How to be a better OT

How to manage pressure injury risks

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Do you feel overwhelmed by the high stakes of managing pressure injury risks? Discover the key principles of pressure care to make an immediate, life-changing impact in your occupational therapy practice.

Episode Summary: In this episode of the How to Be a Better OT podcast, host Clare Batkin breaks down a topic guaranteed to pop up on most clinical caseloads: pressure injury risk management. While pressure care is a massive field, Clare delivers an "in a nutshell" guide covering what pressure injuries are, how to conduct thorough risk and functional assessments, how to select the right assistive technology (AT), how to deliver targeted client education and what you need to evaluate. Whether you work in a hospital or community setting, you’ll be able to apply the principles covered in this episode.

 

Key Takeaways:

  • Pressure Injuries 101: Understand how injuries occur and about the stages of injuries, and how the simple garden hose analogy can help you explain this to clients. 
  • The assessment process: Learn about the standardised screening tools like the Waterlow scale, and how a PEO approach to a function-focused non-standardised assessment is essential to understand how pressure injuries may develop for your client. 
  • Assistive technology prescription: Hear an overview of the obvious cushion and mattress options, as well as a reminder about how other equipment also has a part to play.  
  • Targeted Client Education: Discover why you must never skip explaining why pressure injuries occur before asking clients to change their behaviour. Revisit the RALFEY framework to ensure you provide the right information at the right time in the right way.
  • Ongoing Evaluation: Why evaluation is an ongoing clinical responsibility, not just a discharge task. Learn how to evaluate the effectiveness of your assessment process, education and assistive technology prescription using a mix of standardised and non-standardised approaches.

 

Links & Resources Mentioned:

 

