Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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DISPLAY FOR USE IN MANAGING MOVEMENT OF A PATIENT IN A BED
This invention relates to a display apparatus for use in managing
movement of a patient in a bed between different positions of lying to prevent
the
development of pressure ulcers.
This application is related to Application No 2,722,252 filed September
7th 2010 which is pending and discloses a similar arrangement for the same
purpose.
BACKGROUND OF THE INVENTION
Pressure wounds are costly in regards to human suffering and human
resource utilization across healthcare settings. In the United States,
reported
incidence or pressure ulcers and wound care in acute settings range from 2% to
29% and costs have been reported from $2000 to $70,000 per wound. It is
estimated that 2.5 million clients are treated every year for wounds related
to
pressure, of which 60,000 die from complications.
According to the Canadian Association of Wound Care (CWAC) there
are 12 recommendations to manage and prevent pressure ulcers. One of these
recommendations looks at the importance of assessing and modifying the
client's
environment, which focuses on the importance of turning and positioning the
client in
bed to offload pressure and prevent ulcers.
Being able to position clients to relieve pressure is a fundamental skill
in health care that requires the practical ability that is vital to enhancing
a client's
physical, social, and psychological wellbeing. Correct therapeutic positioning
of
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clients is essential to maximize physiological functioning and recovery. Poor
bed
positioning can compromise a client's airway, cause joint dislocations,
displacement
of fractures, peripheral nerve damage, spasms and pressure ulcers.
The recommendations for positioning focus on treating pressure
ulcers, however, the principles can be applied to other types of wounds that
require
pressure relief. The positions and principles can be generalized to suit the
client's
individual needs. Frequent turning and proper re-positioning will help
decrease the
pressure forces and reduce the chance of wounds related to pressure from
occurring. To accomplish this it is important to educate health care workers
and the
client on proper positioning techniques to enhance the client's physical and
psychological wellbeing. Thus interrupted or reduced pressure on wounds will
reduce ischemia and will likely improve tissue healing. However only full body
change of position completely relieves pressure.
According to best practice, clients should be repositioned at least every
2 hours. However, the turning and positioning schedule should be
individualized to
the client's needs, which depends on the type and severity of the wound.
It has been proposed to use diagrams with clocks and body positions
of clients are helpful in reminding health care workers when and how to
position the
client. Turning schedules featuring crude pictures of clocks or sign off
sheets are
commonly used in healthcare settings but lack the required functionality in
regards to
the ability to substantially individualize the routine, provide a clear
picture as to how
the client should be positioned, and allow ease of supervision of the routine.
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In US Patent 6,031,791 of Thoni issued February 29th 2000 is
disclosed a monitoring clock for use in monitoring the turning of patients in
a bed.
This includes a clock face with hands indicating the current time and the
clock face
divided into sections. Each section is marked with a displayed coding which
indicates a required position for the patient during that time section. Also
there is
disclosed a necessary legend for decoding the display to inform the caretaker
of the
required position.
SUMMARY OF THE INVENTION
It is one object of the invention to provide a display apparatus for use
in managing movement of a patient in a bed.
According to one aspect of the invention there is provided a display
apparatus for use in managing movement of a patient in a bed between a
plurality of
separate positions of lying in the bed, comprising:
a substrate for supporting elements to be displayed;
a plurality of display elements each having graphics thereon illustrating
a required lying position for the patient;
the substrate providing a plurality of locations each for receiving a
respective one of the display elements;
the locations being arranged on the substrate in association with
graphics on the substrate indicating a time during which the lying position is
to be
adopted;
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the display elements being arranged such that the display element at
each location on the substrate can be changed so as to allow each location to
be
filled with a selected one of the display elements;
wherein each of the locations is defined by a window in the substrate
at which a respective one of the display elements is visible;
and wherein each of the display elements has graphics thereon
indicating a plurality of lying positions and is movable relative to the
window so as to
move a selected one of the graphics to the window to be displayed.
Preferably there are six locations arranged at angularly spaced
positions around a center of the substrate.
Preferably the substrate includes a clock face and the locations are
arranged around the center so as to be associated with specific time zones
around
the clock face.
Preferably the graphics on the display elements are arranged to
illustrate the positions supine, left side and right side lying positions for
the patient.
