This paper is one of three examining innovations in pressure ulcer prevention and management. Among a number of fascinating innovations introduced in Japan, the problem of how to prevent pressure damage in patients with an extreme bony prominence is discussed.

Key innovations in Japan

1. Adoption of routine ultrasound use to identify deep tissue damage.
2. Implementation of temperature measurement (thermography) as a tool to predict delayed wound healing.
3. Development of a special support surface for patients in Japan because of the problem of extreme bony prominence.
4. Development of a hand-held measuring sensor device to accurately determine the interface pressure between the mattress and patient. This can be used to check whether pressure-relieving interventions are being used effectively.
5. Involvement by the Japanese government to enforce regulation specifying that a penalty fee must be paid by hospitals where there is an inappropriate pressure ulcer management system in place.
6. Introduction of a government reimbursement system in Japan involving the use of specially trained nurses in pressure ulcer prevention and management.

INTRODUCTION

In Japan, research and development initiatives in pressure ulcer management and prevention are conducted by professionals from many disciplines. These include nurses, physicians, rehabilitation therapists and researchers from universities and industry. Their continuing efforts have dramatically improved the outcome and quality of life for many patients.

Three key innovations have arisen from work undertaken in Japan:

• A new management strategy for identifying pressure ulcer deterioration by using ultrasound
• The use of thermography to identify wounds at risk of delayed healing
• The development of a hand-held pressure sensor to accurately determine interface pressure and the effectiveness of interventions.

These technology-based wound care devices have changed practice and helped promote a better understanding of the processes and progression of deep tissue injury and prediction of non-wound healing.

In addition, the development of a specific pressure-reducing mattress for managing patients with extremely bony prominences and a major new drive to improve pressure ulcer prevention using a financial incentive will be discussed.