Guide Book - LINET

Guide Book EARLY MOBILIZATION WITH LINETOverview of marketing communication materials

Improve Early Mobility in your unit

Early Mobilization with LINETUtilizing LINET

advanced features

The advanced features

of the LINET frame are

easily integrated into

an Early Mobilization

Program.

ALT therapyMobi-L

ift®

Lateral Tilt

Reverse Trendelenburg Orthopnoeic C

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2

LINET | EARLY MOBILIZATION WITH LINET

LINET’S ROLE within a mobility program

Integrating the advanced features of the LINET bed frame into the Intensive and Critical Care Environment

can help simplify an Early Mobilization program. All these features are standard to the LINET bed frame,

which can improve utilization and compliance.

ALT therapyMobi-L

ift®

Reverse Trendelenburg Orthopnoeic C

hair

30°

STO

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3


Immobility impacts the

An early mobilization program is intended to have a

positive impact on all body systems.

Neurological

— Depression, anxiety, delirium, ICU psychosis.

Delirium occurs in up to 80% of ICU patients.1

Cardiovascular

— Immobilization can cause multiple cardiac

complications including atrophy and hemodynamic

instability2

Respiratory/pulmonary

— Pneumonia, atelectasis, VAP, pulmonary emboli,

ARDS.3

Gastrointestinal

— Altered patterns of elimination, incontinence,

constipation, fecal impaction.4

4


whole patient

Renal

— Stasis, nephritis, catheter-associated urinary tract

infections.4

Metabolic

— Acid-Base Balance, Metabolic Syndrom.5

Musculoskeletal

— Muscle Atrophy is seen in 25-90% of patients with

prolonged hospitalization.6

Skin

— Pressure ulcers. Lack of mobility increases the risk of the

development of a pressure injury.7

Structured early mobilization especially for an intensive

care patient is performed with the aim to:

— Improve respiratory function

— Reduce adverse effects of immobility

— Increase levels of consciousness

— Increase functional independence

— Improve cardiovascular fitness

— Increase psychological well-being

— Reduce the risk of delirium

5


Clinical evaluation form – Early Mobilization with LINET

Hospital:

Unit / Ward Name:

Date evaluation commenced: Date evaluation completed:

Completed by:

Position:

Mobile No:

Email address:

LINET/Partner representative:

LEVEL 1:

Would you recommend ALT/frame-based lateral tilt as a solution for unconscious patients in level 1

also to your colleagues?

Strongly recommend RecommendUndecided Not recommend Strongly not recommend

LEVEL 2:

Would you recommend combination of Reverse Trendelenburg and Orthopnoeic chair on LINET bed in

order to help muscle straightening to your colleagues?


LEVEL 3:

Would you recommend Mobi-Lift in level 3 as a good support for patients also to your colleagues?


LEVEL 4:

Would you recommend Mobi-Lift for the patients as a standing-up assistant/tool also to your colleagues?


Would you recommend Lateral Tilt in level 4 as good help for patients for standing-up also to your

colleagues?


Please could you provide any additional comments regarding Early Mobilization with LINET:

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User experience

with Multicare and Lateral Tilt

LINET RESEARCH

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LINET | User experience with Multicare and Lateral Tilt

3

designed and shaped to adapt to the lateral tilt.

Stabilisation aids ensure the safe operation of the

set programme and maintain a constant body position

in the centre of the bed. On the basis of these aids,

patient safety cannot be compromised during the

lateral tilts.

When activating the program, the manufacturer’s

instructions must be followed. If you try to activate the

lateral tilt when some of the side rails are not raised,

the program will not start. Instructions and warnings

are given on the bed’s display screen.

Before automatic lateral therapy, a test cycle must

always be run. The main purpose of this test is to

prevent undesirable situations. Most importantly, the

distribution of all invasive protrusive inputs and the

hose system must be checked. It is safe to use the

ventilator circuit holder sited on each positioning bed

to prevent extubation. The holder can be installed

from the left, the right or even the top centre of

the bed, according to the needs of staff and the

requirements of other parts of the bed.

Our experience with this system has been very

good. Extubation during automatic lateral therapy has

never occurred.

3. Verticalisation of the patient

Patients can be gradually verticalised in this bed,

which is another great benefit. Many patients in our

department undergo analgosedation for the acute

phase of their condition on and just after admission to

hospital. With regard to positioning, the patient needs

24/7 care, so that immobilisation syndrome1 does not

cause any secondary damage.

When the acute phase of the health condition is

over, subsequent efforts are made to mobilise the

patient in the shortest possible time.

From the rehabilitative point of view, a passive

rehabilitation exercise is required first. A fully qualified

physiotherapist uses this exercise to focus on the

ability to restore the normal function of the patient’s

musculoskeletal system without any effort of his/her

will. The patient’s ability to assist the physiotherapist

or to execute a specified movement independently

is called active exercising. The patient’s active

movement with the help of medical staff is followed

by verticalisation; this means that the patient is able

to stand on his/her feet next to the bed. The adapted

multifunctional bed has helped us greatly to this task.

Specifically, the physiotherapist will instruct the patient

to sit on the bed with his/her legs hanging down

while grasping the side rails, which are there to help

the patient stand; firstly, of course with the help of a

physiotherapist, later on his/her own.