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SPEAKER_00

One last thing to think about is that someone who already has a pressure injury could have been told that they require long periods of bed rest. Now, this doesn't mean that OT is not needed because the person will just be in bed on their pressure-relieving mattress. If anything, OT becomes even more important. So when you're confined to bed, your lifestyle, your routine completely changes. You're missing out on valued activities that are meaningful for your quality of life. So our role here is to look at what those activities are and how we may be able to suggest adaptations or modifications to them so the person still has meaningful engagement in their daily life. Welcome to the How to Be a Better OT podcast. I'm Claire Batkin, an OT and clinical educator who is on a mission to make professional development simple, practical, and worth it for OTs. If you're ready to step back from the overwhelm and bring core frameworks to life, join me for step-by-step guides and practical solutions that will build your confidence and confidence so you can deliver the best outcomes for your clients and truly love what you do. Hello, today we are tackling a topic that is pretty much guaranteed to pop up in most clinical caseloads and probably all caseloads involving working with adults with physical impairments and disabilities. We're talking about how to manage pressure injury risks. Now, if you wanted to learn absolutely everything there is to know about pressure care, we could easily spend days deep diving into all the details, but today I'm going to give you the in a nutshell version of the key things you need to know to make an immediate impact in your practice, including what pressure injuries are, what you should do when assessing risks, some of the most common AT options and education we might provide, and how to complete appropriate follow-up to ensure that all that we did actually worked. Let's start with pressure injuries 101. Firstly, the terminology. Now when I say pressure injury, I'm also referring to pressure ulcers and bed sores. They just go by different terminology depending on where you live in the world. So in Australia, the preferred terminology is pressure injury, so that's what I'll be using in this podcast. A pressure injury is localized damage to the skin or its underlying tissue, often over a bony prominence, and it's the result of prolonged pressure, friction, or shear forces or a combination of any of those factors. So pressure injuries can also be related to medical devices such as nasal prongs and the pressure from that against the skin. When there's pressure, the blood's not flowing normally, and when there's no blood, there's no oxygen and nutrients getting through to the tissue and the skin cells and they start to die. So to explain this to a client, I often use the garden hose analogy. Imagine your blood vessels are like a garden hose supplying oxygen and nutrients to your skin. If someone stands on that garden hose, the tube gets squashed and the water can't get through. It's the exact same thing with constant prolonged pressure on your skin. If those blood vessels are squashed, the blood and the nutrients can't reach the tissue and your skin will start to die, and that's when you get a wound. Now, when it comes to managing pressure injury risks, there are four key components that I like to cover. We need to assess the risk, or if an injury is already present, we need to know the extent of that injury. We'll often prescribe pressure relieving equipment such as special cushions and mattresses, as well as being aware of how other equipment such as wheelchairs or commodes may be contributing to pressure injury risks. We need to provide lots of education about risk factors, about the equipment we prescribe, and about strategies that can be incorporated into the person's daily life to minimize pressure injury risks. And finally, the most important part, we need to evaluate the effectiveness of our assessment, equipment prescription, and education. And this is not something that we just do at the end of the process before discharging the client from our services. It's something that we do on an ongoing basis while ever we are involved in the client's care. Something also to keep in mind is that those four components don't necessarily happen in a linear nature. We're often jumping between them or working on two things simultaneously. So while I'm going to go through them now one at a time, just remember it's more of a system of components rather than a step-by-step process in reality. The other point to remember that as a proud OT nerd, we need to be thinking about how to be evidence-based clinicians. And luckily on this topic, there is no shortage of evidence or guidance. The key document to be aware of is the International Clinical Practice Guidelines for the Prevention and Treatment of Pressure Injuries. They are freely available online in both the full long version and a quick reference guide, so I'll make sure I drop the link to that website in the show notes for you. The guidelines are relevant not just to OTs but to any health professional involved in preventing and managing pressure injuries, so it's something the whole multidisciplinary team should be aware of and using. And just quickly, who is part of that multidisciplinary team? It could be medical, surgical, and nursing staff who will be managing the wound itself, physiotherapists who advise about mobility and transfer aids, dietitians who assist with managing nutrition to prevent and heal injuries, and for those with significant pressure injuries, it may also involve psychologists or social workers who assist people to cope with the life changes and losses that can accompany a significant pressure injury, which often results in long periods of bed rest and hospital admissions. But for now, let's go back to the OT role and let's start with the assessment, including assessing someone's risk factors, assessing the extent of a pressure injury if one's already present, and assessing whether there were any specific factors that contributed to that particular pressure injury developing. So here are some of the common risk factors that place someone at a higher risk of developing a pressure injury. Age is a significant factor with older people being at a higher risk of pressure injuries. A person's size increases their pressure injury risk, both in terms of people who are underweight and those who are overweight, which sounds counterintuitive, but if you think about it, underweight people are at a higher risk because there is less tissue padding between the skin