The work we do at the Helen Hamlyn Centre for Design at the Royal College of Art in London focuses on developing projects with a strong emphasis on identifying and understanding everyday situations that people have difficulty with. Our approach is inclusive: we work with many ‚Äėusers‚Äô of a product, service or system in order to develop design solutions for and with them.
Ultimately what we aim for is to create something that will improve lives in a small or big way.
Roughly a third of our work is dedicated to addressing current and future healthcare challenges by collaborating closely with patients, clinicians and industry. In this particular project, we partnered with ArjoHuntleigh (a company specialized in patient handling and care) and set out to look at the bedsore issue from a people centred design perspective, aiming to define a new approach to managing and preventing pressure ulcers outside of hospital care. Finding a solution to bedsores requires a deep understanding of the complexities of community healthcare delivery and a creative approach to problem solving, two areas where designers have a lot to offer.
Putting bedsores under pressure
Pressure ulcers, also known as bedsores, normally develop when an area of the body is under pressure for a relatively long time, and are usually an avoidable side-effect of poor patient care. While healthy people adjust their position when the body feels sore, patients in many cases are not capable to do so (they may not feel the pressure or won‚Äôt be able to shift position).
About 1 in 5 patients in hospital are at risk of developing pressure ulcers, adding to 320,000 new wounds annually (Bennett, G., et. al, 2004. The cost of pressure ulcers in the UK. Age and Ageing, 33(3), p.230-235.). Outside hospitals however, the numbers are much harder to calculate but there is evidence to suggest that there are more people suffering from pressure sores in care homes, their own homes and on long-term care than in hospital environments.
The creative process
Consulting with experts in the field and reviewing existing pressure redistributing technologies provided a baseline. To help define the problem, we employed a series of research methods including interviews, observations, role-playing exercises and workshops with experts, involving patients wherever possible.
Great insights on standards of care came by observing how nurses at the Royal Hospital for Neurodisability and the Wound Healing Centres in Eastbourne cared for patients. We discovered that the main barrier to achieving hospital levels of care at home lies simply in staff availability to perform key tasks at the right time. While it is a routine task for nurses to carry out activities such as changing, washing, feeding, or repositioning patients, doing this with the same consistency at home can become a logistical ordeal for care providers.
The next step was to conceptualise possible solutions around the challenges identified. A large number of ideas were sketched out or mocked-up and presented back to our expert contacts to get their feedback. We had to look into details, such as, material to be used on beds taking into account low mobility levels, logistical issues of caretakers, and ease of product use. After a few rounds of iterations and refinement three propositions were chosen for proof-of-concept development.
Sensors to help scheduling – The first idea taken forward seeks to address the problem of ensuring a repositioning schedule. The prototype created helps carers determine patients‚Äô positions and the time spent in each position. It also determines the pressure levels on different parts of the body by placing inexpensive sensors on the patient‚Äôs mattress.
The dashboard – The data collected by the ‚Äúsensing surface‚ÄĚ described above can also include the measurement of other vital signs and can be linked to a digital patient dashboard. Factors such as continence and position would be logged and alert carers when a patient is in need. This would also help in allocating human resources more efficiently by creating better patient routes for caretakers.
Cushioning – Thirdly, we developed a solution that helps mitigate pressure ulcers on patients suffering from spasticity and involuntary muscular contractures. Pressure is created when a patient is ‚Äėcurled up‚Äô and the limbs force pressure on each other. This is a common problem especially among elderly patients suffering from dementia as well as in spinal injury patients of all ages. Our proposal is a small inflatable cushion with air chambers that can be inserted between the person‚Äôs limbs and alternate pressure in the chambers with the help of a connecting pump.
The three concepts outlined above are a result of in-depth user research into the practical issues surrounding care for patients with pressure ulcers in the community. Even though they are still in an early phase of development, end users believe it could show much potential in improving pressure ulcer management in the community.
- Gianpaolo Fusari, Senior Research Associate, Helen Hamlyn Centre for Design
(Photo credit: Jonathan West and Gianpaolo Fusari)