Pop box methods and systems for assessing risk of pressure related skin injury and determining a recommended treatment thereof

Abstract

A system or method for assessing a patient for pressure related skin injury risk and recommended treatment including measuring extrinsic and intrinsic skin pressure of the patient and assigning a rating responsive to the skin pressure 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 skin pressure, 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.

1 . A system for assessing a patient for pressure related skin injury risk and recommended treatment comprising:
 a memory;   an input device;   an output device; and   a processor,   wherein the memory and processor include computer executable instructions for implementing the method of   receiving a measured skin pressure of the patient;   assigning a rating responsive to the received skin pressure measurement;   receiving a measured tissue oxygenation of the patient;   assigning a rating responsive to the received oxygenation measurement;   receiving a measured perfusion of the patient;   assigning a rating responsive to the received perfusion measurement;   summing the skin pressure, tissue 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 a recommended treatment from among a plurality of recommended treatments for the patient in response to the determined risk of pressure related skin injury.   
     
     
         2 . The system of  claim 1  wherein the computer executable instructions for receiving measured tissue oxygenation include receiving measured tissue oxygenation as determined by StO2 and wherein the assigned rating for oxygenation is responsive to the received StO2 measurement. 
     
     
         3 . The system of  claim 2  wherein assigning a rating for the measured tissue oxygenation based on StO2 includes:
 assigning a first StO2 rating where StO2 levels of WNL SO2 are less than 10 percent of normal;   assigning a second StO2 rating where StO2 is between 10 and 20 percent of normal;   assigning a third StO2 rating where StO2 is between 20 and 30 percent of normal; and   assigning a fourth StO2 rating where StO2 is greater than 30 percent of normal.   
     
     
         4 . The system of  claim 1  wherein receiving the measured tissue oxygenation includes one or more of the following processes:
 receiving a measurement of a venous oxygen saturation (SvO2) or a central venous oxygen saturation (SvcO2) and assigning a rating responsive to 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 assigning a rating responsive to the measured P/F ratio;   receiving a measurement of a desaturation recovery time of oxygen saturation (SpO2) of the patient and assigning a rating responsive to the measured (SpO2);   receiving a measurement of a blood glucose of a patient and assigning a rating responsive to the measured blood glucose;   receiving a hemogolin/hematocrit (H/H) measurement of the patient and assigning a rating responsive to the measured H/H;   receiving a measured vital sign of the patient including the blood pressure and heart rate and assigning a rating responsive to the measured vital sign;   receiving a Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV) measurement of the patient and assigning a rating responsive to the measured CI, CO or SV;   receiving a measured or identified presence of one or more pressor agents and assigning a rating responsive to the measured or identified pressor agent; and   receiving an identified maceration of the patient and assigning a rating responsive to the identified maceration.   
     
     
         5 . The system of  claim 1  wherein receiving measured skin pressure includes one or more of the following processes:
 determining a Braden Score and assigning a rating responsive to the Braden Score determining an age of the patient and assigning a rating responsive to the determining;   receiving a determined presence of steroid use by the patient and assigning a rating responsive to the determining;   receiving a measured Edema of the patient and assigning a rating responsive to the measuring;   receiving a determined presence of pain or paralysis of the patient and assigning a rating responsive to the determining;   receiving a measured Albumin level of the patient and assigning a rating responsive to the measuring;   receiving an identified presence of one or more mechanical apparatus associated with the patient wherein in the assigning is responsive to the number of identified apparatus present; and   receiving a determined pressure redistribution surface time of the patient and assigning a rating responsive to the determining.   
     
     
         6 . The system of  claim 1  wherein receiving a measuring perfusion includes one or more of the following processes:
 receiving a measured vital sign of the patient including the blood pressure and heart rate and assigning a rating responsive to the measuring;   receiving a measured Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV) of the patient and assigning a rating responsive to the measuring;   receiving an identified presence of one or more pressor agents and assigning a rating responsive to the identifying; and   receiving an identified maceration of the patient and assigning a rating responsive to the identifying.   
     
