of Pressure, tissue oxygenation, and Perfusion (POP) Box (POP Box) scores and an associated skin injury risk and a recommended treatment for each; receiving a measured pressure on skin of the patient; comparing the received measured pressure on skin with the received predefined measurement values for pressure on skin; assigning a pressure on skin weighted rating responsive to the comparing of the received pressure on skin measurement with the received predefined measurement values for pressure on skin, wherein the assigned weighted rating is the predefined weighted rating associated with the comparable predefined measurement value for the received measured pressure on skin; receiving a measured tissue oxygenation of the patient; comparing the received measured tissue oxygenation with the received predefined measurement values for tissue oxygenation; assigning a tissue oxygenation weighted rating responsive to the comparing of the received measured tissue oxygenation with the received predefined measurement values for tissue oxygenation, wherein the assigned weighted rating is the predefined weighted rating associated with the comparable predefined measurement value for the received measured tissue oxygenation; receiving a measured perfusion of the patient; comparing the received measured perfusion with the received predefined measurement values for perfusion; assigning a perfusion weighted rating responsive to comparing of the received perfusion measurement with the received predefined measurement values for perfusion, wherein the assigned weighted rating is the predefined weighted rating associated the comparable predefined measurements value for the received measured perfusion; summing the assigned pressure on skin, tissue oxygenation and perfusion weighted ratings to determine a POP Box score; determining a risk of pressure related skin injury for the patient in response to comparing the determined POP Box score to the received predefined POP Box scores and identification of the associated received predefined skin injury risk; determining a recommended treatment responsive to a comparing at least one of the POP Box score and the determined risk of pressure related skin injury to the associated received predefined recommended treatments; communicating the determined recommended treatment to the caregiver; receiving by the caregiver the determined recommended treatment for the patient; and performing the received determined recommended treatment in the treatment of the patient for the treatment of pressure related skin injury.
2. 2 . The method of claim 1 wherein the received predefined weighted ratings with the associated predefined measurement value and the assigning of the tissue oxygenation weighted rating based on tissue oxygenation includes: a first tissue oxygenation weighted rating where tissue oxygenation levels of within normal levels (WNL) tissue oxygenation is less than 10 percent of normal; a second tissue oxygenation weighted rating where tissue oxygenation is between 10 and 20 percent of normal; a third tissue oxygenation weighted rating where tissue oxygenation is between 20 and 30 percent of normal; and a fourth tissue oxygenation weighted rating where tissue oxygenation is greater than 30 percent of normal.
3. 3 . The method of claim 1 further comprising: receiving a measurement of a venous oxygen saturation (SvO2) or a central venous oxygen saturation (SvcO2) and the comparing thereof and the assigning of the tissue oxygenation weighted rating being based on the measured SvO2 or SvcO2; receiving a measurement of a ratio of arterial oxygen concentration to the fraction of inspired oxygen (P/F ratio) of the patient and wherein the assigning of the tissue oxygen weighted rating is responsive to the measured P/F ratio; receiving a measurement of a desaturation recovery time of oxygen saturation (SpO2) of the patient and wherein the assigning of the tissue oxygenation weighted rating is responsive to the measured desaturation recovery time of SpO2; receiving a measurement of a blood glucose of a patient and wherein the assigning of the tissue oxygenation weighted rating is responsive to the measured blood glucose; receiving a hemoglobin/hematocrit (H/H) measurement of the patient and wherein the assigning of the tissue oxygenation weighted rating responsive to the measured H/H; receiving a measured vital sign of the patient including the blood pressure and heart rate and wherein the assigning of the tissue oxygenation weighted rating is responsive to the measured vital sign; receiving a Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV) measurement of the patient and wherein the assigning of the tissue oxygenation weighted rating is responsive to the received measured CI, CO or SV; receiving a measured or identified presence of one or more pressor agents and wherein the assigning of the tissue oxygenation weighted rating is responsive to the measured or identified pressor agent; and receiving an identified maceration of the patient and wherein the assigning of the tissue oxygenation weighted rating is responsive to the identified maceration.