It is my opinion that the lateral tilt and the Mobi-

Lift handle2 functions are useful aids to progressive

verticalisation. The cardiovascular system of a patient

who has not stood up for a long time will naturally

weaken. Using the Mobi-Lift handle increases safety

levels during the transition to an upright position for

both the patient and the staff regarding the possible

occurrence of postural hypotension. If the patient is

unable to stand up because of low muscle strength,

no danger will arise – the patient cannot fall, but would

just sit down on the bed again.

A highly positive feature of the LINET positioning

bed is the range of positioning programs that

contribute significantly to the adaptation of the human

body as it gradually starts to verticalise.

This document has been drawn up under the

supervision of MUDr. Michal Otáhal, Prague General

University Hospital, Clinic of Anaesthesiology,

Resuscitation and Intensive Medicine

MUDr. Michal Otáhal

Bc. Jana Wimerová

The frame-based Lateral Tilt is a unique LINET feature which can

help accelerate recovery of critical care patients.

Lateral Tilt

Automatic Lateral Therapy (ALT) is a platform-based Lateral Tilt

which can be individually programmed and is recommended for

patients unable to tolerate manual turning. ALT can be used in cases

of higher risk of VAP which are unable to train the patient’s body to

tolerate side to side movement.

Automatic Lateral Therapy

Micro-shifting makes it possible to tilt the patient one degree

at a time.

Micro-shifting

30° stop maintains optimal head of bed (HOB) angle in compliance

with pressure injury prevention and Ventilator Associated Pneumonia

prevention.

30° stop

Download the full brochure

1st LEVEL

of Early Mobilization with LINET

Discover next level!

LINET | GUIDE BOOK – EARLY MOBILIZATION WITH LINET2

CLINICALLY-BASED campaign – LINET COMPETENCE — Clinical competence → Product features/Product → SALE

— 4 level program following worldwide standards (ACCNA – American association of critical care nurses) in intensive care

— Show how LINET ICU SOLUTION enriches each level

MAIN MESSAGES — Help to reduce the workload of intensive care staff

— Support prevention, therapy and diagnostics

— Improve the safety and comfort of the patients

— Improve patient outcome

RELEVANT TARGET GROUPS — ICU nurse

— ICU physiotherapist

— ICU doctor

— Hospital management

CALL-TO-ACTION

Why “Early Mobilization with LINET”

TRY EARLY MOBILIZATION WITH LINET

LINET | GUIDE BOOK – EARLY MOBILIZATION WITH LINET 3

What can you use = marketing tools

General campaign support— Brochure 4

— Leaflet 6

— PPT presentation 7

— Advertisement 8

— Video 9

— PR articles 11

— Roll-up 12

On-line campaign support— Facebook Posts 13

— Paid on-line displays 14

— Landing page 15

— Motivational leaflet 16

— Clinical Studies for download 17

— Signature banner 18

— Mailing 18

— Corporate Identity 19

— Evaluation of a trial in the hospital 20

— Photos (set of photos to use) 21

— Claims and references 29

— Booth (concept, visualization) 30

— Where you can find Early Mobilization materials 32


General campaign supportBrochure Full version brochure, 20 pages


Early Mobilization with LINET

19_01_EarlyMob_brozura_EN_ver31-PRINT.indd 1 17.01.19 17:51

Level 1Many ICU patients suffer from orthostatic hypotension. This hemodynamic instability may cause a delay or omission in turning, repositioning, and other interventions to advance patient mobility and may contribute to the formation of pressure ulcers and higher risk of VAP. Micro-shifting technology and Automatic Lateral Therapy can assist in reducing these complications.

Decrease VAP by using ALT!* 10

Automatic Lateral Therapy (ALT) is a platform-based Lateral Tilt which can be individually programmed and is recommended for patients unable to tolerate manual turning. ALT can be used in cases of higher risk of VAP which are unable to train the patient’s body to tolerate side to side movement.

The frame-based Lateral Tilt is a unique LINET feature which can help accelerate recovery of critical care patients.

30° stop maintains optimal head of bed (HOB) angle in compliance with pressure injury prevention and Ventilator Associated Pneumonia prevention.

Micro-shifting makes it possible to tilt the patient one degree at a time.

* VAP – Ventilator-Associated Pneumonia; ALT – Automatic Lateral Therapy

8 LINET | EARLY MOBILIZATION WITH LINET


Level 2Immobile ICU patients can experience trunk or core weakness, reducing their ability to support themselves in an upright position. The full chair and reverse Trendelenburg positions help with muscle strengthening exercises as well as hemodynamic and orthostatic training.

IMPROVE Sv̄O2* by 22%by utilizing a LATERAL TURN11

45° stop is helpful for patients with respiratory distress.

In the reverse Trendelenburg, the patient is able to do weight-bearing exercises that are necessary for the patient to be able to stand up or walk.

Orthopnoeic Chair is the full chair position used for hemodynamic and muscle training. One-button function on LINET beds.

The fi rst physiotherapy session is aimed at stability and leg support of the patient in the reverse Trendelenburg position.