and the bony prominences, while overweight people may have reduced skin quality due to moisture buildup between skin folds, or they may have a higher risk of shearing if they're squeezing into furniture that's not the correct size for them. Skin that is drier or more fragile has higher pressure injury risk. If someone is incontinent or if they sweat a lot, that increases moisture on the skin, which can compromise skin quality and increase their pressure injury risk. If someone has reduced mobility and they're not able to easily reposition themselves when they feel that pressure building up, then they're at higher risk. If they have poor sensation and they can't feel the pressure building up and don't have those cues to reposition, they're at higher risk of an injury too. And it can often take longer to identify pressure injuries here because they won't have that red flag of feeling pain. People with impaired cognition can also be at a higher risk because of the impact that that impaired cognition has on their ability to manage the other risk factors, such as not being able to ask for help to reposition or to change incontinence pads. And finally, there are other risk factors related to neurological function, their nutrition, whether they've lost weight, and whether they're a smoker or have diabetes, which will impact blood circulation. The good news is that you don't need to remember all of those risk factors in your head. There are a number of standardized screening tools that you can use that incorporate these risk factors and will provide you with a score or rating that will indicate how significant someone's pressure injury risk will be. The most common tools are the Waterlow Scale, the Braden Scale, and the Norton Scale. If you work within public health in Australia, chances are you're most familiar with the Waterlow scale, as it seems to be the tool of choice, even to the extent where nursing staff would have Waterlow Wednesdays where they would routinely review and update the waterlow scores of any admitted patients. My key tips when deciding which tool to use is to choose one that will capture the key risk factors adequately. And often this will be the waterlow because it is the most comprehensive, but also consider ease of use and what the rest of the team is using. If you're working in a multidisciplinary team and the nursing staff use the Norton scale because it's a more efficient choice, it would make sense for you to use that too so that you're speaking the same language, because there are actually differences in the rating scale. So for the waterlow, the higher the score, the higher the risk. While for the Norton and Braden scales, the higher the score, the lower the risk. So that's the other hot tip. Don't just give a score, name the tool, and quantify that risk into low, moderate, or high or severe. So that's the first part of the assessment component, assessing risk factors. But now if a pressure injury is already present, we also have to be aware of the extent of that injury. If you're an experienced OT in this space, you may be able to identify yourself what stage of injury the pressure injury is. However, often this is the domain of nursing staff who may be managing the wound dressings or the medical professionals. I'm not going to go into detail about the different stages of pressure injury because time's limited and you may be eating your lunch, but there is a chapter in the International Clinical Practice Guidelines, including some visual resources that you can go and check out. The key thing to know is that the higher the stage, the more severe the injury. A stage one pressure injury is a red area but the skin hasn't yet broken, whereas a stage four injury extends well beyond the skin deep into the tissue and exposing bone, muscle, or tendon, and often requires surgical intervention to treat. There are also other stages for those injuries where you can't quite tell how deep it is, but those are all explained in the guidelines. While you might not be responsible for attributing what stage a pressure injury is, you do need to understand what each stage means as it will influence the urgency of your input and also modify the recommendations you might make for strategies and equipment, which we'll go into more detail about later. So we can use a risk assessment tool and if a pressure injury is present we should be aware of the stage of the injury. But there's something else very important we need to look at, which as OTs really is our bread and butter. We need to complete a functional assessment that identifies and analyses any potential causes of pressure injuries within our clients' daily routine. And the best way to do this is to use our trusted PEO framework. So under the person factors, it involves paying close attention to a lot of those risk factors that the standardized screening tools will pick up, but we go further than just the level of detail on a ward low. We ask much more questions and really understand from a functional perspective. So for example, for mobility and transfers, can they independently adjust their position or do they slump and slide? That slumping will cause friction and shearing forces that tear fragile skin. Is there any asymmetry in their posture that places certain bony prominences at higher risk? And how can we accommodate this in the supports we recommend? In terms of cognition, do they have the cognitive capacity to realize that they're uncomfortable or the ability to ask for help to change their position? Or likewise if they're incontinent, can they identify when that has happened and call for assistance promptly so that the moisture isn't sitting against their skin for too long? Or does impaired cognition lead to agitation during transfers and does this increase the risk of shearing injuries? And if it does, how can we put in place strategies that may reduce that agitation? Under the environment factors, we're looking at what equipment is currently in place and how it's being used. Is their cushion set up correctly or is a Roho cushion over or underinflated? I still remember one home visit I did to a new client who reported they had a new pressure injury and they were already on a pressure-relieving mattress, but it was only because I didn't just stop at ticking it off as a yes, I actually checked the mattress settings and found that there was an inflation setting that was much too high. This poor person was resting on what felt like an inflated beach ball rather than something that was immersive. So remember it's not just whether the equipment is there or not, but whether it's set up correctly and being used correctly. And then under