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Whitepapers
Fact Sheets
Videos
Leaf Research
Pressure Ulcer Prevention Info
Patient Mobility Info
White Papers
White Paper

Improving Patient Outcomes, Preventing Hospital-Acquired Conditions, and Reducing Readmissions

Studies show that encouraging hospitalized patients to move more helps them heal faster and reduces their risk for developing hospital-acquired condition (HACs), which are costly and life- threatening conditions that are considered preventable. New technology now makes it possible to electronically monitor and automatically document a patient's mobility progression to help avoid the serious complications associated with immobility.

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White Paper

Susan M. Kennerly, PhD, RN, WCC and Tracey L. Yap, PhD, RN, WCC, FAAN

Manual turning of patients has many benefits beyond pressure ulcer prevention. It is the first step in early mobilization of bedbound patients to prevent cardiovascular and musculoskeletal effects of immobility, such as a change in muscle and/or bone mass and a reduction in plasma volume. Manual turning also helps prevent gravitational equilibrium, which eventually makes it more difficult for the patient to tolerate position changes. Turning is a key component in prevention of pneumonia and post-operative fever and has been shown to lead to fewer ICU days and better patient outcomes.

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White Paper

A new device helps ensure high levels of adherence with standard prevention measures in an effort to prevent pressure ulcers

Pressure ulcers are a vast and growing problem in the United States and account for ~ $10 billion dollars in annual health care spending. In 2008, the Centers for Medicare & Medicaid Services discontinued reimbursement for hospital-acquired pressure ulcers (HAPUs), thus increasing the demand for early-stage prevention. Each year, over 1 million patients will suffer from a hospital-acquired pressure ulcer.

Pressure ulcers occur most commonly in the elderly, which is the fastest-growing segment of the population. As a result, the number of patients at risk for developing pressure ulcers is expected to increase dramatically in the coming decades. Given the tremendous burden that pressure ulcers place on the healthcare system, there is a substantial need for improved prevention methods.

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White Paper

A high level technical review of a new wireless monitoring system

This paper presents a brief overview of the technical attributes of the Leaf Patient Monitoring System. The Leaf Patient Monitor is a system that enables hospitals, long term care facilities (LTC), and nursing homes to wirelessly monitor the real-time orientation and activity of patients susceptible to pressure ulcers; and to provide alerts when patient orientation or activity deviates from individualized turn management protocols set by the healthcare provider.

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White Paper

A review of the direct and indirect costs associated with pressure ulcers

The costs associated with pressure ulcers are considerable. According to the Agency for Healthcare Research & Quality (AHRQ), pressure ulcers cost the US healthcare system an estimated $9.1-$11.6 billion annually. In addition to direct treatment related costs, pressure ulcers also result in litigation, government penalties, and impact hospital performance metrics. On top of the financial implications, pressure ulcers also have a significant impact on patient morbidity, mortality, and quality of life. To further exacerbate the problem, as the population ages, the percent of patients at risk for developing pressure ulcers is growing, thus increasing the demand for early stage prevention.

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White Paper

An innovative system helps ensure the completion of routine tasks to avoid adverse events

Despite effective methods for identifying risk and preventing hospital acquired pressure ulcers (HAPUs), pressure ulcers remain the most prevalent preventable hospital acquired condition. A major contributor to the continued prevalence of pressure ulcers is the typical acute care environment in which patient care activities are often interrupted by emergent situations, care coordination and communications with patients, family and staff. Attempts to use technology to transform the patient care environment to be more predictable and less interrupt driven have proven unsuccessful.

One technology solution for preventing HAPUs has combined a novel wireless sensor with software that facilitates the consistent and timely completion of routine preventive actions in spite of the interrupt driven care environment. This solution relieves caregivers the task of turning patients who have already turned themselves, communicates turn periods in a way that can be easily understood and accomplished when time is available, and ensures patient turns are not missed.

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Fact Sheets
Solution Overview

A summary of how the Leaf Patient Monitoring System monitors patient activity and movement to help coordinate mobility protocols to avoid immobility related complications like HAPU, pneumonia, DVT/PE, and tracks mobility progression to facilitate patient discharge with reduced risk of readmission.

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Solution Overview

A two page overview detailing how the Leaf Patient Monitoring System works to monitor patient movement and activity, automate patient turning protocols and alerts when a patient requires staff assistance to help avoid hospital acquired pressure ulcers.

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Solution Brief

A one page bulleted brief outlining how the Leaf Patient Monitoring System can help improve patient outcomes, reduce costs associated with HAPUs and is easy to implement and use.