     
         7 . The system of  claim 1  wherein receiving measured skin pressure, oxygenation and perfusion includes one or more of the following processes:
 receiving a determined body mass index of the patient and assigning a rating responsive to the determining;   receiving a determination of whether the patient was found in a down position prior to evaluation and assigning a rating responsive to the determining;   receiving a determined operating room variable of the patient wherein in the assigning is responsive to the number of such operating room variables present;   receiving a determined presence of one or more disease processes present in the patient wherein in the assigning is responsive to the number of such present disease processes;   receiving a determined length of stay for both ICU and regular hospital stays for the patient and assigning a rating responsive to the determining;   receiving an evaluation of an emergency room procedure experience by the patient and assigning a rating responsive to the evaluating; and   receiving an identified previous or existing skin injury of the patient and assigning a rating responsive to the identifying.   
     
     
         8 . The system of  claim 1  wherein determining a recommended treatment for the patient in response to the determined risk of pressure related skin injury includes an assigning of a rating from 1 to 4 for each assignment; and
 wherein the POP Box score is determined to be in the range of 0 to 25, the determined recommended treatment is taking no action;   wherein the POP Box score is determined to be in the range of 25 to 50, the determined 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 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 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 recommended treatment is providing the patient with a low air loss bed with continual turning.   
     
     
         9 . Computer readable medium having computer executable instructions for assessing a patient for pressure related skin injury risk and recommended treatment, the computer executable instructions performing the method comprising:
 receiving a measured skin pressure of the patient;   assigning a rating responsive to the received skin pressure measurement;   receiving a measured oxygenation of the patient;   assigning a rating responsive to the received oxygenation measurement;   receiving a measured perfusion of the patient;   assigning a rating responsive to the received perfusion measurement;   summing the skin pressure, 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 a recommended treatment from among a plurality of recommended treatments for the patient in response to the determined risk of pressure related skin injury.   
     
     
         10 . The computer readable medium of  claim 9  wherein the computer executable instructions for oxygenation include receiving measured tissue oxygenation as determined by StO2 and wherein the assigning a rating for tissue oxygenation is responsive to the received StO2 measurement. 
     
     
         11 . The computer readable medium of  claim 9  wherein the computer executable instructions assigning a rating for the measured oxygenation based on StO2 includes:
 assigning a first StO2 rating where StO2 levels of WNL SO2 are less than 10percent of normal;   assigning a second StO2 rating where StO2 is between 10 and 20 percent of normal;   assigning a third StO2 rating where StO2 is between 20 and 30 percent of normal; and   assigning a fourth StO2 rating where StO2 is greater than 30 percent of normal.   
     
     
         12 . The computer readable medium of  claim 9  wherein the computer executable instructions for oxygenation includes one or more of the following processes:
 receiving a measurement of a venous oxygen saturation (SvO2) or central venous oxygen saturation (SvcO2) and assigning a rating responsive to 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 assigning a rating responsive to the measured P/F ratio;   receiving a measurement of a desaturation recovery time of oxygen saturation (SpO2) of the patient and assigning a rating responsive to the measured SpO2;   receiving a measurement of a blood glucose of a patient and assigning a rating responsive to the measured blood glucose;   receiving a hemogolin/hematocrit (H/H) measurement of the patient and assigning a rating responsive to the measured H/H;   receiving a measured vital sign of the patient including the blood pressure and heart rate and assigning a rating responsive to the measured vital sign;   receiving a Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV) of the patient and assigning a rating responsive to the measured CI, CO or SV;   receiving a measured or identified presence of one or more pressor agent and assigning a rating responsive to the measured or identified pressor agent; and   receiving an identified maceration of the patient and assigning a rating responsive to the identified maceration.   
     
     
         13 . The computer readable medium of  claim 9  wherein the computer executable instructions for receiving a measured skin pressure and assigning a rating responsive to the received skin pressure measurement include one or more of the following combination processes:
 determining a Braden Score and assigning a rating responsive to the Braden Score determining an age of the patient and assigning a rating responsive to the determining;   receiving a determined steroid use by the patient and assigning a rating responsive to the determining;   receiving a measured Edema of the patient and assigning a rating responsive to the measuring;   receiving a determined presence of pain or paralysis of the patient and assigning a rating responsive to the determining;   receiving an Albumin level of the patient and assigning a rating responsive to the measuring;   receiving an identified presence of one or more mechanical apparatus associated with the patient wherein in the assigning is responsive to the number of identified apparatus present; and   receiving a determined pressure redistribution surface time of the patient and assigning a rating responsive to the determining.   
     
