Pressure ulcers, also known as bedsores, normally develop when an area of the body is under pressure for a relatively long time. I experienced pressure ulcers first hand when I was recovering from a spontaneous spinal cord haemorrhage in 2009. My first encounter with pressure ulcers was when I spent months on end on a wheelchair with no mobility. It was a painful journey I endured as a result of quick fixes rather than established protocol.
Having gone through the pains of pressure ulcers, I eagerly read Gianpaolo Fusari’s recent blog, When design meets medtech: Three ideas in preventing and managing pressure ulcers. I was keen on learning a designer’s view on identifying solutions to the pressure ulcer problem. As a patient we rarely get to see this side of the story – the creative process involved in identifying solutions such as cushioning, sensors to help scheduling and more. However, experiences have taught me that solutions to the pressure ulcer problem may not lie with innovative technologies or textures but with an established protocol to deliver care to the patient.
At the hospital
During my 9 months in the Intensive Care Unit, I was bedbound with an occasional few hours in a chair. My skin became weak; my muscles so slim that I could not lift my head from the pillow and yet I did not develop any significant pressure sores. They equipped me for several weeks with a special bed, which gave some movement and shifted angles from time to time resulting in no pressure sores whatsoever during those 9 months of being bedbound.
Lessons learned: Although I am not familiar with the technical side, I found that the special bed provided was a universal solution to dealing with patients who are bedbound for a long period. Unfortunately, this special bed did not provide additional benefits for my condition.
Once I was discharged, I was checked into a rehab centre for the next 14 months. That’s where pressure sores came into the spotlight. After being equipped with an electric wheelchair (courtesy of the rehab centre) we started experimenting on positions and seating angles as well as cushioning to find the ideal state where pressure ulcers would be minimized. For those who haven’t read it yet, I urge you to read Gianpaolo’s blog, which gives a peek into the research that takes place in this area.
We tried a variety of cushions – some ranging up to 800EUR. Unfortunately, the base of the chair made of wood was never replaced. I had periodical sores, it was worst during the summer (sweat and stickiness are a great breeding ground) and no matter how many seating tests we ran, they kept recurring. The worst period was when the pressure ulcers made me bedridden for 3 months, including an operation. This period probably cost my insurer well over 20,000 EUR.
Lessons learned: This was truly a trial & error process. Together with the professionals, we ran one seating test after another in order to figure out what the best solution was. There was much time spent on quick fixes and surprisingly the base of the chair was never replaced.
As my rehabilitation was paying off and my state progressed I was given a manual wheelchair. Instead of a wooden base, however, this one had straps and belts and was fitted with a fairly simple cushion crafted by the technical department of the rehab centre. And that made a huge difference. Ever since I started using this wheelchair I have had no issues with pressure sores. The simple idea of changing the base from a wooden to a strap-based one practically eliminated most of the pressure sores I had.
Lessons learned: Replacing wood with straps made my pressure sores disappear.
I experiment too
When patients go through the pains of any health and comfort issue, we are driven to find solutions that work.
Currently I’m trying out how it would be if I did not use my special mattress for a few days. I also use an electro-stimulating device at nights, which helps blood circulation to different parts of my body. I am planning to test pressure sores on my elbows with a new set of seating tests in the coming weeks. Yet, that’s as far as I can go right now as it’s quite expensive to experiment.
In a variety of settings: hospital, rehab centre, and home, various issues were identified, and different solutions worked. But all of these were found by a trial-&-error approach and most of them provided quick fixes rather than a long-term solution. I understand that different solutions work best for different people, and it is hard to find universal ways of dealing with bedsores. I’m very thankful for all the help I have received so far and looking back I wonder if it would be possible to change the ‘quick fix’ approaches in healthcare to more sustainable and thought though processes and protocols?
As a patient, I think yes.
– Hylke Sieders, father, avid sports fan and survivor