*The response of mixed venous oxygen saturation (Sv̄O2)

9LINET | EARLY MOBILIZATION WITH LINET



Advanced mobility

EARLY MOBILIZATION program

CAN REDUCE the incidence

of delerium by up to 50%!8

– Turning Q2hrs (assisted)

– Consider Using Automatic lateral therapy (ALT)

– Micro-Shifting if patient is too unstable for ALT

– STOP 30°– STOP 45°

Level 1 Level 2 Level 3 Level 4

– Turning Q2hrs (assisted)

– Chair position– Reverse

Trendelenburg with footboard reversed for weight bearing

– ALT– STOP 30°– STOP 45°

– Turning Q2hrs (self/assisted)

– Chair position– Dangling out of

bed– STOP 30°– STOP 45°

– STOP 30°– Turning Q2hrs

(self/assisted)– Sitting out of

the bed (in an adequate mobilization chair)

– Walking with or without assistance

– STOP 30°– STOP 45°



programResults of using a mobility program

EARLY MOBILITY in the

ICU could minimize LOSS of

FUNCTIONAL abilities and

possibly SHORTEN hospital

stay by 28%9

Length of hospital stay Ventilator Associated Pneumonia (VAP)

Ventilator Associated Pneumonia significantly decreased from a rate of 2.14 per 1,000 days to zero.9

12

10

8

6

4

2

0

3

2

1

0

Length of hospital stay significantly decreased from 12 to 8.6 days.9

12 days

2.4/1,000 days

ZERO

8.6 days

100

50

0

Reduced by

60%

Hospital-associated infections (HAI)9



Utilizing LINET advanced features

The advanced features of the LINET frame are easily integrated into an Early Mobilization Program.

ALT therapyMobi-Lift®

Lateral Tilt

Reverse Trendelenburg Orthopnoeic Cha

ir



LINET’S ROLE within a mobility program Integrating the advanced features of the LINET bed frame into the Intensive and Critical Care Environment can help simplify an Early Mobilization program. All these features are standard to the LINET bed frame, which can improve utilization and compliance.

ALT therapyMobi-Lift®

Reverse Trendelenburg Orthopnoeic Cha

ir

30°

STO

P




Start here Level 1 Level 2 Level 3 Level 4

Nurses activities

If the patient fails this criterias start with level 1, if the patient passes continue to level 2.Done within 24 hours of admission.

Patient Assessment: Patient Assessment: Patient Assessment: Patient Assessment:

RASS −5 to −3SAS 1–3

RASS > −3 to −1SAS > 3

RASS 0 – +1SAS > 3

RASS 0 – +1SAS > 4

BasicAssessment

FailsBasic Assessment(reassess in 24 hrs)

PassesBasic Assessment



NeurologicalRASS > −3

RespiratoryPEEP < 10FiO2 < 70SpO2 > 90%RP > 5 < 40

Cardiovascular HR > 50 < 140MAP > 55 < 140SBP > 90 < 200Vassopressor infusionNo new or increasing No new arrhythmia

– HOB 30° STOP– Turning Q2hrs (assisted)– Consider using

Automatic lateral therapy (see the ALT protocol)

– Reverse Trendelenburg with foot board reversed for weight bearing

– PROM for all extremities– Micro-Shifting if patient is

too unstable for ALT

– ALT– HOB 30° STOP– Turning Q2hrs (assisted)– Chair position– Reverse Trendelenburg

with footboard reversed for weight bearing

– HOB 30° STOP– Turning Q2hrs

(self/assisted)– Chair position– Sitting edge of the bed

– HOB 30° STOP– Turning Q2hrs

(self/assisted)– Sitting in bedside chair – Walking with or without

assistance

FailsStart level 1

PassesStart level 2

Assess to level 1 or 2 Tolerates Level 1Continue to LEVEL 2

Tolerates Level 2Continue to LEVEL 3


Tolerates Level 4Continue walking longer distances


19_02_EarlyMobilisation-sheet (EMSH)_ver18.indd 1 12.03.19 14:02

Start here Level 1 Level 2 Level 3 Level 4

Physiotherapy

Order PT/OT assessment within 24 hours

Patient Assessment: Patient Assessment: Patient Assessment: Patient Assessment:

RASS −5 to −3SAS 1–3

RASS > −3 to −1SAS 4–5

RASS 0 – +1SAS 4–5

RASS 0 – +1SAS 4–5

BasicAssessment

Passes Basic assesment




MD order required Neurology ICP less 15mmHg (if messured) Respiratory SpO2 > 88% or Pao2 /FiO2 > 250PEEP < 10 or not increasing Arterial pH > 7.25Cardiovascular HR > 50 < 140 MAP > 55 < 140 SBP > 90 < 200 Vassopressor infusion no new or increasing No new arrhythmia, DVT, PE

– PROM for all extremities 2 × d

– Respiratory physiotherapy

– NMES

– Active Assisted ROM UE/LEs on all planes, use the following features of the bed to assist in achieving all planes; turn assist, vascular position, reverse Trendelenburg with foot board reversed, and chair

– Bed mobility skills/core strengthening using turn assist and vascular position

– Active ROM UE/LEs.– Weight bearing activities

in reverse Trendelenburg with the foot board reversed

– Balance activities in chair position and sitting EOB using mobilization button and mobi-lift

– Standing activities using turn assist and mobi-lift.