4. 4 . The method of claim 1 , further comprising: determining a Braden Score and the assigning the pressure on skin weighted rating responsive to the Braden Score; determining an age of the patient and wherein the assigning of the pressure on skin weighted rating responsive to the determining of the age; receiving a determined presence of steroid use by the patient and wherein the assigning of the pressure on skin weighted rating is responsive to the determining of the presence of steroid use; receiving a measured Edema of the patient and wherein the assigning of the pressure on skin weighted rating responsive to the measuring of the Edema; receiving a determined presence of pain or decreased mobility of the patient and wherein the assigning of the pressure on skin weighted rating responsive to the determining of the present of pain or paralysis; receiving a measured Albumin level of the patient and wherein the assigning of the pressure on skin weighted rating responsive to the measuring of the Albumin level; receiving an identified presence of one or more mechanical apparatus associated with the patient and wherein the assigning of the pressure on skin is responsive to the number of identified apparatus present; and receiving a determined pressure redistribution surface time of the patient and wherein the assigning of the pressure on skin weighted rating responsive to the determining.
5. 5 . The method of claim 1 , further comprising one or more of the following processes: receiving a measured vital sign of the patient including the blood pressure and heart rate and wherein the assigning of the perfusion weighted rating responsive to the received measured vital sign; receiving a measured Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV) of the patient and wherein the assigning of the perfusion weighted rating is responsive to the received measured cardiac measurement; receiving an identified presence of one or more pressor agents and wherein the assigning of the perfusion weighted rating responsive to the received identified pressor agent; and receiving an identified maceration of the patient and wherein the assigning of the perfusion weighted rating is responsive to the received identified maceration.
6. 6 . The method of claim 1 , further comprising one or more of the following processes: receiving a determined body mass index of the patient and assigning a body mass index weighted rating to the received body mass index is responsive to the received determined body mass index; receiving a determination of whether the patient was found in a down position prior to evaluation and assigning a down position weighted rating responsive to the received determination of patient found in a down position; receiving a plurality of determined operating room variables of the patient and assigning an operating room weighted rating responsive to the number of such operating room variables received; receiving a determined presence of one or more disease processes present in the patient and assigning a disease process presence weighted rating responsive to the number of received present disease processes, wherein the one or more disease processes includes one or more of hemodialysis or continuous veno-venous hemodialysis; receiving a determined length of stay for both ICU and regular hospital stays for the patient and assigning a hospital length of stay weighted rating responsive thereto; receiving an evaluation of an emergency room procedure experience by the patient and assigning an emergency room procedure experience weighted rating responsive thereto; and receiving an identified previous or existing skin injury of the patient and assigning a preexisting skin injury weighted rating responsive thereto and wherein the summing to determine the POP Box score further includes the assigned weighted rating for the one or more above additional received factors.
7. 7 . The method of claim 1 wherein the weighted rating range for pressure on skin and perfusion is a rating value from 1 to 4; and wherein the POP Box score is determined to be in the range of 0 to 25, the determined and communicated recommended treatment is taking no action; wherein the POP Box score is determined to be in the range of 25 to 50, the determined and communicated recommended treatment is providing normal turn on redistributing surface practice; wherein the POP Box score is determined to be in the range of 50 to 75, the determined and communicated recommended treatment is adapting care of the patient for low air loss overlay or surface with constant air redistribution; wherein the POP Box score is determined to be in the range of 75 to 100, the determined and communicated recommended treatment is providing the patient with a low air loss bed, providing a more frequent turn schedule and/or providing for continual turn bed; and wherein the POP Box score is determined to be greater than 100, the determined and communicated recommended treatment is providing the patient with a low air loss bed with continual turning.
8. 8 . The method of claim 1 , further comprising: repeating the treatment steps of receiving, comparing, and assigning for each of the pressure on skin, tissue oxygenation and perfusion and the steps of summing, determining the risk, and determined the recommended treatment until the POP Box score is in a no treatment range; and when it is determined that the determined treatment is in the no treatment range, taking no further action for the treatment of pressure related skin injury.
9. 9 . The method of claim 1 wherein the weighted rating range for pressure on skin and perfusion is a rating value from 1 to 4.
10. 10 . The method of claim 1 wherein: the POP Box score is determined to be in a first treatment range, the determined recommended treatment is providing normal turn on redistributing surface practice; the POP Box score is determined to be in a second treatment range, the determined recommended treatment is adapting care of the patient for low air loss overlay or surface with constant air redistribution; the POP Box score is determined to be in a third treatment range, the determined recommended treatment is providing the patient with a low air loss bed, providing a more frequent turn schedule and/or providing for continual turn bed; the POP Box score is determined to be in a fourth treatment range, the determined recommended treatment is providing the patient with a low air loss bed with continual turning; and the POP Box score is determined to be in a no treatment range wherein the method provides for taking no further action for treatment of pressure related skin injury.
