Mattresses and fluoroscopy.
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While a plethora of pressure-relieving and reducing equipment is available to nurses for the prevention and treatment of pressure ulcers, very little of it is specifically designed or appropriate for paediatric patients. The limited choice that does exist concentrates on neonates or babies, which is problematic for the nurse dealing with the older child. Children may be at increased risk of developing pressure injury as a result of the forces of friction, shearing and pressure that results from being nursed on a support system designed for the adult patient. This gap in service provision may cause dilemmas for the nurse who has a duty to 'cause no harm' (UKCC, 1992) in his/her attempt to protect and treat a child. This article introduces a new product available from Karomed (a division of the Verna Group) that has been specifically designed with the child in mind.
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Pressure ulcers are distressing, frequently occur in immobile and malnourished patients and the cost to patients in terms of pain and anguish must be a prime consideration. There is little information on the incidence and prevalence of pressure ulcer development within the independent sector, as this is difficult to obtain. However, with advances in treatment and technology, combined with more people with complex and multiple needs being cared for at home, the requirement for specialist pressure-relieving support surfaces in the community is increasing. This article reviews the need for clinical and cost-effective pressure-relieving surface solutions in the community and introduces the concept of the Russka pressure-relieving low air-loss system.
Within this article, the authors have put forward a solution to keep track of pressure-relieving devices using internet-based secure online systems. In partnership with a therapy bed company they set up a system that was able to manage and monitor the requirements of their trust and ensure that products are used for patients who most need them. In using these systems they were also able to gather real-time data on usage and costs as well as time-dependent analysis. The system has also allowed a means of gathering outcome measurement of all products in use. Over a 6-month period the authors have shown how a forecasted 18% budget deficit has been turned into a 10% under spend of the overall budget. It is suggested that these systems could be one way of managing the pressure-relieving needs of hospital trusts ensuring both clinical effectiveness and cost-benefit.
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Because of decreased scleral rigidity of tissue, penetrating keratoplasty in the pediatric age group is difficult. We have applied an early keratoplasty technique of graft fixation with indirect "bridge" or "overlay" sutures to temporarily stabilize the graft and facilitate wound closure.
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