– Transfer training to chair

– Resistance exercises– High-level balance

activities– Endurance exercises– Progress walking and

gait training– ADLs

FailsPT is not recommendedre-evaluate in 24 hours

PassesStart level 1

Assess to level 1 or 2 Tolerates Level 1Continue to LEVEL 2



Tolerates Level 4Continue walking longer distances

LINET | Edition 02/ 2019 | Slight colour differences are possible. Change of technical parameters reserved. | General English


19_02_EarlyMobilisation-sheet (EMSH)_ver18.indd 2 12.03.19 14:02

Leaflet Step by step guide for intensive care nurse and physioterapists, 2 pages




page 2

Patie

ntM

anag

emen

t

Staf

f— Regular repositioning— Reduced pressure injury

risk— Improved fall prevention— Improved outcomes — Effective physiotherapy— Mental well-being


— Less work-load for staff

— Less injuries

— Easier patient positioning

— Effective care

— Shorter hospital stay

— Less work-related injuries

— Cost-saving

— Effective care

PPT presentation PPT presentation based on full brochure version


solution360

care360

services360

obstetrics and gynecological care 360 women

care 360

pediatriccare 360

acutecare 360

intensivecare 360

one daycare 360

long-term care 360 mother and child

care 360

around you

Level 3Level 1 Level 2 Level 4

www.linet.com


Use the LINET INTENSIVE CARE SOLUTION to infl uence the length of stay in your unit.

19_03_EM_inzerce_A4_ver20-210x286.indd 1 14.03.19 10:09


www.linet.com


Use the LINET INTENSIVE CARE SOLUTION to infl uence the length of stay in your unit.

19_03_EM_inzerce_A4_ver20-210x286.indd 2 14.03.19 10:09

Advertisement


Early Mobilization with Linet - instruction for intensive care nurseshttps://www.youtube.com/watch?v=jZQ0W1lqbec

Early Mobilization with Linet - instruction for intensive care physiotherapistshttps://www.youtube.com/watch?v=EYV1SiSJOqE

Video


Early Mobilization with Linet – testimonial video for physiotherapists with Molly https://www.youtube.com/watch?v=2YY-rPgj_dkW

Early Mobilization with Linet – testimonial video for intensive care nurses with Zdenkahttps://www.youtube.com/watch?v=0Qokw21xaBY

Video


Meet Molly, our special guest at the Arab Health 2019 Molly Dudek is a Clinical Applications Specialist and she is a member of the LINET Americas team. She has been a licensed Physical Therapist Assistant for the past 23 years and she is also a Certified Ergonomics Assessment Specialist. For the past 7 years, she has been working in the medical device field specializing in safe patient handling and mobility equipment.

What is your key message about the LINET

intensive care solution e.g. the Multicare bed?

I believe that the key message about the LINET MC ICU bed is that we are the only critical care bed frame on the market. All the other manufactures use a mattress for turning and CLRT. Having a frame-based tilt allows any mattress to be placed on the frame without losing any of the critical care features. This also allows the mattress to focus just on wound care. The frame-based tilt also allows us to turn one degree at a time for micro shifting.

You are involved in the international Early

mobilization project, what do you think about

cooperation across the LINET Group?

I have great cooperation from the LINET Marketing team as well as everyone in the LINET Group. Early Mobility has been a big focus in the US for a few years now and LINET Americas has had to make some of their own marketing tools for our customers so it is nice that the importance of Early Mobility is being recognized more worldwide and that LINET is focusing on it more as this allows everyone to have more Early Mobility resources.

What is the current trend in the US in hospital

bed industry?

In the US hospital beds are viewed as more of a medical device than a piece of furniture, thus they are looking for the bed to assist them to have better outcomes with their hospital initiatives. The main hospital initiatives across the US are Falls Management, Wound Care, Early Mobility and Safe Patient Handling. As a result of this, the hospitals are looking to vendors to have evidence-based research to show how their devices can improve outcomes in these areas.

I am seeing a big trend in hospitals across the US looking to reduce rental costs so they are looking for hospital beds that can be used for a wide range of patient populations and mattresses that can also be used for a wide range of patient populations.

Linet spol. s r. o. | Želevčice 5 | 274 01 Slaný | Czech Republic | www.linet.com

Edition 03/2019

1

Pressure injury are together with hemodynamic instability one of the most common complications of ICU patients. Pressure ulcers are associated with adverse patient outcomes, and contribute to patient pain, depression, loss of function and independence, increased incidence of infection and sepsis, additional surgical interventions, and prolonged hospital stays. Therefore, the best treatment for pressure ulcers is to prevent their development.

Regular repositioning of the patients is a crucial in pressure injury prevention, but some studies show that that less than 3% of the critically ill patients in their study were turned every 2 hours as recommended by current guidelines within an 8-hour time frame.

Moreover, subsequently observed that more than 50% of these patients had no change of body position during this 8-hour period.3,4

EPUAP/NPUAP recommends to determine repositioning with consideration to the individuals2 and also to consider the medical condition of the individuals. Regular positioning is not possible for some individuals because of their medical condition, and an alternative prevention strategy such as providing a high-specification mattress or bed may need to be considered.2

Especially in intensive care setting are many patients in critical condition where repositioning it’s restricted or contraindicated for safety reason.

