Interview with Steve Mogensen and John Hertig
Mogensen: Those recommendations consist of a set of preventive protocols [see sidebar, "Soft-Tissue Management Interventions With Use of High-Frequency Ultrasound"]. We worked with nursing homes, reviewing their existing protocols, to develop these.
Hertig: Never before could we see below the skin to detect pressure ulcers in their infancy. So what do you do for a developing wound before it's even visible? For example, if it's caused by pressure, what steps do you take to prevent an expensive-to-treat wound? We don't dictate to facilities that they must adopt our approach rather than doing what they've done before. We're just giving them direction and the confidence to carry out their interventions in a targeted, focused approach.
We learned early on that nursing homes need specific protocols to know what to do when they can't see a developing wound with their eyes or detect it by touch. We help by saying, "Given past experience and successes, this is a way to address the problem."
Zinn: What kind of equipment is required to perform the scans?
Mogensen: The scans are obtained with a portable, high-frequency ultrasound scanner, manufactured by Longport, Inc., in Swarthmore, Pennsylvania. It consists of an IBM-compatible personal computer with a Windows« operating system, a custom electronics board that's placed into the PC, and a custom-designed probe-the handheld device that is held against the skin to obtain a scan-which is connected to the electronics board.
Zinn: How are the scans performed?
Mogensen: The staff member operating the scanner simply puts gel on the probe to ensure good sound transmission between the probe and the skin and positions it over the area to be scanned. The computer captures the images and then they are e-mailed-using secure, HIPAA-compliant encryption technology-to our radiologists' facility in Pennsylvania, where they are read. After reading and interpreting the scanned images, the radiologist generates a report and sends it back to the nursing home via e-mail within 12 hours, with a hard-copy follow-up.
Zinn: Do long-term care facilities have to purchase the ultrasound scanner, or can it be leased?
Mogensen: We provide the scanners to the facilities. They can buy their own, but this is quite expensive.
Zinn: Is the equipment portable enough to be placed on a cart and wheeled from room to room, so that scans can be performed wherever it's convenient?
Mogensen: Yes, it is. In fact, as part of our services we provide a cart and all the necessary equipment to permit nursing staff to perform scans at bedside.
Zinn: Which members of the nursing home's staff would be best qualified to perform these scans?
Mogensen: Anybody can be trained by our wound care experts to perform the scans; it's not difficult. To help a facility determine which of their staff members should be trained, we try to identify those with leadership skills-people who are quality-of-care advocates who will be likely champions of pressure ulcer prevention. The training course lasts two days, and typically four or five direct care staff from a nursing home are trained. The experts conducting the training proctor a competency test to ensure that the trainees have demonstrated the necessary skills and basic understanding of ultrasound technology to operate the equipment and capture quality scans. During the next few days, the trained staff members practice, and generally by the following week, the quality of their scans is excellent.
When we visit a facility, we can sense whether its nursing staff has the level of commitment needed to get behind a wound prevention program. It's generally not the administrator who will make using this technology worthwhile, but the direct care staff. Depending on the clinical staff members' familiarity with computers, there is a slight learning curve because of their initial fear of learning a new, computer-based technology, but they generally absorb the information rapidly. After they're trained, what motivates them is seeing results. When they hear from our radiologist that a resident has a phase III developing pressure ulcer and needs a pressure-relieving mattress and then act on that advice, they can see for themselves that the wound is prevented before it surfaces. They can see the problem reversing more each week as they do follow-up scans. That spreads a full commitment to pressure ulcer prevention throughout an organization.
Zinn: In how many long-term care facilities have you placed the portable ultrasound scanner for use in assessing and preventing pressure ulcers?
Mogensen: Although the technology has been in development for more than a decade and in use in long-term care for several years, it is just now being incorporated into a nationwide service. There are currently more than 20 skilled nursing facilities in the United States using this technology.
Zinn: Are data available from those facilities that show an improvement in their prevention of pressure ulcers after they began using the equipment?
Hertig: The scanner has been in use in some facilities for as long as five years-for example, at Little Flower Manor in Wilkes Barre, Pennsylvania-and they have been tracking results. That particular facility has been able to show a 40 to 50% reduction in the incidence of pressure ulcers, which is quite significant given the high acuity level of its population.
Also, studies conducted at two Skilled Healthcare LLC facilities (Foothill Ranch, California) in the Southwest have shown that the technology detected and prevented 18 decubitus ulcers during its first 12 weeks of use.