occupation, we need to map out our clients' daily routine to understand what surfaces they're sitting or lying on and for how long. Actually get an hour by hour breakdown of how long they spend in bed versus sitting in their chair. And if they can't tell you, you may need to set up a daily log with the person or their carers to be able to find out. By asking all those questions and making time for observations, we'll be able to identify where the risks are or what the contributing factors were so we can be more targeted with the education and assistive technology we provide. We'll go on to talk about the equipment and education in a moment, but let's just pause and pull together what we know so far with a case study. We'll use the case study of Mrs. Taylor, who is an 83-year-old female with mild dementia. Now I will say if you'd like to do a deeper dive into any of these topics and to see a step-by-step walkthrough of the OT process using Mrs. Taylor's case study, you can find a full one-hour webinar on managing pressure injury risks as part of my EuroT Tutor Connector membership, and I'll drop the details in the show notes about where you can find out more about that membership. But let's go back to Mrs. Taylor. Her daughter is her primary carer and helps with her transfers. She can walk short distances with a four-wheeled walker, but when she goes out with the family two or three times a week, they push her in a manual wheelchair. She sits in that wheelchair for up to three hours at a time. She has occasional urinary incontinence, she uses pads, she's had recent weight loss, and she has a brand new stage one pressure injury on her sacrum. So how can we explore these risk factors in more detail as an OT? Firstly, we want to know more about the wound itself, so where exactly on her sacrum is it, but also how new is it and how is it currently being managed, so we can refer on for extra nursing help if needed. We wanted to actually observe her transfers that the daughter was assisting with to make sure that she's not experiencing any shearing forces from that. And we'd also like to observe her sitting tolerance and whether that fatigues over time, because we know she has outings that last for up to three hours, and if her posture changes in that time, it may be contributing to why those injuries are developing. We know she has dementia, but that diagnosis alone doesn't tell us a great deal about her cognition. We need to assess whether she can identify when she needs to be repositioned or to have a pad change, and whether she does initiate those requests for help. We'll also ask questions around her toileting and continence, including the frequency, how it's being managed, and whether a continence nurse has been involved to make sure that the management of her incontinence has been optimized. We'll try to map out her daily schedule to understand how long she may be in certain positions for, and we'll look closely at her current equipment, such as her wheelchair and whether there are any pressure relieving cushions in place. Finally, we know she's experienced a recent weight loss, and while this doesn't immediately relate to the OT role, we need to remember that particularly in a community setting, we may be the first health professional involved in managing a pressure injury or its risk factors. So we want to ask enough questions to make sure we can refer on to a dietitian if it's warranted. Would we do a standardized assessment like a waterload for her? Absolutely. It helps us objectively measure and prove to funding bodies or her GP just how high her risk is, so we can justify further referrals to other health professionals or funding requests for assistive technology. Let's move on now to talk some more about those assistive technology options, and in this section I wanted to cover both the obvious equipment options such as pressure relieving cushions and mattresses, but also the less obvious options that can play a big part in managing pressure injury risks, including electric profiling or adjustable beds, and the specific features of wheelchairs or mobile shower commodes. We'll start with the obvious ones, the cushions and mattresses. There's actually a whole chapter on support surfaces in the clinical practice guidelines, so make sure you go and check that out. But overall there are three main categories based on what they are made out of, so foam, gel or fluid, and air, which can be static or alternating. We'll start with foam. This is your lowest level of pressure relief. It's cheap, lightweight, and requires zero maintenance, but it's really only suitable for comfort or very low risk clients because there are limitations in the relief that it can provide. You also need to be wary of the need for protective covers for clients with incontinence as cleaning can be tricky. Now, while I say it's the lowest level of relief, the technology is always evolving and there are foam cushions and mattresses out there that can actually provide higher levels of relief. So always go back to your equipment supplier or product rep to find out all the details as not all foams are created equal. Next is gel or fluid, so this provides medium to high pressure relief. A classic example is the J2 Deep Contour Cushion, which features a firm foam base for postural support with a deep gel pack on top. Gel is fantastic because it's highly stable for transfers and for maintaining posture, compared to something like air, which can feel like you're sitting on a waterbed or bean bag that's constantly shifting beneath you. It's also a nice low maintenance option for clients or their carers because often all that's required is pushing the gel around in the cushion after the person's been sitting on it so that it's evenly distributed before they sit on it again the next day. Gel options are much more common for cushions rather than mattresses, but one thing to be wary of is that they are often quite heavy. So if your client needs to independently move their cushion onto different surfaces, that weight may be a consideration. And finally we have air, so this is your gold standard highest level of pressure relief. Alternating air mattresses use a pump to inflate and deflate different cells in various sequences, either on a completely automated offloaded schedule or a sequence that has been prescribed by the clinician. Now air mattresses are becoming much more user-friendly to operate due to all the automation that's built in, and they're also becoming quieter too, compared to the noisy pump that I was first exposed to when I was a new grad in a hospital. In comparison, air cushions are probably the most high maintenance type