Hemodynamic instability is a term commonly used to describe labile changes in cardiopulmonary status. Instability is caused by stationary position for long time. The prevalence of orthostatic hypotension is age dependent ranging from 5%- 30%7.The clinician‘s perception of hemodynamic instability may cause a delay or omission in turning, repositioning, and other interventions to advance patient mobility and may contribute to pressure ulcer formation. The intensive care unit‘s practice culture and individual clinician perceptions regarding hemodynamic instability may lead to staff not turning patients out of fear that they are “too unstable to turn.”1 Use of lateral tilt rotation may prevent the orthostatic intolerance that cause hemodynamic instability

while patients manually turned and afterward mobilized5,6.

One of the specific group are critical ill patients who are treated by using ECMO device. Used of lateral tilt rotation was described and recommend with ARDS patients treated with ECMO as safe practice8. Though use of lateral tilt rotational therapy was not proven to be affective as more research needs to be done, some intensive care nurses specialist actively use the application of lateral tilt rotation for their patients9 and share their experience on international level.

Linet spol. s r. o. | Želevčice 5 | 274 01 Slaný | Czech Republic | www.linet.com 1

How to support pressure injuries prevention using Automatic Lateral Therapy?

In the critical care population, heart rate and rhythm, blood pressure, respiratory rate, and oxygen saturation patient status. Hemodynamic instability is a term commonly used by clinicians to describe labile changes in cardiopulmonary status. The clinician‘s perception of hemodynamic instability may cause a delay or omission in turning, repositioning, and other interventions to advance patient mobility and may contribute to pressure ulcer formation. The intensive care unit‘s practice culture and individual clinician perceptions regarding hemodynamic instability may lead to staff not turning patients out of fear that they are “too unstable to turn.”1

Microshifting its method that allows patient to be turned one degree at the time, this method is recommended for patients who cannot tolerate continuous lateral rotational therapy.

Automatic Lateral Therapy is recommended as solution for hemodynamic patients. If the patient does not tolerate manual turning as evidenced by a sustained decrease in blood pressure and oxygen saturation and/or an increase in heart rate, the patient should be returned to the supine position and the nurse should consider the use of continuous lateral rotational therapy (Automatic Lateral Therapy) in an effort to train the patient’s body to tolerate side-to-side movement2. Automatic Lateral Therapy should be managed by a protocol.3

How to manage support of prevention of

respiratory complication using bed??

The use of positioning therapy has been advocated for the management of respiratory complication for many years.4,5 This treatment is focused on method of positioning patients that uses a programmable bed that turns on its longitudinal axis, intermittently or continuously, with the aim of preventing and / or treating respiratory complication in critical ill patients. The generic term commonly used for this therapy is continuous lateral rotation therapy. Special bed that with frame based tilt move patients in a regular pattern around a longitudinal (i.e. head to toe) axis.

The literature has shown that patients receiving continuous lateral rotation therapy are less likely to contact nosocomial pneumonia or other pulmonary complication and their re-

admission rate are lower than patients who do not receive the continuous lateral rotation therapy.4

Lateral tilt can be used as combination with other position of the bed to reach postural drainage positions for better pulmonary drainage therefore pulmonary hygiene.

Automatic Lateral Therapy (ALT) is platform based lateral tilt which can be individually programmed for each patients. With default setting of the ALT is the use of therapy more friendly for nurse. To identify the right patients for ALT us algorithm and protocol created by our clinical team.3

How to support the treatment of respiratory

complication using bed??

ARDS (Acute Respiratory Distress Syndrome) is the most several pulmonary complication in which more than 50 % cases is caused by pneumonia. ARDS is associated with high morbidity and mortality6. Current best practice is focused on ventilator strategy to protect the lung and reduce static positioning. Positive effect of body position on ventilation was studied in large PROSEVA study7.

Used of lateral tilt rotation was described and recommend with ARDS patients treated with ECMO as safe practice8. Our clinical nursing team actively use the application of ALT for their patients9 and share their experience on international level.

The result of our clinical trials3 were ALT was used with subject with several ARDS was also presented in many international critical care conferences.


How to manage hemodynamic instability with bed?

Pressure injury are one of the most common complications of ICU patients. Pressure ulcers are associated with adverse patient outcomes, and contribute to patient pain, depression, loss of function and independence, increased incidence of infection and sepsis, additional surgical interventions, and prolonged hospital stays. Therefore, the best treatment for pressure ulcers is to prevent their development.

Pressure-ulcer prevention and management guidelines recommend support-surface therapy to help prevent and treat pressure ulcers. Support surfaces include pads, mattresses, and cushions that redistribute pressure. Full cushions and cushion pads are considered therapeutic support surfaces if used to redistribute a patient’s pressure in a chair or wheelchair.

The National Pressure Ulcer Advisory Panel (NPUAP) defines support surfaces as “specialized devices for pressure redistribution designed for the management of tissue loads, microclimate, and/or other therapeutic functions.” These surfaces address the mechanical forces associated with skin and tissue injury, such as pressure, shear, friction, and excess moisture and heat.3

Immersion and envelopment properties of a support surface are crucial.

