References1. Bennett G, Dealey C, Posnett J, The cost of pressure ulcers in the UK, Age and Ageing, Issue 33, p230-235, 2004.2. Royal College of Nursing, The management of pressure ulcers in primary and secondary care – A Clinical Practice Guideline, September 2005.3. Posnett J et al., The resource impact of wounds on health-care providers in Europe, Journal of Wound Care, Vol 18, No 4, April 2009.4. Graves N, Birrell F, Whitby M, Effect of Pressure Ulcers on length of Hospital Stay, The University of Chicago Press, on behalf of SHEA, Vol 26, No 3, pp 293-297, 2005. 5. Leonard S, Ormond K, An evaluation of a shaped dermal pad and their influences on pressure ulcers in an acute foundation trust, 2008, poster presentation, Wounds UK conference Harrogate.6. Hampton S, Tadejand M, Young S, An evaluation of Aderma Heel Pad, Wound healing centre, Eastbourne, 2011.

The following support materials are available for you to order:

• A3applicationposter• EvaluationForm• Skinguide• A5rangeguide

ADERMA Dermal PadDesigned to help prevent pressure ulcers

Hospital Community

ADERMA™ singles per carton S&N code NHS code S&N code PIP-code

Sheet 10x10x0.3cm 5 10-660 ELY373 FP0065 328-3918

Sheet 10x10x1.2cm 5 10-561 ELY065 FP0066 328-3934

Sheet 20x20x0.3cm 2 10-680 ELY371 FP0067 328-3900

Sheet 20x20x1.2cm 2 10-630 ELY367 NA NA

Strip 30x5.0x0.3cm 5 10-650 ELY372 FP0064 328-3926

Strip 50x2.5x0.3cm 5 10-670 FES9551 FP0063 365-5024

Heel standard 2 10-600 FES7524 FP0061 365-5032

Heel standard 30 10-600-BLK FES9552 NA NA

Heel extra large 2 10-640 ELY366 FP0062 365-5040

Sacrum/Anklewrap 1 10-610 FES7525 FP0060 365-5057

Ordering Codes

www.aderma.info

© Smith & Nephew April 2012 ™TrademarkofSmith&Nephew35050

Wound Management Smith & Nephew Healthcare Ltd Healthcare House 101 Hessle Road Hull HU3 2BN

T 01482 222200F 01482 222211

DesignADERMA was used on 28 residents across 3 nursing homes, all with a Waterlow score over 15 (highrisk)andexistinggrade1pressuredamagetothe heel. A visual and ultrasound inspection was carried out at the start of the study and after 1, 4, and8weeks.

DesignADERMA was used for 3 months in an acute NHS foundation trust as part of a Care Plan across 2 elderly wards, 1 orthopaedics ward and 1 general surgery ward. ADERMA was added to the care plan that already includedrepositioningandregularskininspections.Figures for incidence, severity and number of pressure ulcers were compared to the 3 months before ADERMA was included.

Clinical Evidence

Pressure ulcer incidence

Overall incidence

Hospital acquired incidence

4.0% 4.5%

3.5% 3.0%

2.5%

2.0% 1.5% 1.0% 0.5%

0.0%Jan-Mar Apr-Jun

Severity of pressure damage

Jan-Mar

Apr-Jun

161412

10

8642

0grade 1 grade 2 grade 3 grade 4

Nursing home

Hospital

ResultsAll the treated heals improved and returned to a pre-injured statewithinweeksofcommencingtreatment.ThevisualinspectionoftheskinshowedareductioninErythema,whereastheultrasoundimagesshowedthattheskincondition improved below the surface as well. The heels without ADERMA receiving standard care did not improve.