of cushion material because they need regular monitoring. Something like the Rojo cushion, which has interconnected rubber air cells, need to be maintained at a certain Goldilocks inflation level where it's not underinflated but also not overinflated, as both situations can defeat the purpose of having a pressure cushion in the first place. If we think back to our case study client, Mrs. Taylor, it's highly likely that her seated position in her wheelchair or other instances where she's sitting contributed to that sacral pressure injury. So we would definitely need to prescribe a pressure relieving cushion if there wasn't already a suitable option in place. So this could involve some sort of gel or air cushion, and we would likely undertake a trial and consider factors such as comfort, postural stability, ease of maintenance, and also funding restrictions. We may not need to jump to changing her mattress straight away unless we identified that she was spending long periods of time in bed, but it is something that we would be keeping on our radar. What we would be exploring though is other equipment. So as I mentioned before, things like wheelchairs, commodes and beds also need to be considered. We'd look at the condition of her wheelchair, whether it's the optimal size to help with maintaining posture and comfort. It may not be relevant for Mrs. Taylor, but we also think about mobile commodes and how they may maintain someone's posture, or how the position of the leg rests or armrests could contribute to pressure injuries in different areas of the body. Finally, while we may be commonly prescribing pressure mattresses, don't underestimate the impact of the bed itself. Being able to easily change positions in terms of hip and knee position can immediately offload pressure, which could be even more successful than the mattress itself at offloading body areas and managing risks. Same with a wheelchair that can move into a tilt and recline. As soon as you tilt someone back, it offloads their bottom, but it does shift the weight elsewhere. So regular position changes are the key. Now that was just a very quick overview of some of the key principles when it comes to prescribing pressure relieving equipment. If you would like a deeper dive, take a look at some of the webinars in my free learning library. I'll drop some of the links in the show notes. In particular, you'll find some collaborative webinars that I've done with the OT educators from Unicare Health on beds, pressure care mattresses, commodes, and pressure care myths. So let's recap. We've assessed risk factors from a functional perspective. We've identified some assistive technology that can assist with managing risks. The next component we're going to talk about is education. That is, education related to both the equipment we've just prescribed, but also related to the strategies that the person can implement into their daily routine. Before we start talking about the type of education we provide, think back to a previous podcast episode on effective client education. Or if you haven't heard that one yet, put it on your to-do list to go check it out later. It's episode three of series one of the How to Be a Better OT podcast. In that podcast episode, I introduced you to the Ralphie framework for effective client education. And the components were readiness, amount, language, format, evaluation, and you're not done yet. These exact principles apply when we're working out where to begin with our pressure care education, how much to cover in one session, what type of language we need to use, the format that we're going to deliver it in, and how we'll check at the end whether the person understood and applied the information. If they didn't, what we'll be doing to fix that. One of the key areas that OTs make when it comes to providing pressure care education is skipping over the information about what pressure injuries are, how they occur, and how severe they can become. Without this information, we're basically asking our client to change their behavior in terms of using new equipment or changing their position more frequently without giving them the motivation to do so. So what I'm saying is don't jump straight to providing education about equipment or repositioning unless your client fully understands and appreciates why using the equipment or strategies will be so important. If your client does know all about pressure injuries, maybe they've had their particular condition for a while and they've heard it multiple times, then with that readiness component in mind, you can jump to whichever part you feel you need to focus on. Overall, the components that you'll eventually cover or check in terms of pressure care education will be topics like this, so pressure injuries 101, skin checks, moisture management, repositioning and equipment use. So rather than providing some generic details, I'll talk you through what this education might look like for someone like Mrs. Taylor. Now, first of all, think about who the target audience is. We'll need to provide education directly to Mrs. Taylor, but because she has dementia, we'll also need to educate her daughter and carer as well, as she will be assisting Mrs. Taylor to implement what we're speaking about. We should also think about their format, so it may be a handout, but it could also be showing them videos or providing live demonstrations too. So if we start with education about pressure injuries 101, this is making sure that they understand what pressure injuries are, how they occur, and the impact that they can have on someone's health and life. So using analogies like the gardenhose analogy, showing pictures if the person isn't too squeamish, and lived experience videos can all be effective, rather than just a handout and a verbal explanation. I found one of the most powerful ways to help the person appreciate the seriousness of a pressure injury, if they do seem a bit blase about addressing high risks, is to show YouTube videos where people have shared what it's like to live with the pain, the smell, and the activity restrictions caused by having a significant pressure injury. We also provide education about the importance of skincare and skin checks, and this needs to go beyond just reminding them to check their skin, but talking through the Logistics of how this will happen. Is it best for Mrs. Taylor to just check herself? Or if she's receiving assistance with showering from her daughter or a paid carer, how can they remind themselves to do a visual inspection over those bony prominences each wash? What creams or lotions should they apply to help maintain skin integrity? We also need