Immersion

The most fundamental strategy for reducing pressure near a bony prominence is to allow the prominence to be immersed into the support surface. Immersion allows the pressure concentrated beneath the bony prominence to be spread out over the surrounding area. Immersion also increases the potential for body weight to be shifted to areas around other bony prominences4.

Envelopment

Envelopment is the ability of the support surface to conform around the body. As the body’s contact area with the support material increases, pressure decreases.4

Clinicians must ensure the support surface meets the patient’s specific needs. If the patient has some mobility, support-surface immersion and envelopment shouldn’t impede independent mobility.3

MicroClimate

The microclimate is the skin’s heat and humidity (temperature and moisture level). Moist skin can result from sensible water loss (as with urinary incontinence) or insensible water loss (perspiration). Moist skin is a risk factor for pressure-ulcer development. Research shows that as the skin warms, moisture increases, weakening the skin.5 Other influences added to fragile skin, such as the mechanical forces of shear and friction, further increase pressure-ulcer risk.

Support surfaces with cover from Microclimate fabric help to lower humidity levels between the skin and fabric. The measurement shows that absolute humidity with this type of fabric increased below the fabric (inside the mattress), demonstrating the increased movement of moister vapour.6 Opticare mattress has micro-vapour-permeable cover but also active circulation of the air inside. That maintain the skin’s heat and relative humidity by providing a flow of air that cools the skin and wicks away moisture. Managing the pressure along with the skin’s microclimate is important in preventing and healing pressure ulcers.


Opticare

PR articles


www.linet.com

Early Mobilization Use the LINET INTENSIVE CARE SOLUTION to infl uence the length of stay in your unit


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services360

obstetrics and gynecological care 360 women

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intensivecare 360

one daycare 360

long-term care 360 mother and child

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Early Mobilization

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Use the LINET INTENSIVE CARE SOLUTION to infl uence the length of stay in your unit

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On-line campaign supportFacebook PostsSet of 13 posts, see example

POST 1Lateral tilt and Automatic lateral therapy can assist with pulmonary hygiene. Evaluate these unique LINET functions in your hospital.

POST 2Provide more therapy options with Multicare bed´s advanced features.


Paid on-line displays See example

POST 1

ENPost copy: Find out how the Early Mobilizationprogram can help with patient handling.

Link headline: Evaluate Multicare today

Link description: Order for free

HL in graphic: I recommend the Multicare bed

POST 2

EN:Post copy: Automatic Lateral Therapy can assistwith pulmonary hygiene.

Link headline: Evaluate Multicare today

Link description: Order for free

HL in graphic: With ALT, patient care is easier


Landing pageSee example of US landing page: http://www.linetamericas.com/en-US/early-mobilization-with-linet


The frame-based Lateral Tilt is a unique LINET feature which can help accelerate recovery of critical care patients.

Lateral Tilt

Automatic Lateral Therapy (ALT) is a platform-based Lateral Tilt which can be individually programmed and is recommended for patients unable to tolerate manual turning. ALT can be used in cases of higher risk of VAP which are unable to train the patient’s body to tolerate side to side movement.

Automatic Lateral Therapy

Micro-shifting makes it possible to tilt the patient one degree at a time.

Micro-shifting

30° stop maintains optimal head of bed (HOB) angle in compliance with pressure injury prevention and Ventilator Associated Pneumonia prevention.

30° stop

Download the full brochure

1st LEVEL of Early Mobilization with LINET

Discover next level!

Motivational leafletMotivation for donwnloading Early Mobilization brochure and another materials


Clinical Studies for download

User experience with Multicare and Lateral Tilt

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LINET | User experience with Multicare and Lateral Tilt 3

designed and shaped to adapt to the lateral tilt.Stabilisation aids ensure the safe operation of the

set programme and maintain a constant body position in the centre of the bed. On the basis of these aids, patient safety cannot be compromised during the lateral tilts.

When activating the program, the manufacturer’s instructions must be followed. If you try to activate the lateral tilt when some of the side rails are not raised, the program will not start. Instructions and warnings are given on the bed’s display screen.

Before automatic lateral therapy, a test cycle must always be run. The main purpose of this test is to prevent undesirable situations. Most importantly, the distribution of all invasive protrusive inputs and the hose system must be checked. It is safe to use the ventilator circuit holder sited on each positioning bed to prevent extubation. The holder can be installed from the left, the right or even the top centre of the bed, according to the needs of staff and the requirements of other parts of the bed.

Our experience with this system has been very good. Extubation during automatic lateral therapy has never occurred.

3. Verticalisation of the patientPatients can be gradually verticalised in this bed, which is another great benefit. Many patients in our department undergo analgosedation for the acute phase of their condition on and just after admission to hospital. With regard to positioning, the patient needs 24/7 care, so that immobilisation syndrome1 does not cause any secondary damage.

When the acute phase of the health condition is over, subsequent efforts are made to mobilise the patient in the shortest possible time.