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View Mobility Continuum

An illustration of patient mobility risk factors, typical orders and interventions and descriptions of how the Leaf system helps at each step along the way.

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Daily Impact Report

An automatically generated daily report delivered to nursing management detailing levels of turn adherence by unit and shift. A great tool for sustaining high performance.

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Videos

"Despite a growing emphasis placed on prevention, pressure ulcers continue to be the most common preventable hospital-acquired condition. In the United States, 1 out of every 30 hospitalized patients will develop a pressure ulcer, resulting in unnecessary patient suffering and costing our healthcare system over $10B per year ..."

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"This video demonstrates how to apply a Leaf Patient Sensor. The sensor can be placed anywhere on the upper anterior torso below the clavicles. When choosing a location within this area, the most important criteria is a flat ..."

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"This video demonstrates how to register a patient on the Leaf Patient Monitoring System. Begin on the "Home" screen of the system's user interface, and locate the "Unassigned Sensors" in the lower right of the display ..."

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"This video will help you interpret the display of the Leaf Patient Monitoring System. The "Home" screen of the system's user interface displays a patient's current turning status, specific details about their position, and relevant ..."

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"This video reviews how to remove the Leaf Sensor and discontinue monitoring. When a patient no longer requires turn monitoring, remove the sensor from the patient and discard it per your facility's used battery disposal policy. On ..."

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"This video demonstrates how to effectively turn and reposition a patient. The first method we will demonstrate requires a combination of positioning wedges and pillows. Begin by collecting 2 wedges and ..."

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"The story I'm going to share with you today starts about six years ago. I was in medical school on a clinical rotation at a local county hospital where I had the opportunity to help care for a woman that unfortunately had sustained a severe burn injury. From the beginning it was unclear if she was going to live ..."

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Leaf Research

Bernadette E Walters, BSN, RN, CWON, Amanda J Spitzer, BSN, RN, CWOCN, CFCN — John Peter Smith Hospital, Fort Worth, TX.

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Amanda J Spitzer, BSN, RN, CWOCN, CFCN, Bernadette E Walters, BSN, RN, CWON — John Peter Smith Hospital, Fort Worth, TX.

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Bernadette Walters, RN, BSN, Kandace Jamison, RN, BSN, CCRN, Debi Zafer, RN, MSN, MBA/HCM, Trudy Sanders, RN, PhD, RN, NEA-BC — John Peter Smith Hospital, Ft. Worth, TX

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Cathy Parker RN, BSN; Mary O'Neil RN, BSN, CWON; Nora Tam, BA — Kaiser Permanente, Redwood City, CA

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Margaret Doucette, DO, FABPM, CWSP, Director of Wound Care and Physical Medicine; Stephanie Adams, RN, Clinical Coordinator; Kelsey Cosdon, RN; Kattie Payne RN, PhD, Nursing Research Evidence Based Coordinator — VA Medical Center, Boise Idaho

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Margaret Doucette, DO, FABPM, CWSP, Director of Wound Care and Physical Medicine; Stephanie Adams, RN, Clinical Coordinator; Kelsey Cosdon, RN; Kattie Payne RN, PhD, Nursing Research Evidence Based Coordinator — VA Medical Center, Boise Idaho

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Margaret Doucette, DO, FABPM, CWSP, Director of Wound Care and Physical Medicine; Stephanie Adams, RN, Clinical Coordinator; Kelsey Cosdon, RN; Kattie Payne RN, PhD, Nursing Research Evidence Based Coordinator — VA Medical Center, Boise Idaho

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Chris Tarver, MS, RN, CNS; Suann Schutt, MSN, RN-BC, CEP, (El Camino Hospital) — Michelle Pezzani, MD, (Palo Alto Medical Foundation)

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Barrett Larson, MD; Daniel Shen, MS; Mark Weckwerth, PhD

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Barrett Larson, MD

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Presenting Author: Barrett Larson, MD, Department of Anesthesiology, Stanford University School of Medicine / Leaf Healthcare
Co-Author: Daniel Shen, MS, Stanford University School of Medicine / Leaf Healthcare

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Pressure Ulcer Prevention Info

Some experts say bedsores should never happen. We know the cause (immobility) and effect (bedsores). "The goal for health care facilities to reduce pressure ulcers is admirable but not adequate," writes Kathy Duncan, a faculty member and nurse at the Institute Improvement. "The goal for pressure ulcer incidence should be zero."

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In support of World Pressure Ulcer Prevention Day, Leaf Healthcare, Inc. released seven key steps clinicians might use to help prevent pressure ulcers. The steps are based on recommendations found in the recently released Pressure Ulcer Prevention and Treatment Guidelines from the National Pressure Ulcer Advisory Panel (NPUAP).