11. 11 . The method of claim 10 wherein wherein the no treatment range is where the determined POP Box score is in the range of 0 to 25; wherein the first treatment range is where the determined POP Box score is in the range of 25 to 50; wherein the second treatment range is where the determined POP Box score is in the range of 50 to 75; wherein the third treatment range is where the determined POP Box score is in the range of 75 to 100; and wherein the fourth treatment range is where the determined POP Box score is greater than 100.
12. 12 . The method of claim 1 wherein the POP Box score is determined to be in the range of 25 to 50, the determined and communicated recommended treatment is providing normal turn on redistributing surface practice; wherein the POP Box score is determined to be in the range of 50 to 75, the determined and communicated recommended treatment is adapting care of the patient for low air loss overlay or surface with constant air redistribution; wherein the POP Box score is determined to be in the range of 75 to 100, the determined and communicated recommended treatment is providing the patient with a low air loss bed, providing a more frequent turn schedule and/or providing for continual turn bed; wherein the POP Box score is determined to be greater than 100, the determined and communicated recommended treatment is providing the patient with a low air loss bed with continual turning; and wherein the POP Box score is determined to be less than 25, taking no action for the treatment of pressure related skin injury.
13. 13 . The method of claim 1 , further comprising: repeating the treatment steps of receiving, comparing, and assigning for each of the pressure on skin, tissue oxygenation and perfusion and the steps of summing, determining the risk, and determined the recommended treatment until the determining of a risk of pressure related skin injury is in a no treatment range; and wherein the determined risk, is in the no treatment range, taking no action for the treatment of pressure related skin injury.
14. 14 . A method of treatment of pressure related skin injury in a patient by a caregiver of the patient comprising: receiving predefined weighted ratings for each of a plurality of factors including pressure on skin, tissue oxygenation, and perfusion factors, each predefined weighted rating being associated with one or more different predefined measurement values for each factor wherein the plurality of tissue oxygenation predefined weighted ratings is weighted in a different weighting range than the weighted rating range for pressure on skin and perfusion; receiving a plurality of pressure, tissue oxygenation, and Perfusion (POP) Box (POP Box) scores and an associated skin injury risk and a recommended treatment for each; receiving a measured pressure on skin of the patient; comparing the received measured pressure on skin with the received predefined measurement values for pressure on skin; assigning pressure on skin a weighted rating responsive to the comparing of the pressure on skin measurement with the received predefined measurement values for pressure on skin, wherein the assigned weighted rating is the predefined weighted rating associated with the comparable predefined measurement value for the received measured pressure on skin; receiving a measured tissue oxygenation of the patient; comparing the measured tissue oxygenation with the received predefined measurement values for tissue oxygenation; assigning a tissue oxygenation weighted rating responsive to the comparing of the measured tissue oxygenation with the received predefined measurement values for tissue oxygenation, wherein the assigned weighted rating is the predefined weighted rating associated with the comparable predefined measurement value for the received measured pressure on skin; receiving a measured perfusion of the patient; comparing the received measured perfusion with the received predefined measurement values for perfusion; assigning a weighted rating responsive to the comparing of the perfusion measurement with the received predefined measurement values for perfusion, wherein the assigned weighted rating is the predefined weighted rating associated the comparable predefined measurements value for the received measured perfusion; summing the assigned pressure on skin, tissue oxygenation and perfusion weighted ratings to determine a POP Box score; determining a risk of pressure related skin injury for the patient in response to comparing the determined POP Box score to the received predefined POP Box scores and identification of the associated received predefined skin injury risk; determining a recommended treatment responsive to a comparing at least one of the POP Box score and the determined risk of pressure related skin injury to the associated received recommended treatments, wherein the POP Box score is determined to be in a first treatment range, the determined recommended treatment is providing normal turn on redistributing surface practice; wherein the POP Box score is determined to be in a second treatment range, the determined recommended treatment is adapting care of the patient for low air loss overlay or surface with constant air redistribution; wherein the POP Box score is determined to be in a third treatment range, the determined recommended treatment is providing the patient with a low air loss bed, providing a more frequent turn schedule and/or providing for continual turn bed; and wherein the POP Box score is determined to be in a fourth treatment range, the determined recommended treatment is providing the patient with a low air loss bed with continual turning; wherein the POP Box score is determined to be in a fifth treatment range, which is a no treatment range wherein the recommended treatment is to take no action for the treatment of pressure related skin injury; communicating over the output interface the determined recommended treatment; receiving by the caregiver the determined recommended treatment for the patient; performing the received determined recommended treatment in the treatment of the patient for the treatment of pressure related skin injury; and repeating the treatment steps of receiving, comparing, and assigning for each of the pressure on skin, tissue oxygenation and perfusion and the steps of summing, determining the risk, and determined the recommended treatment, until the determined POP Box score is in the no treatment range wherein the method provides for taking no action for the treatment of pressure related skin injury.