From the rehabilitative point of view, a passive rehabilitation exercise is required first. A fully qualified physiotherapist uses this exercise to focus on the ability to restore the normal function of the patient’s musculoskeletal system without any effort of his/her will. The patient’s ability to assist the physiotherapist or to execute a specified movement independently is called active exercising. The patient’s active movement with the help of medical staff is followed by verticalisation; this means that the patient is able to stand on his/her feet next to the bed. The adapted multifunctional bed has helped us greatly to this task. Specifically, the physiotherapist will instruct the patient to sit on the bed with his/her legs hanging down while grasping the side rails, which are there to help the patient stand; firstly, of course with the help of a physiotherapist, later on his/her own.

It is my opinion that the lateral tilt and the Mobi-Lift handle2 functions are useful aids to progressive verticalisation. The cardiovascular system of a patient who has not stood up for a long time will naturally weaken. Using the Mobi-Lift handle increases safety levels during the transition to an upright position for both the patient and the staff regarding the possible occurrence of postural hypotension. If the patient is unable to stand up because of low muscle strength, no danger will arise – the patient cannot fall, but would just sit down on the bed again.

A highly positive feature of the LINET positioning bed is the range of positioning programs that contribute significantly to the adaptation of the human body as it gradually starts to verticalise.

This document has been drawn up under the supervision of MUDr. Michal Otáhal, Prague General University Hospital, Clinic of Anaesthesiology, Resuscitation and Intensive Medicine

MUDr. Michal OtáhalBc. Jana Wimerová

Postural risk reduction and the electric profiling bed

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LINET | Postural risk reduction 2

Postural risk reduction and the electric profiling bedAuthors: Centre of Excellence in Posture, Movement & Handling, Birmingham City University

Beds are key items of equipment in health and social care, yet the importance of providing the right bed for patients and care service users is sometimes overlooked. The right bed can enhance the quality of life of those who use them; poorly designed or inappropriately chosen beds can have a significant detrimental effect. Typically, injuries happen while moving patients up or down the bed or helping them to sit up or turning them in bed (Hignett 2003*). The provision of an electric profiling bed would seem a logical step in reducing such risks by enabling a patient to move from a recumbent, to sit-to-stand position, with minimal aid. The purpose of this initiative was to quantify the risk reduction encountered within this single, commonly undertaken, task.

The data was collected, with the full co-operation of LINET UK, using a vibration feedback harness to ascertain if there is an impact when using the Mobi-Lift® mobilising handle or lateral tilt function on LINET electric profiling beds. LINET beds provide the patient with independence through active mobilisation with unique features such as integrated Mobi-Lift® mobilising handle and lateral tilt function. These safety features ensure patient safety when standing and reassure nursing staff. The Mobi-Lift® mobilising handle is integrated into the bed’s mattress platform to act as a support for the patient when getting out of bed. A Hi-Lo button is integrated into the Mobi-Lift® handle which eases the efficiency of patient standing and allows the patient to actively control their own movement.

* Hignett, S. Lang, R. (2003) ‘Project managing a change to electric hospital beds’. British Journal of Health Care Management. 9 (8) 271–276

Results OverviewNormal Tilt Mobi

Total Time 17.400 23.350 12.600

Stand< -15 0.575 0.125 0.075

> 10 1.775 0.05 0.225

Frequency< 15 17 4 2

> 10 14 2 5

Percentage (Time)

< -15 3.30 0.72 0.43

>10 10.20 0.29 1.29

Percentage (Angles)

< -15 34.69 8.16 4.08

> 10 28.57 4.08 10.20

Individual Angles 49 24 23

Movement DataThe movement data highlights that with both the normal electric profiling (Figure 1) and the use of the Mobi-Lift® mobilising handle ( Figure 2) there is a standing spike which is not present with the lateral tilt function (Figure 3). The movement data from the lateral tilt function shows that the patient adopts a more natural standing movement. The use of a standard bed (to stand a patient) adversely affects the patient’s posture as a spike of up to a 47 degree forward curve of the spine is shown.

Figure 1 Movement data captured using a normal electric profiling bed The sit-to-stand movement was completed in approximately 17 seconds and the spikes in the graph show the number of times where a spinal movement, in excess of 15° forwards and 10° backwards, were encountered.

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Signature banner

Mailing5 mailers (1 general + 4 for each level of Early Mobilization). Short video included in mailer - motivation to open every level of Early Mobilization.


Corporate Identity = how to use Early Mobilization with LINETGeneral recommendation (graphic elements)

ABCDE abcde 12345

1. Logo LINET

2. Logo 360º intesive care

4. PhotosUse only photos from the supplied stock.

3. TextUse Helvetica Neue LT Pro, 45 lightIn three colors: a) Main text = black (CMYK 0/0/0/100)b) Title text = shadow (CMYK 0/0/0/65)c) Important message = red (CMYK 0/100/100/0)


Clinical evaluation form – Early Mobilization with LINETHospital:

Unit / Ward Name:

Date evaluation commenced: Date evaluation completed:

Completed by: Position:

Mobile No: Email address:

LINET/Partner representative:

LEVEL 1:

Would you recommend ALT/frame-based lateral tilt as a solution for unconscious patients in level 1 also to your colleagues?

Strongly recommend Recommend Undecided Not recommend Strongly not recommend

LEVEL 2:

Would you recommend combination of Reverse Trendelenburg and Orthopnoeic chair on LINET bed in order to help muscle straightening to your colleagues?