Preferably each of the display elements comprises a disk mounted on
the substrate for rotation about a center axis thereof at right angles to the
substrate
with the graphics arranged thereon at angularly spaced positions around the
axis so
as to rotate a selected one of the graphics to the window to be displayed.
Preferably the substrate includes graphics illustrating a circular clock
face which is divided into six angularly spaced sections where the locations
are
arranged on the substrate each in a respective one of the sections.
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Preferably there is provided a further display element which indicates
the requirement of the patient to be removed from the bed for meals.
Preferably there is provided a further display element which indicates
the requirement of the patient to be removed from the bed for placement in a
chair.
5
BRIEF DESCRIPTION OF THE DRAWINGS
One embodiment of the invention will now be described in conjunction
with the accompanying drawings in which:
Figure 1 is a front elevational view of a first manual version of an
apparatus according to the present invention.
Figures 2A to 2C are plan views of separate panels which display
different positions to be taken up by the patient.
Figure 3 is a front elevational view of a second electronic version of an
apparatus according to the present invention.
Figure 4 is a front elevational view of a second manual version of an
apparatus according to the present invention.
In the drawings like characters of reference indicate corresponding
parts in the different figures.
DETAILED DESCRIPTION
A first embodiment is shown in Figure 1 and comprises a flat
rectangular board 10 arranged to be located on a wall or adjacent the bed of a
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patient. The board has a front face 11 with a coating 12 of a known
characteristic
which is arranged to form a wet/dry erase board for marking with desired
graphics or
words and includes a ferromagnetic layer for attachment thereto of one or more
magnetic logos. The front face of the board carries printing graphics on it as
shown
in figure 1.
A first item of the graphics located in a center of the board is indicated
at 13 and comprises an image 14 of a clock face with conventional numbered
hours
around the periphery. The graphics include six boxes numbered 1 to 6 and
indicated at 15 to 20 surrounding the clock. The graphics include a plurality
of
arrows 21 which are located between each box and the next indicating a
clockwise
direction from one box to the next with the arrows also numbered 1 to 6. The
graphics further include a plurality of tabs 22 each of which is provided on
the top of
a respective box with the label "Max Time" and a space of sufficient size to
write in
manually a time limit in hours.
The graphics further include a box 23 in the upper right hand corner
which includes a designation of the client's room number with an open space
allowing the information to be added manually on the wet/dry erase material of
the
board.
The graphics further include a box 24 in the lower left of the board is
utilized to indicate when or whether the client can be removed from the bed to
a
seating position for meals. That is the graphics provide a series of options
relating
to the ability of the patient to be removed from the lying position and boxes
allowing
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a check mark to be applied indicative of the option selected, dependent on the
abilities and condition of the patient.
The graphics further include a box 24A in the lower right of the board
indicates how often to remove the patient from the bed for repositioning the
patient
in wheelchair. That is the graphics provide a series of options relating to
the ability of
the patient to be removed from bed to a wheelchair and boxes allowing a check
mark to be applied indicative of the option selected, dependent on the
abilities and
condition of the patient.
The very bottom of the board includes graphics which allow a space for
writing in any additional instructions the health care provider needs to be
aware of.
All writing on the board is done utilizing a dry or wet erase pen.
Working in combination with the board are five different magnetic
panels each with art work printed on it that are utilized to indicate the
turning and
positioning requirements of the client. The magnetic panels, as shown in
Figure 1
and Figures 2A to 2C, include:
A panel indicating the position "Supine" (Figure 2A) with printed
artwork showing a client lying on their back in a supine position.
A panel indicating the position "Right Partial Side Lying" (figure 26)
with printed artwork showing a client positioned in right partial side lying.
A panel indicating the position "Left Partial Side Lying" (figure 2C) with
printed artwork showing a client positioned in left partial side lying.
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The above three panels in Figures 2A, 2B and 2C are shaped and
arranged to sit over respective ones of the boxes 15 to 20 without the panel
impinging on another of the boxes or the clock 14 or other box of the board.
The three panels indicate all of the separate positions that are suitable
for a patient in this condition. The number of boxes, which is selected as
six, allows
only a situation where only two of the positions to be selected or all three
of the
positions to be used. Thus when two positions only are used, each of the six
boxes
will be filled with alternate ones of the two positions to be used, thus
requiring three
sets of two panels of each position. Where all three positions are to be used
for the
patient, two sets of three panels are used and are placed consecutively in the
six
boxes.