ADERMA™ on grade 1 pressure ulcers6

ResultsThe addition of ADERMA to the care plan contributed to an 87% drop in incidence of hospital acquired pressure ulcers. The reduction in the overall number of pressure ulcers was 75% including an eradication of all grade 3 and 4 pressure ulcers.

www.aderma.info

ADERMA as part of a Care Plan5

Sacrum around the ankle

ADERMA dermal padsDesigned to help prevent pressure ulcers

For patients. For budgets. For today.™www.aderma.info

™Trademark of Smith & Nephew© Smith & Nephew March 2012 34825

Strip Sheet Sacrum Heel

Early signs of pressure damage

Deep tissue damage Recently healed pressure ulcers Areas at risk of pressure damage

Use on intact skin only

Can be cut with scissors

Can be held in place with secondary fixation tape

Can be washed and re-used on the same patient

Keep packaging for easy storage

Early signs of pressure damage

Deep tissue damage Recently healed pressure ulcers

Areas at risk of pressure damage

ADERMA can be used on:

Wound Management Smith & Nephew Healthcare Ltd Healthcare House 101 Hessle Road Hull HU3 2BN

T 01482 222200F 01482 222211

Trimmed strip under masks

Sacrum over the shoulder

Heel long way across the heel (immobile patients)

Trimmed strip behind the ear

Sheet on the back of the head

Strip down the spineSacrum on the sacral area

Strip down the spineSacrum on the sacral area

Sheet under the shoulder

Sheet for hand contractures

Strip between fingers or toes

Heel long way across the foot (mobile patients)

Sheet between knees

Sheet around the foot

Heel over the knee or elbow

1 2

3 4

There are 3 layers to the skin1. EpidermisAlso known as the outer layer of the skin. The epidermis acts as the body’s major barrier against an inhospitable environment.

2. DermisAlso known as the middle layer of the skin and is composed of two layers, the papillary and reticular dermis.

3. HypodermisAlso called the subcutaneous tissue is the lower layer of the skin. The hypodermis consist primarily of loose connective tissue and lobules of fat, it contains large blood vessels and nerves.

Early signs on the skin of theformation of a pressure ulcer include:-

Change in skin colour either redder or darker indicate skin damage. A category 1 pressure ulcer exhibits non-blanching erythema, and as you can see in the picture below symptoms include a reddened (erythema) area on the skin. If you were to apply a small amount of pressure to this area it will not turn white (non-blanching).

Heat or cold can indicate the formation of a pressure ulcer as hot skin points to a sudden rush of blood suggesting circulation was cut for an amount of time.Whereas cold skin indicates the skin is dead and there is no blood flow in this area.

Discomfort or pain can be a sign of pressure ulcer formation as the area of skin and underlying tissue has been damaged due to either pressure, shearing or friction.

Any sign of skin damage can indicate the formation of a pressure ulcer however analysing the circumstances i.e. If the patient is immobile or being moved and handled, will help identify the cause of the damage.

Pressure ulcer grades 1 - 4 Depending on the grade of the pressure ulcer all layers of the skin can be affected. However some pressure ulcers cannot be categorized including those with deep tissue injury.

• Areasatriskorshowingsignsofdevelopingskin damage1

• Grade1pressureulcerstopreventdeterioration and aid tissue recovery2

• Recentlyhealedpressureulcerstohelpprevent re-ulceration3

They can be washed very quickly and re-used by the same patient making them very cost and time effective as part of a daily skin inspection routine.

Pressure ulcers can form due to a combination of factors including pressure, friction, immobility, sensory loss, poor blood circulation and malnutrition.

Preventing skin damage therefore starts with early risk assessments and a care plan for at-risk patients that includes regular repositioning, daily skin inspection, good nutrition and equipment such as specialized beds, cushions or skin care products.

ADERMA™DermalPads are an excellent addition to any prevention care plan to protect at-risk areas from pressuredamage,inparticularbonyareas.Madefroma unique polymer gel, the Dermal Pads are indicated for use on intact skin and can be used on:

The skin and its layers Signs on the skin Preventing skin damage

Epidermis

Dermis

Hypodermis

The skin is the largest organ of the body, and its derivatives (hair, nails, sweat and oil glands) make up the integumentary system. One of the main functions of the skin is protection from external factors such as bacteria, chemicals, and temperature.

