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JKM > Volume 45(2); 2024 > Article
Jin, Lee, Kim, Min, Bang, and Leem: Case series of 3 Pressure Ulcers Cured with Education through Telemedicine

Abstract

Objectives

The case series with pressure ulcers who was cured by education through telemedicine will be presented as a model for how a Korean medicine doctor can participate in the telemedicine of pressure ulcers. We also aim to report on the perspectives of medical staff and patients regarding the improved telemedicine services in Korean medicine.

Methods

The study included three cases of pressure ulcers in home care, and education on pressure ulcer management was provided to patients, caregivers, and collaborators via telemedicine. Basic training was provided to teach the sealed wet dressing therapy method. After the basic training, feedback on the treatment was provided by taking photos or videos of the patient’s treatment process, and the feedback process was repeated until the dressing method was perfected.

Results

A combination of telemedicine, home visits, and home care successfully treated pressure ulcers in home care patients using a multidisciplinary approach. The education through telemedicine alone improved the National Pressure Ulcer Advisory Panel (NPUAP) stages and the total score of the Pressure Ulcer Scale for Healing (PUSH) Tool, and all three cases were finally cured with an average treatment duration of 26.7 days. The patient’s and clinician’s perspectives also showed that telemedicine can effectively engage patients, caregivers, and collaborators, and motivate them to manage pressure ulcers.

Conclusions

For patients having trouble visiting the hospital or desiring treatment at home, consideration can be given to telemedicine for traditional Korean medicine education in pressure ulcer management.

감사의 말씀

This work was supported by a National Research Foundation of Korea grant funded by the Korea government (No NRF-2022R1C1C2008738). This research was also supported by the Bio&Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (No. RS-2023-00261934).

Notes

Supplementary video 1. Sealed Wet Dressing Therapy process:

https://www.youtube.com/watch?v=RMJBVZNZIGc

Fig. 1
Acupuncture on the buttock region of case2 patient.
jkm-45-2-122f1.gif
Table 1
Baseline Characteristics of the Included Patients
Case 1 Case 2 Case 3
Collaborators Visiting nursing center(Nurse), Caregiver Home visiting healthcare service(KMD), Caregiver Caregiver
Sex Female Male Female
Age 80s 20s 80s
Pressure ulcer history None Two times Unknown
Cardiopulmonary disease Yes None Yes
Urinary and fecal incontinence Yes Yes Yes
Neurodegenerative diseases Yes None Yes
Reduced physical activity Yes Yes Yes
Onset date 2023.03 2023.04 2023.07
Start date for telemedicine 2023.08.30 2023.09.12 2023.08.31
End date for telemedicine 2023.09.25 2023.09.25 2023.10.10
Treatment duration 21 days 22 days 37 days
Number of telemedicine 3 times 2 times 1 time
Cure date 2023.09.20 2023.10.04 2023.10.10
NPUAP Pressure ulcer stages (first visit) 2 stage 2 stage 3 stage
Location of pressure ulcer Coccyx Buttocks Sacrum
Number of pressure ulcer 1 1 for each 1
PUSH Tool 3.0 (first visit)
Length x Width 1.1*1.9 (2.09) Rt 1.4*0.3 (0.42)
Lt 2.3*1 (2.3)
Unknown
Exudate amount 3 Rt 2
Lt 2
Unknown
Tissue type 2 Rt 2
Lt 2
3
Total score 10 Rt 6
Lt 9
Unknown

KMD; Korean Medicine Doctor, NPUAP; The National Pressure Ulcer Advisory Panel, PUSH; The Pressure Ulcer Scale for Healing

Table 2
The National Pressure Ulcer Advisory Panel Pressure Ulcer (NPUAP) Stages/Categories(2007)
Stage Categories
1 Non-blanchable erythema
  • Intact skin with non-blanchable redness of a localized area usually over a bony prominence.

  • Painful, firm, soft, warmer or cooler as compared to adjacent tissue

2 Partial thickness
  • Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough.

  • An intact or open/ruptured serum-filled or serosanguinous filled blister.

  • shiny or dry shallow ulcer without slough or bruising*.

3 Full thickness skin loss
  • Full thickness tissue loss.

  • Subcutaneous fat may be visible but bone, tendon or muscle are not exposed.

  • Slough may be present but does not obscure the depth of tissue loss.

  • May include undermining and tunneling.

4 Full thickness tissue loss
  • Full thickness tissue loss with exposed bone, tendon or muscle.

  • Slough or eschar may be present.

  • Often includes undermining and tunneling.

* bruising indicates deep tissue injury.

Table 3
Pressure Ulcer Scale for Healing (PUSH Tool 3.0)
Length x Width (cm2) 0 1 2 3 4 5
0 0 ~ 0.2 0.3 ~ 0.6 0.7 ~ 1.0 1.1 ~ 2.0 2.1 ~ 3.0
6 7 8 9 10
3.1 ~ 4.0 4.1 ~ 8 8.1 ~ 12.0 12.1 ~ 24.0 >24

Exudate amount 0 1 2 3
None Light Moderate Heavy

Tissue type 0 1 2 3 4
Closed Epithelial tissue Granulation tissue Slough Necrotic tissue

Total score
Table 4
Clinical courses of Case 1
Case1 2023. 08. 30. 2023. 09 .06. 2023. 09. 11. 2023. 09. 20.
NPUAP stages 2 2 2 End of treatment
Length x Width (cm2) 1.1*1.9 0.9*1.1 0.6*0.9 End of treatment
Exudate amount 3 2 1 End of treatment
Tissue type 2 1 1 End of treatment
Total score 10 6 4 End of treatment
Photograph jkm-45-2-122f2.gif jkm-45-2-122f3.gif jkm-45-2-122f4.gif jkm-45-2-122f5.gif
jkm-45-2-122f6.gif jkm-45-2-122f7.gif jkm-45-2-122f8.gif

The photo shows a horizontal and vertical view of the same area.

NPUAP; The National Pressure Ulcer Advisory Panel

Table 5
Clinical courses of Case 2 (Left buttock)
Case2 2023. 09. 11. 2023. 09. 20. 2023. 09. 25. 2023. 10. 04
NPUAP stages 2 2 2 End of treatment
Length x Width (cm2) 2.3*1.0 1.5*0.8 1.0*0.5 End of treatment
Exudate amount 2 2 1 End of treatment
Tissue type 2 1 1 End of treatment
Total score 9 7 4 End of treatment
Photograph jkm-45-2-122f9.gif jkm-45-2-122f10.gif jkm-45-2-122f11.gif jkm-45-2-122f12.gif

NPUAP; The National Pressure Ulcer Advisory Panel

Table 6
Clinical courses of Case3
Case3 2023. 09. 01. 2023. 09. 26. 2023. 10. 10
NPUAP stages 3 2 End of treatment
Length x Width (cm2) Unknown Unknown End of treatment
Exudate amount 3 1 End of treatment
Tissue type 3 1 End of treatment
Total score Unknown Unknown End of treatment
Photograph jkm-45-2-122f13.gif jkm-45-2-122f14.gif jkm-45-2-122f15.gif

NPUAP; The National Pressure Ulcer Advisory Panel

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