A panel 28 indicating a small arrow utilized to mount on the center area
of the clock to indicate the time of the next turn on the center clock and
movable by
magnetic connection for repositioning to identify the next position to be used
for the
positioning of the patient.
A panel 29 indicating "Current Position" which is a small magnetic
panel that is place beside the selected one of the panels in Figures 2A, 2B
and 2C in the
selected one of the boxes 15 to 20 to indicate how the client should currently
be
positioned in bed.
To utilize the clock the magnetic panels in Figures 2A, 2B and 2C with
artwork are arranged in each of the boxes arranged in a clockwise pattern
around
the board according to the individual needs of the client. For example a
client with a
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coccyx ulcer would typically not be placed in supine and would not utilize the
supine
logo so that the boxes 15 to 20 would contain alternate ones of the panels 26
and
27. Thus the right and left partial side lying panels would be alternated in
the 6
clockwise boxes around the board indicating the client is to be turned between
these
two positions. Based on their clinical reasoning the health care provider is
required
to indicate in the max time tab 22 the amount of time the client should spend
in that
position before being turned again, for example 1 hour or 2 hours.
The health care provider is required to indicate in box 23 the room
number or bed number for the client. The health care provider is required to
indicate
in box 24 how often the client should be out of bed. The health care provider
is
required to indicate in box 24A how often the client should be repositioned in
their
wheelchair.
The Current Position magnet panel 29 is placed on the board, adjacent
to the box 15 to 10 displaying the current position, by the health care worker
to
indicate the position the client is currently in. The Next magnet panel 28 is
placed on
the board within the clock to indicate the time the health care worker needs
to return
to complete the next turn of the client. The time of the next turn is
calculated by
adding the time within the max time tab of the box 15 to 20 to the current
time. For
example if the current time is noon and the max time tab beside the current
position
magnet indicates 2 hours, the Next magnet would be positioned to point to the
2
printed within the clock. At the time of the next turn the health care worker
should
return, reposition the client according to the magnet clockwise to the next
box and
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move the current position magnet panel clockwise above this magnet panel in
the
box concerned. The Next magnet 28 is then be moved again to indicate the time
of
the next turn as indicated by the max position tab 22. This process continues
following the magnet panels clockwise around the board as long as the client
5 remains in bed.
Turning now to Figure 3 there is shown an electronic version of the
arrangement described above. This comprises a board and magnetic panels
substantially as previously described.
In this embodiment the board is modified to comprise an electric board
10 with built in timer and indicator lights. Thus the board now includes a
control unit 33
which operates the time on the electronic clock 14A which is activated in
response to
inputs from a current position illuminated button 30 and from a timer input
31.
Thus instead of using markers and panels 14 and 29, the board has
indicator lights carrying out these functions. The electronics of the board
are
powered by a battery or AC adapter. This clock is a numbered digital LED clock
in
the center and is illuminated to a low level at all times. The on/off switch
35 for the
board is located on the back of the board. There are as described previously 6
boxes 15 to 20 surrounding the clock 14 with an arrow 21 between each box
indicating a clockwise direction.
Above each of the boxes 15 to 20 is a "Current Positioning" indicator
light in the form of a press button 30 that lights up when activated. On the
clock is
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provided a timer input 31 which is used to set the amount of time for which
the
patient should remain in the current position.
As previously, a box in the upper right hand corner of the board
indicates the client's room number. A box in the lower left of the board is
utilized to
indicate when the client can be up. A box in the lower right of the board
indicates
how often to reposition in wheelchair. The very bottom of the board allows
space for
writing in any additional instructions the health care provider needs to be
aware of.
All writing on the board is done utilizing a dry or wet erase pen.
To utilize the clock the selected magnetic panels with artwork are
placed in each of the boxes arranged in a clockwise pattern around the board
according to the individual needs of the client. The selected current Position
illuminated indicator button 30 is pushed by the health care provider to
indicate the
position the client is currently in and illuminates when activated. The
digital LED
clock then is operated to indicate the time the health care provider needs to
return to
complete the next positioning change of the client. This can be set at one,
one and
a half or two hours after the time the current position button is activated.
The length
of time is selected by utilizing the slider switch 31 on the LED clock to
select
between one hour, one and a half hours and two hours.