ADERMA is available on prescription and can be ordered through your local pharmacy

Patient admitted into care

Early risk assessment

Care Plan for at-risk patients

ADERMA is a dermal gel pad that redistributes pressure to protect critical areas. Itistypicallyusedonbonyareastohelppreventskindamagefrompressure.

ADERMA™ Dermal Pads ADERMA™ as part of a Care Plan ADERMA™ can be used on:

How it works

High pressure points can disrupt the flow of blood and the supply of oxygen which can cause damage totheskin.

ADERMAworksbyredistributingpressure over a larger area to reducethepeakpressureatanyone point (usually a bony area liketheheelorthesacrum).Instead, the force is spread over a larger area, reducing the average pressureontheskin.

The human and economic cost of pressure ulcersAround412,000peoplearelikelytodevelopapressureulcer annually1, including 4-10% of patients admitted to hospital2.Anestimated31%aregrade3or4(EPUAP)3, causing severe pain and discomfort to the patient.

The costs of treating pressure ulcers has been estimated between £1.4bn - £2.1bn per year – the average cost to treat one grade 4 is £10,551 per episode1. Pressure ulcers also increase length of stay with an average of 4 days4, significantly increasing the demand on nursing time and resource.

ADERMA contributed to a 75% reduction of pressure ulcers 5

A Care Plan with ADERMA ADERMA dermal pads are an excellent addition to any Care Plan by

protecting at-risk areas from pressure damage, in particular bony areas. They can be washed and re-used by the same patient as part of a regular skin inspection routine:

1. Remove ADERMA and inspect the skin2. Clean the skin and the ADERMA pad with the same solution,

for example soap and water3. Dry the skin and the ADERMA pad and reapply

ADERMA has been shown to contribute to a significant drop in the number of pressure ulcers. To help you achieve a reduction in pressure ulcers you could add ADERMA to your care plan checklist:

Check if ADERMA is in place on at-risk areas

Care PlanACarePlanforpressureulcerpreventioncantakemanydifferentformsbutusuallyincludeselementslike:

• Regularrepositioning• Regularskininspection• Keepingtheskincleananddry

Somecaresettingshaveputtheseelementsintoasimplechecklist,forexampleas part of Intentional Rounding or using the SKIN Bundle. Such plans are based onregularchecksforcommonriskfactorsandroutinecaresuchasrepositioningor toileting assistance. An effective care plan could help to reduce call rates, patient falls and pressure ulcers, and increase patient satisfaction.

• Specializedbeds• Goodnutrition• Cushions

Early signs ofpressure damage

Deep tissuedamage

Recently healedpressure ulcers Areas at risk of

pressure damage

Use on intact skin only Can be cut with scissors Can be held in place with stockinette, tubular bandage, medical tape or silicone tapeCan be washed and re-used

on the same patientKeep packaging for easy storage

ADERMA

StripSacrum

HeelSheet

Heel - The heel can be used with the long way across the foot for mobile patients or with the long way across the heel for immobile patients. It can also be used on elbowsandknees.

Sacrum - This shape can be held in place with incontinence pads or underwear. Common practice includes usingasanklewraporaroundtheshoulder,hiporbackofthehead

Sheet - Can be used under the foot orheadwhilstresting,betweenkneesorunder the chin. They can also be used for handcontractures,makingthemidealforstrokerehabilitation.Thelargesheetscanbe used under the shoulder whilst lying down.

Strips - The strips are ideal for more trickyareaslikebetweenfingersandtoes,behind the ear, or over the nose under face masks.Thewiderstripisalsocommonlyused down the spine.

EarlyRiskAssessmentToidentifywhichpatientsneedacareplan,anearlyriskassessmentisusuallycarried out in the first 4-6 hours after the patient is admitted into care. Popular scoringcardslikeBradenorWaterlowlookatcommonriskfactorssuchas:

• Pressure&Friction• Moisture• Immobility• Skincondition

• Sensoryloss• Poorbloodcirculation• Malnutrition• Age,gender,weight

ADERMA redistributes pressure

Grade 4 pressure ulcer