LEVEL 3:

Would you recommend Mobi-Lift in level 3 as a good support for patients also to your colleagues?Strongly recommend Recommend Undecided Not recommend Strongly not recommend

LEVEL 4:

Would you recommend Mobi-Lift for the patients as a standing-up assistant/tool also to your colleagues?Strongly recommend Recommend Undecided Not recommend Strongly not recommend

Would you recommend Lateral Tilt in level 4 as good help for patients for standing-up also to your colleagues?


Please could you provide any additional comments regarding Early Mobilization with LINET:

Evaluation of a trial in the hospital


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Claims and references

Reference(1) AACN practice alert: delirium assessment and management. http://www.aacn.org/WD/ practice/docs/practicealerts/

delirium‑practice‑alert‑2011.pdf(2) Rion, J. H., & Kautz, D. D. (2016). The walk to save: Benefits of inpatient cardiac rehabilitation. Medsurg Nursing, 25(3), 159‑162.

Retrieved from https://search‑proquest‑com.contentproxy.phoenix.edu/docview/1798713883?accountid=134061(3) Morris P, Griffin L, Berry M, Thompson C, Duncan Hite R, WinkelmanC, Hopkins R, Ross A, Dixon L, Leach S, Haponik E (2011)

Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci 34:373–377

(4) Fraser, D., Spiva, L., Forman, W., & Hallen, C. (2015). Original research: Implementation of an early mobility program in an ICU. AJN, American Journal of Nursing, 115(12), 49‑58. doi:10.1097/01.NAJ.0000475292.27985.fc

(5) LTC Clinical Pearls: Powered by HCPro’s Long‑Term Care Nursing Library, November 27, 2012(6) Koukourikos, K., Tsaloglidou, A., & Kourkouta, L. (2014). Muscle atrophy in intensive care unit patients. Acta Informatica Medica,

22(6), 406‑410. doi:http://dx.doi.org.contentproxy.phoenix.edu/10.5455/aim.2014.22.406‑410(7) Krupp, A. E., & Monfre, J. (2015). Pressure ulcers in the ICU patient: An update on prevention and treatment. Current Infectious

Disease Reports, 17(3), 1‑6. doi:http://dx.doi.org.contentproxy.phoenix.edu/10.1007/s11908‑015‑0468‑7(8) Schweickert W, Pohlman M, Pohlman A, Nigos C, Pawlik A, Esbrook C, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt

G, Bowman A, Barr R, McCallister K, Hall J, Kress J (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–1882

(9) Titsworth WL, et al. The effect of increased mobility on morbidity in the neurointensive care unit. J. Neurosurg. 2012; 116:1379 1388.

(10) Otáhal M, Wimerová J., User experience with Multicare and Lateral Tilt(11) Vollman, K. M. (2012). Hemodynamic instability: Is it really a barrier to turning critically ill patients? Critical Care Nurse, 32(1), 70‑

75. doi:10.4037/ccn2012765(12) Centre of Excellence in Posture, Movement & Handling: Postural risk reduction and the electric profiling bed, Birmingham City

University(13) Davis, K. G., & Kotowski, S. E. (2015). Prevalence of Musculoskeletal Disorders for Nurses in Hospitals, Long‑Term Care Facilities,

and Home Health Care: A Comprehensive Review. Human Factors, 57(5), 754–792. https://doi.org/10.1177/0018720815581933(14) Krishnagopalan S, Johnson W, Low LL, Kaufman LJ. Body position of intensive care patients: clinical practice versus standards.

Crit Care Med. 2002; 30: 2588‑2592(15) Patient Handling Positioning Statement. www.osha.gov, Accessed June 10, 2004* VAP – Ventilator‑Associated Pneumonia; ALT – Automatic Lateral Therapy** The response of mixed venous oxygen saturation (Sv̄O2).

Claims

Early Mobilization program can reduce the incidence of delerium by up to 50%!8

Early mobility in the ICU could minimize loss of functional abilities and possibly shorten hospital stay by 28%9

Decrease VAP by using ALT!*10

Improve Sv¯O2** by 22% by utilizing a Lateral Turn11

Decrease the patient’s injury risk during active mobilization by using the Lateral Tilt and Mobi-Lift® 12

The Lateral Tilt and Mobi-Lift® can reduce the effort of bed exiting by 50%!12

Employ a multidisciplinary team to make your Early Mobilization more effective, safe and feasible


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LINET spol. s r.o.Želevčice 5 | 274 01 Slaný | Czech Republictel.: +420 312 576 400 | fax: +420 312 522 668 | e-mail: [email protected] | www.linet.com

Members of LINET GroupLINET | Edition 03 /2019 | Slight colour differences are possible. Change of technical parameters reserved.

Where you can find Early Mobilization materials

Internal partners can find all relevant materials here:S:\Departments\Marketing\SBU_2\01_PRODUCT_SUPPORT\CAMPAINGS\2019_ICU_EarlyMobilizationWithLinet\Global_package

External partners can find some materials on extranet here:http://extranet.linetgroup.com/en/products/health-care/beds/intensive-care-beds/multicare

For more information contact Brand Manager for intensive care, Jarmila Vindušková, [email protected]

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Documents

Guide Book - LINET