After the Current Position button is activated the LED clock will
alternate between flashing the actual time of the next turn and displaying the
time
remaining until the next turn. At the time of the next turn the health care
provider will
be notified by flashing the activated current position light.
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Variations can include:
Activating an audible buzzer utilizing a built in speaker.
Activating a nurse call bell system through a wired interface.
Activating a nurse call bell system through a non wired interface (wifi,
radio signal, Bluetooth etc.)
Sending a text message to a hand held PDA, cell phone, or computer
Activating a wireless pager
At the time of the next turn, the health care provider is caused to
return, reposition the Client according to the next position panel in the
clockwise
progression of the boxes 15 to 20 and then is required to press the new
"Current
Position" button above the next box. At this point, the control system 33 acts
to
control the lights and the clock so that the light is automatically turned off
on the
previously activated "Current Position" button and the newly activated
"Current
Position" button lights up. Simultaneously, the digital clock automatically
indicates
the time of next position change. This process continues following the magnet
panels in the boxes 15 to 20 clockwise around the board as long as the client
remains in bed.
If the healthcare provider does not reposition the Client within the set
time limit, both the digital clock and the "Current Position" indicator button
will begin
to blink once the limit is exceeded. This blinking indicates to both
supervisors and
other workers that the time limit has been exceeded. However, once the health
care
provider changes the Client's position and presses the "Current Position"
button
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above the next box in the progression, the blinking stops as the clock sets
forward
by the required set time to indicate the time of next position change. As
before, the
"Current Position" indicator button lights up to indicate the position in
which the
Client is currently in.
In accordance with another version (not shown), a software based
program can be provided that incorporates the concepts of version 2 and
version 1
but does not utilize a physical board in the client's room. Turning schedule
for the
client is set up in the software program on a computer, PDA, or cell phone. At
the
time of each reposition a message is sent wirelessly through the internet or
utilizing
a text message system to the health care provider's cell phone, PDA, wireless
pager
or computer indicating it is time to reposition the client. On internet based
versions a
picture of the position to turn the client into will be displayed and the
healthcare
provider will send a signal back to the main computer via their hand held
device to
indicate they have received the message and the turn has been completed. On
text
message version the position to turn the client into will be described in
text. The
cycle will continue as long as the Client is in bed.
In Figure 4 is shown a modified embodiment which includes many of
the features described above including the image 14 of a clock face with
conventional numbered hours around the periphery; the box 24 in the lower left
of
the board is utilized to indicate when or whether the client can be removed
from the
bed to a seating position for meals; the box 24A in the lower right of the
board which
indicates how often to remove the patient from the bed for repositioning the
patient
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in wheelchair; and at the bottom of the board graphics which allow a space for
writing in any additional instructions the health care provider needs to be
aware of.
In this arrangement, the substrate includes graphics illustrating the
circular clock face which now surrounds or contains the majority of the
substrate and
provide the locations 1 to 6 which are located inside respective ones of the
six
angularly spaced sections. In this embodiment each of the locations is defined
by a
window 1A to 6A in the substrate at which a respective one of the display
elements
is visible.
Each of the display elements comprises a disk 50 mounted on the
substrate for rotation about a center axis 51 thereof at right angles to the
substrate
with the three graphic elements 52, 53 and 54 arranged thereon at angularly
spaced
positions around the axis so as to rotate a selected one of the graphics to
the
window 1A to 6A to be displayed.
The locations 1 to 6 are arranged on the substrate in association with
graphics on the substrate indicating a time during which the lying position is
to be
adopted. That is each window 1A to 6A is located in a respective one of the
six two
hour periods making up the 12 hour time period of the clock face.
The mounting of the graphic elements on the display elements formed
by the six disks 50 at spaced positions around the center of the clock face
allows the
display element at each location on the substrate to be changed by the portion
of the
disk which is exposed at the periphery. This allows each location to be filled
with a
selected one of the display elements, by manually grasping an exposed edge
portion
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56 of the disk to be moved at the edge of the substrate. Each edge portion 56
includes wording at the exposed edge corresponding to and identifying the
graphics
which are exposed in the window.
Thus each of the display elements has graphics thereon, shown in
5 Figures 2A to 2C but not shown in Figure 4, indicating the plurality
of lying positions
which are supine, left side and right side lying positions for the patient,
and is
movable relative to the window so as to move a selected one of the graphics to
the
window to be displayed.
