Smith & Nephew: Helping You See the Bigger Picture at Every Turn
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Smith & Nephew: Helping You See the Bigger Picture at Every Turn

Since the days of Florence Nightingale, it has been common practice to turn and reposition bed-ridden patients at regular intervals. Nightingale recognized that frequent patient movement was beneficial to patients and prevented serious complications, such as pressure injuries. In an effort to ensure that all patients were mobilized sufficiently, Nightingale introduced the concept of patient turning protocols, which have since become the foundation for pressure injury prevention. However, despite the widespread adoption of patient turning protocols, studies have shown that compliance to these protocols is low. Due to these challenges ensuring that hospitalized patients are turned with sufficient frequency and quality, pressure injuries continue to plague our healthcare system.

Enter medical technology business Smith & Nephew, whose purpose is to enable a Life Unlimited by restoring people’s bodies and their self-belief. This mission includes working to eliminate Hospital-Acquired Pressure Injuries (HAPIs) through a unique patient monitoring solution and a complimentary portfolio of other advanced wound care products. Eliminating pressure injuries is a tall order, considering that this problem impacts 2.5 million patients each year in the United States alone. While patients with diabetes, obesity, and other comorbid conditions are more vulnerable to pressure injuries, this complication can potentially impact any patient that does not get moved sufficiently during their hospital stay.

Alarmingly, the number of patients developing pressure injuries continues to increase, even as hospitals are able to curtail other hospital-acquired complications, such as falls, surgical site infections, and other ‘Never Events.’ In its quest to put an end to the pressure injury epidemic, Smith & Nephew recently acquired Leaf Healthcare, Inc.—a developer of the unique Leaf Patient Monitoring System. By leveraging the Leaf System, the first FDA-cleared medical technology that continuously monitors patient activity and position to identify patients that could benefit from repositioning, Smith & Nephew is advancing healthcare delivery for patients and their providers. Thanks to this novel technology, nurses are promptly notified when a patient needs to be repositioned in order to prevent a pressure injury. Additionally, the Leaf System lets caregivers know how far a patient needs to be turned in order to adequately offload vulnerable tissue. The technology is embedded into a small, lightweight, wearable sensor that wirelessly monitors a patient’s position and their mobility while in a hospital. Thereafter, the tracking data is used as a tool to help augment nursing care and optimize turn protocol management. “The Leaf Patient Monitoring System can guide the nurse/ caregiver on appropriate patient turning from a time perspective—based on a previously-agreed device algorithm. Secondly, it gives nurses data-based insights into the quality of the patient turn—whether the patient received a good offloading of their dependent body parts, and so on. Through this technology, we have inserted science behind a theory originally conceived by Florence Nightingale,” explains Mike Zagger, Sr. VP, Smith & Nephew.

Reducing Pressure Injury Incidence by 73 Percent

The effectiveness of the Leaf Patient Monitoring System—which complies with guidelines recommended by the National Pressure Ulcer Advisory Panel (NPUAP)—was on full display, in early 2018, when Stanford University conducted a Randomized Controlled Trial (RCT). The study involved over 1,200 patients in two ICUs. The study revealed that patients who had their care augmented by data from the Leaf System were 73 percent less likely to develop a pressure injury. In addition to frequent repositioning and early mobilization, the NPUAP’s pressure injury prevention guidelines also recommend the use of prophylactic foam dressings and to ensure a patient’s skin remains dry and doesn’t attract moisture as part of a comprehensive protocol.


Through this technology, we have inserted science behind a theory originally conceived by Florence Nightingale


“The Leaf System is just one leg of a three-legged stool provided by Smith & Nephew. As an organization, we have strictly adhered to NPUAP guidelines and included all three elements in our prevention planning and solution. However, the Leaf System is a unique tool and our biggest value-addition in the advanced wound management landscape,” adds Zagger.

In the aftermath of Stanford University’s RCT, a number of medical institutions have documented the real-world benefits of the Leaf System. Among them is the Illinois Graham Hospital that reported an incredible 95 percent reduction in pressure injuries. Earlier this month, another hospital presented a study at the American Organization of Nurse Executives (AONE) 2019 Annual Conference in San Diego, demonstrating the benefits of the Leaf Patient Monitoring System. The year-long study, which implemented Leaf’s patient repositioning program in a 132-bed community hospital, found that sacrococcygeal HAPIs—one of the most common pressure injuries—decreased by 50 percent and severe HAPIs were eliminated entirely. Interestingly, investigators also noted that rates of other complications of immobility decreased upon implementing Leaf. In fact, it was reported that hospital-acquired pneumonia rates decreased by 40 percent during the study period, which was attributed to increased patient turning and mobilization. “Hospital-acquired pneumonia is a known complication of patient immobility. During the study, investigators noticed that the benefits of improved turning and mobility extend beyond pressure injury prevention,” says Zagger.

A Nonintrusive Piece of Equipment

It’s a rather straightforward process to deploy the Leaf Sensor at a hospital facility. A wireless, single-use, disposable device that is adhered to a patient’s chest; the sensor weighs less than an ounce and comes with an elegant design. Embedded with an accelerometer, the sensor provides notifications to indicate a patient’s mobility status at a glance. A digital timer shows the time remaining until a turn is required, according to each patient’s prescribed turning protocol. A green color indicates that the patient does not require a turn, while a red color indicates that a patient could benefit from being repositioned. The Leaf System also generates reports that allow administrators to manage turning protocols more efficiently. These reports help hospitals highlight achievements and identify opportunities for improvement. “We install a very simple mesh network in the hospital unit by plugging Leaf antennas into a wall outlet, and a Leaf user interface (LCD screen) on work stations where someone can monitor the relative position of the patient. This way, we can detect where a particular patient is positioned within that network of antennae. The antenna is unobtrusive and can be plugged into the wall, and doesn’t require us to disrupt the hospital’s existing electrical infrastructure. In short, the technology is very easy to understand, install, and implement,” says Zagger. Indicated for single-patient use only, the waterproof Leaf sensor has a battery life of up to 16 days.

With the recent addition of the Leaf system to the PIP portfolio, Smith & Nephew now has a comprehensive solution to address the pressure injury epidemic that includes digital technology. “We are excited about our robust portfolio and expansion opportunities the Leaf system will help us realize,” concludes Zagger.