15. 15 . The method of claim 14 wherein the assigning of the tissue oxygenation weighted rating based on tissue oxygenation is a function of the received predefined weighted ratings with the associated predefined measurement value and includes: a first tissue oxygenation weighted rating where tissue oxygenation is within 10 percent of normal; a second tissue oxygenation weighted rating where tissue oxygenation is between 10 and 20 percent of normal; a third tissue oxygenation weighted rating where tissue oxygenation is between 20 and 30 percent of normal; and a fourth tissue oxygenation weighted rating where tissue oxygenation is greater than 30 percent of normal.
16. 16 . The method of claim 14 , further comprising one or more of the following: a measured a venous oxygen saturation (SvO2) or a central venous oxygen saturation (SvcO2) and receiving a plurality of SvO2 or SvcO2 predefined measurement values and the comparing thereof and assigning a venous oxygen saturation (SvO2) or a central venous oxygen saturation (SvcO2) weighted rating being based on the measured SvO2 or SvcO2; a measured a ratio of arterial oxygen concentration to the fraction of inspired oxygen (P/F ratio) of the patient and assigning an arterial oxygen concentration to the fraction of inspired oxygen (P/F ratio) weighted rating is responsive to the measured P/F ratio; a measured a desaturation recovery time of oxygen saturation (SpO2) of the patient and assigning a desaturation recovery time of oxygen saturation (SpO2) weighted rating is responsive to the measured desaturation recovery time of SpO2; a measured a blood glucose of a patient and assigning of a blood glucose weighted rating is responsive to the measured blood glucose; a measured a hemoglobin/hematocrit (H/H) of the patient and assigning a hemoglobin/hematocrit (H/H) weighted rating responsive to the measured H/H; a measured vital sign of the patient including the blood pressure and heart rate and assigning a vital sign weighted rating is responsive to the measured vital sign; a measured a Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV) measurement of the patient and assigning a Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV) weighted rating is responsive to the received measured CI, CO or SV; an identified presence of one or more pressor agent and assigning a pressor agent weighted rating is responsive to the identified pressor agent; and an identified maceration of the patient and assigning a maceration weighted rating is responsive to the identified maceration.
17. 17 . The method of claim 14 , further comprising one or more of the following processes: receiving a determined Braden Score and wherein assigning the pressure on skin weighted rating is responsive to the received Braden Score; receiving an age of the patient and assigning the pressure on skin weighted rating is responsive to the received age; receiving a determined steroid use by the patient and assigning the pressure on skin weighted rating is responsive to the received determined steroid use; receiving a measured Edema of the patient and assigning the pressure on skin weighted rating is responsive to the received measured Edema; receiving a determined a presence of pain or paralysis of the patient and assigning the pressure on skin weighted rating is responsive to the received determined presence of pain or paralysis; receiving a measured Albumin level of the patient and assigning the pressure on skin weighted rating is responsive to the received measured Albumin level; receiving an identified presence of one or more mechanical apparatus associated with the patient wherein the assigning the pressure on skin is responsive to the number of identified apparatus present; and receiving a determined pressure redistribution surface time of the patient and assigning the pressure on skin weighted rating is responsive to the received determined pressure redistribution surface time.
18. 18 . The method of claim 14 , further comprising one or more of the following processes: receiving a measured vital sign of the patient including the blood pressure and heart rate and assigning the perfusion weighted rating is responsive to the received measured vital sign; receiving a measured Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV) of the patient and assigning the perfusion weighted rating is responsive to the received measured Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV); receiving an identified presence of one or more pressor agent and assigning the perfusion weighted rating is responsive to the received identified pressor agent; and receiving an identified maceration of the patient and assigning the perfusion weighted rating is responsive to the received identified maceration.