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New guidelines developed by the National Pressure Ulcer Advisory Panel (NPUAP), European Pressure Ulcer Advisory Panel (EPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA) include 575 explicit recommendations and/or research summaries on pressure ulcer prevention and treatment.

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CMS and the Agency for Healthcare Research and Quality have indicated that the risk of Never Events, including pressure ulcers, is significantly influenced by hospital policies and procedures — meaning that if hospitals implement the proper procedures, these events are unlikely to occur. Further, CMS indicated, "Based on the comprehensive assessment of an individual, the facility must ensure that an individual who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they are unavoidable."

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The U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) has published a manual that outlines the scope of the pressure ulcer problem — including the fact that more than 2.5 million people will develop pressure ulcers in the U.S. and about 60,000 will die each year, will cost $9.1 billion to $11.6 billion annually, and the range in costs for individual patients from $20,900 to $151,700 per pressure ulcer. The report provides recommendations to help healthcare providers deal with the problem.

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A faculty member of the Institute for Healthcare Improvement (IHI) discusses the challenges healthcare institutions face in reducing pressure ulcers and emphasizes the importance of using carefully crafted protocols and procedures to combatting the problem. The article appeared in the Safety First Blog of the Institute for Healthcare Improvement.

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A new study suggests that pressure ulcers in ICU patients may have been either over or undertreated due to a widely-used predictive tool that may not be sensitive enough for critically ill patients. Reviewing the electronic health records of 7,790 ICU patients, researchers found the Braden Scale, used to assign patients an ulcer risk factor score, isn't accurate in evaluating ICU patients.

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A study from Virginia Commonwealth University provides a link between pressure ulcers and immobility, and presents results of a critical care consensus panel on safe and effective turning of critical care patients.

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University of Kentucky study identifies prolonged immobility being a key risk factor for pressure ulcers in critical care patients receiving ECMO. The research team developed an evidence based guideline for patient turning and repositioning. The institution was able to reduce pressure ulcer rate in ECMO patients by 44% in the first year after release of the turning guideline.

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Findings from this study establish a link between more frequent turning of critically ill patients and lower incidence of hospital acquired pneumonia. Even after factors such as backrest elevation, supine positioning, and use of paralytic agents were accounted for, pneumonia was more likely to develop in patients who were turned less often. Authors suggest that critical care nurses should address barriers to turning to reduce complications of immobility.

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A retrospective study using 2010 data from 1,491 NDNQI participating hospitals provides empirical support for pressure ulcer prevention guideline recommendations on skin assessment and routine repositioning.

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A large multicenter cohort study finds compliance to two hourly turn protocol to be low and suggests that U.S. hospitals and physicians have numerous opportunities to improve care related to pressure ulcer prediction and prevention.

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Patient Mobility

Movement is critical to improving patient health. Patient ambulation, the ability to walk from place to place independently with or without an assistive device, is necessary to improve joint and muscle strength, as well as prevent pressure ulcers during extended bed rest. It is a critical factor in improving patient well-being while in the hospital, as well as reducing total length of stay (LOS).

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Study examined the impact of early ambulation to length of stay in patients admitted to an Acute Care for Elders Unit in an acute care hospital. Patients who increased their walking by at least 600 steps from the first to second 24-hour day were discharged approximately 2 days earlier than those who did not.

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Study evaluated differences between rapid mobilization of hip and knee replacement patients on the day of surgery compared to standard mobilization. Rapid mobilization was well tolerated by patients and resulted in a significantly shorter length of hospital stay than those who began mobilization day after surgery.

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Toolkit for implementing an early mobility program in the ICU includes articles, videos and clinical practice guidelines.

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A model by Johns Hopkins University for estimating annual cost savings derived from early mobility programs in critical care.

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Study reveals that early mobilization of mechanically ventilated patients improved the rate of discharge to home without neurological deficits. An early mobilization program also prevents disuse atrophy and muscle weakness, increases the clearance of lung secretions, and maintains lung expansion.

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Early Mobility Reduces ICU Patient Delirium Days. Case studies, articles and resources for implementing an early mobility program in the ICU.

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Randomized, controlled trial evaluated the impact of early mobilization in hospitalized patients with acute stroke. Patients who started out-of- bed activities within 24 hours of stroke onset were significantly more likely to have higher functional scores at discharge and be independent in activities of daily living 3 months following their hospitalization.

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Patient-focused clinical practice guideline institutionalizes early mobility in total joint replacement patients to reduce post-operative complications.

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Ambulation is a strong component of quality patient care and a hospital ambulation program prevents functional decline in patients.

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