     
         14 . The computer readable medium of  claim 9  wherein the computer executable instructions for receiving a measured perfusion and assignment a rating to the received perfusion measurement includes one or more of the following combination processes:
 receiving a measured vital sign of the patient including the blood pressure and heart rate and assigning a rating responsive to the measuring;   receiving a measured Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV) of the patient and assigning a rating responsive to the measuring;   receiving an identified presence of one or more pressor agent and assigning a rating responsive to the identifying; and   receiving an identified maceration of the patient and assigning a rating responsive to the identifying.   
     
     
         15 . The computer readable medium of  claim 9  wherein the computer executable instructions includes one or more of the following processes:
 receiving a determined a body mass index of the patient and assigning a rating responsive to the determining;   receiving a determination of whether the patient was found in a down position prior to evaluation and assigning a rating responsive to the determining;   receiving a determined operating room variable of the patient wherein in the assigning is responsive to the number of such operating room variables present;   receiving a determined presence of one or more disease processes present in the patient wherein in the assigning is responsive to the number of such present disease processes;   receiving a determined length of stay for both ICU and regular hospital stays for the patient and assigning a rating responsive to the determining;   receiving an evaluated emergency room procedure experience by the patient and assigning a rating responsive to the evaluating; and   receiving an identified previous or existing skin injury of the patient and assigning a rating responsive to the identifying.   
     
     
         16 . The computer readable medium of  claim 9  wherein the computer executable instructions for determining a recommended treatment from among a plurality of recommended treatments for the patient in response to the determined risk of pressure related skin injury includes the following:
 assigning a rating from 1 to 4 in each assigning step, and:   wherein the POP Box score is determined to be in a range of 0 to 25, and the determined recommended treatment is taking no action;   wherein the POP Box score is determined to be in the range of 25 to 50, and the determined 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, and 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 the range of 75 and 100, and the determined recommended treatment is providing the patient with a low air loss bed, provide a more frequent turn schedule and/or continual turn bed; and   wherein the POP Box score is determined to be greater than 100, and the determined recommended treatment is providing the patient with a low air loss bed with continual turning.   
     
     
         17 . A method for assessing a patient for pressure related skin injury risk and recommended treatment comprising:
 measuring skin pressure of the patient and assigning a rating responsive to the skin pressure measurement;   measuring tissue oxygenation of the patient and assigning a rating responsive to the tissue oxygenation measurement;   measuring perfusion of the patient and assigning a rating responsive to the perfusion measurement;   summing the skin pressure, tissue 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 a recommended treatment from among a plurality of recommended treatments for the patient in response to the determined risk of pressure related skin injury.   
     
     
         18 . The method of  claim 17  wherein measuring tissue oxygenation includes measuring StO2. 
     
     
         19 . The method of  claim 18  wherein assigning a rating for the measured StO2 includes:
 assigning a first StO2 rating where StO2 levels of WNL SO2 are less than 10 percent of normal;   assigning a second StO2 rating where StO2 is between 10 and 20 percent of normal;   assigning a third StO2 rating where StO2 is between 20 and 30 percent of normal; and   assigning a fourth StO2 rating where StO2 is greater than 30 percent of normal.   
     
     
         20 . The method of  claim 17  wherein measuring tissue oxygenation includes one or more of the following processes:
 measuring a venous oxygen saturation (SvO2) or central venous oxygen saturation (SvcO2) and assigning a rating responsive to the measuring;   measuring a ratio of arterial oxygen concentration to the fraction of inspired oxygen (P/F ratio) of the patient and assigning a rating responsive to the measuring;   measuring a desaturation recovery time of oxygen saturation (SpO2) of the patient and assigning a rating responsive to the measuring;   measuring a blood glucose of a patient and assigning a rating responsive to the measuring;   measuring a hemogolin/hematocrit (H/H) of the patient and assigning a rating responsive to the measuring;   measuring a vital sign of the patient including the blood pressure and heart rate and assigning a rating responsive to the measuring;   measuring a CI or CO of the patient and assigning a rating responsive to the measuring;   identifying a presence of one or more pressor agent and assigning a rating responsive to the identifying; and   identifying maceration of the patient and assigning a rating responsive to the identifying.   
     