19. 19 . The method of claim 14 , further comprising one or more factor processes selected from the group consisting of: receiving a determined body mass index of the patient and assigning a weighted rating responsive to the received body mass index; receiving a determination that patient was found in a down position prior to evaluation and assigning a found down weighted rating responsive thereto; receiving a determination of an operating room variable of the patient and assigning an operating room variable weighted rating responsive to the number of such operating room variables present; receiving a determination of a presence of one or more disease processes present in the patient and assigning a present disease weighted rating responsive to the number of such present disease processes, wherein the one or more disease processes includes one or more of hemodialysis or continuous veno-venous hemodialysis; receiving a determination of a length of stay for both ICU and regular hospital stays for the patient and assigning a hospital length of stay weighted rating responsive thereto; receiving a determination of an evaluation of an emergency room procedure experience by the patient and assigning an emergency room procedure experience weighted rating responsive to the received determined evaluation; and identifying previous or existing skin injury of the patient and assigning a preexisting skin injury weighted rating responsive to the identifying; and wherein the summing to determine the POP Box score further includes the assigned weighted rating for these one or more factor processes.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS This application is a continuation-in-part of co-pending U.S. application Ser. No. 15/862,358, filed Jan. 4, 2018, which is a continuation application of U.S. application Ser. No. 12/793,514 filed on Jun. 3, 2010, which claims the benefit of U.S. Provisional Application No. 61/183,667, filed on Jun. 3, 2009, the disclosures of which are incorporated herein by reference in their entireties. FIELD The present disclosure relates to methods and systems for medical evaluation care and, more specifically, to systems and methods for evaluating a patient for pressure related skin injury risk and recommended treatment. BACKGROUND The statements in this section merely provide background information related to the present disclosure and may not constitute prior art. In medical treatment, pressure ulcers are currently tagged as hospital acquired conditions (HAC) unless they were present on admission (POA) of the patient. When pressure ulcers are classified as HAC, they are almost always considered to be preventable with appropriate treatment. It has been estimated that the cost in the United States for treating stage 3-4 pressure ulcers can be as high as $11 Billion annually. However, the costs for treatment of such patient conditions are withheld per guidelines for pressure ulcers as issued by the Center for Medicare and Medicaid Services (CMS). The current risk identification tools used most commonly for assessment of patient risk of pressure related skin injury are the Braden and the Norton scale (not attached). These tools have become the gold standard for basic risk assessment. However, as described herein, these tools are only the start of the necessary assessment for risk related injury as neither scale addresses the more complex components of critical illness, physiological responses and treatments. All of which have non-visible caustic potential. While measures should be taken to prevent pressure related injury during medical treatment or a hospital stay, pressure ulcers have been found to occur regardless of strict compliance to preventative measures such as the regular turning of bed ridden patients every two hours, (i.e., turn q2), the redistribution of a patient's weight, mechanical loading and nutritional support. Patients continue to suffer from skin injury even where medical and nursing care is diligent and timely consistent with best practices. SUMMARY As addressed herein, the inventor hereof has determined that not all pressure sores or pressure ulcers, even though not initially POA, are purely due to poor nursing care or improper application of medical treatment and found that there are other characteristics and factors that need to be considered when evaluating a patient and providing treatment to a patient. As described herein are new and improved systems and methods for evaluating risk of patients for pressure related injury. These systems and methods can, in some embodiments, provide a more extensive system than currently used and that is inclusive of interrelated variables that can effect integrity of skin or rather the impairment of skin integrity. These variables or factors may be either extrinsic or intrinsic in nature. As described herein, the Pressure, Oxygenation, and Perfusion (POP) Box (hereinafter “POP Box”) systems and methods have been created to expose and apply physiologic factors that lead to skin failure and increased risk of pressure ulcers. In general these intrinsic and/or extrinsic variables and factors have been determined by the inventor to affect pressure, oxygenation or perfusion to skin surface. The POP Box as described herein builds on prior assessments and applies a variety of factors related to the integumentary system, homeostasis and physiological stressors that more fully addresses risks for each patient. The present method and system does not stop or limit itself to the prior risk factors teachings and belief that following the current care practices will prevent pressure ulcers in all cases. The use of the POP Box as described herein utilization, will not by itself prevent all HAC pressure ulcers even with excellent health care, as the inventor hereof has determined that not all HAC pressure ulcers are preventable. For example, it has been determined that some pressure ulcers are the result not of poor nursing care, but are associated with impaired tissue oxygenation that can occur as a result of a large number of factors, other than medical care practitioners following pre-established bedside procedures. The systems and procedures as described herein are consistent with other evidence based medicine (EBM) procedures for enhancement of health care services. The inventor has determined that it is highly likely that the affects of pressure, oxygenation and perfusion at a microvascular level provide additional variables that can often lead to skin injury. As described herein, underlying health conditions and insults at a micro