     
         21 . The method of  claim 17  wherein measuring skin pressure includes one or more of the following processes:
 determining a Braden Score and assigning a rating responsive to the Braden Score determining an age of the patient and assigning a rating responsive to the determining;   determining steroid use by the patient and assigning a rating responsive to the determining;   measuring an Edema of the patient and assigning a rating responsive to the measuring;   determining a presence of pain or paralysis of the patient and assigning a rating responsive to the determining;   measuring an Albumin level of the patient and assigning a rating responsive to the measuring;   identifying a presence of one or more mechanical apparatus associated with the patient wherein the assigning is responsive to the number of identified apparatus present; and   determining a pressure redistribution surface time of the patient and assigning a rating responsive to the determining.   
     
     
         22 . The method of  claim 17  wherein measuring perfusion includes one or more of the following processes:
 measuring a vital sign of the patient including the blood pressure and heart rate and assigning a rating responsive to the measuring;   measuring a Cardiac Index (CI), Cardiac Output (CO), or Stroke Volume (SV) of the patient and assigning a rating responsive to the measuring;   identifying a presence of one or more pressor agent and assigning a rating responsive to the identifying; and   identifying maceration of the patient and assigning a rating responsive to the identifying.   
     
     
         23 . The method of  claim 17  wherein measuring skin pressure, tissue oxygenation and perfusion includes one or more of the following processes:
 determining a body mass index of the patient and assigning a rating responsive to the determining;   determining whether the patient was found in a down position prior to evaluation and assigning a rating responsive to the determining;   determining an operating room variable of the patient wherein in the assigning is responsive to the number of such operating room variables present;   determining a presence of one or more disease processes present in the patient wherein in the assigning is responsive to the number of such present disease processes;   determining length of stay for both ICU and regular hospital stays for the patient and assigning a rating responsive to the determining;   evaluating an emergency room procedure experience by the patient and assigning a rating responsive to the evaluating; and   identifying previous or existing skin injury of the patient and assigning a rating responsive to the identifying.   
     
     
         24 . The method of  claim 17  wherein determining a recommended treatment for the patient in response to the determined risk of pressure related skin injury includes the following:
 wherein each assigning includes assigning a rating from 1 to 4; and   wherein the POP Box score is determined to be in the range of 0 to 25, determining a recommended treatment includes taking no action;   wherein the POP Box score is determined to be in the range of 25 to 50, determining a recommended treatment includes providing normal turn on redistributing surface practice;   wherein the POP Box score is determined to be in the range of 50 to 75, determining a recommended treatment includes 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 and 100, determining a recommended treatment includes providing the patient with a low air loss bed, provide a more frequent turn schedule and/or continual turn bed; and   wherein the POP Box score is determined to be in the range of 100, determining a recommended treatment from among a plurality of recommended treatments includes providing the patient with a low air loss bed with continual turning.   
     
     
         25 . The method of  claim 17 , further comprising:
 in a computer system configured for assessing a patient for pressure related skin injury risk and recommended treatment having a memory, an input device, an output device, a processor, and wherein the memory and processor include computer executable instructions for implementing the method including   receiving the measured skin pressure of the patient and the assigning of the rating responsive to the skin pressure measurement;   receiving the measured tissue oxygenation of the patient and the assigning of the rating responsive to the tissue oxygenation measurement;   receiving the measured perfusion of the patient and the assigning of the rating responsive to the perfusion measurement;   and the summing of the skin pressure, tissue oxygenation and perfusion ratings to obtain a POP Box score and the determining of the risk of pressure related skin injury for the patient in response to the POP Box score and the determining of a recommended treatment from among the plurality of recommended treatments for the patient in response to the determined risk of pressure related skin injury.