to cover information about the importance of repositioning. So in general, people who have very limited or fully dependent mobility should be repositioned every two hours, but for Mrs. Taylor out on an outing in the community, we can encourage her to stand so she's out of her wheelchair every 30 minutes if this is feasible for her. And there could be people who we reposition on a less frequent basis, depending on individual factors and considerations. So for example, for someone who's at higher risk of a pressure injury but also receiving palliative care, we may decrease a frequency if that repositioning itself is causing pain or discomfort. Repositioning can occur through completely offloading the area by standing or weight shifting, or by using the features of wheelchairs like tilt and space. We provide education about moisture management in terms of education for managing incontinence, and this can also be done by or in conjunction with a continence nurse. This includes exploring their toileting regime, whether the pads they are using are adequate, and whether any waterproof sheets that they're using could actually be compromising the pressure relieving quality of the cushion or mattress that they've been provided. We also cover information about the equipment we provided, so how to clean and maintain it, how to check that the setup stays correct for air mattresses or cushions, what to do if there seems to be a problem with the AT. So do they come to you first or can they go directly to the equipment supplier? And finally, we want to make sure that we pull all this information together so that they know how it fits into their daily routine. And again, making sure we are doing this with them, not just rattling off a bunch of strategies. So what I mean is don't just say change position regularly, don't sit too long in one place, make sure you check the cushion on a regular basis. Instead, we map out a daily schedule as an example, showing how it starts with a cushion check each morning. What activities might be better to do seated in a recliner chair versus seated on a standard chair with the cushion in place. When they go out to the cafe, mapping out how long she can stay seated before doing a stand-up to relieve pressure, then at night time adding in some scheduled toileting before bed to minimize any overnight incontinence. The keys to help them apply the information and principles don't just tell them what to do, unless your time is limited and you know the client or the support system will be all over it. And one last thing to think about is that someone who already has a pressure injury could have been told that they require long periods of bed rest to completely offload the wound. Now this doesn't mean that OT is not needed because the person will just be in bed on their pressure-relieving mattress. If anything, OT becomes even more important. So when you're confined to bed, your lifestyle, your routine completely changes. You may experience occupational deprivation where you're missing out on valued activities that are meaningful for your quality of life and role performance, and this can have a significant impact on their mental well-being. So our role here is to look at what those activities are and how we may be able to suggest adaptations or modifications to them so the person still has meaningful engagement in their daily life. Now we're at the final component, the evaluation. We need to evaluate all the other components I've just spoken about, our assessment, education, and equipment prescription. For evaluating the assessment process, this involves considering whether the standardized tool we used fully captures our clients' risks and whether we have been thorough enough in our non-standardized investigations. We also need to have a plan for when we would reassess using a standardized tool like the Wardlow, and this will really vary based on individual factors, but at the minimum it does need to be redone whenever there is a change in one of the risk factors listed. To evaluate our education, go back to the Ralphie podcast episode for more details, but we need to do this at the end of each education session before leaving, through asking them questions or getting them to explain back to us the key principles or instructions that they need to follow. And finally, for evaluating the pressure care assistive technology prescription, it can be either a mix of standardized outcome measures like the Quest 2.0 or the PADs, which I mentioned in the How to Prescribe Assistive Technology podcast episode, which is series one episode five, or non-standardized evaluation that involves checking is the equipment still comfortable, is it working? It's easy to maintain and being used in the way that we'd recommended. It's just so important that there is some plan for follow-up at some point after prescription. But then also thinking longer term, it's really likely that people who require pressure relieving devices will need them for life. So how can we facilitate a self-management approach where we can eventually discharge them from our services because we're confident that they'll be able to identify when there are red flags or concerns and reach out to either us as a health professional or directly to suppliers where appropriate? To make this a little more meaningful for you, let's revisit Mrs. Taylor's case study one last time. The evaluation stage involves asking questions like, is the cushion still clean and intact? Is her daughter checking the inflation or gel distribution regularly? Has her skin redness on her sacrum resolved or improved? And are they successfully implementing that repositioning schedule during their community outings? Fingers crossed the answer to all of these questions is yes. Just make sure you collect the details about how they are doing it so that you can be thorough in your evaluation and documentation, especially if you're preparing to discharge them from your service and will be relying on their ability to self-manage and seek assistance if something goes wrong. And guess what? We have reached the end of the episode. I know that sometimes pressure care can feel incredibly overwhelming because the stakes are so high, but if you stick to the evidence-based approach, doing a thorough PEO assessment, delivering targeted client education, matching the equipment features to your client's needs and risk factors, and committing to a solid follow-up, you will help save your client's skin and potentially save their lives. Now, just a reminder, if you would like a deeper dive to walk you through these pressure care components, or the opportunity to ask questions on a regular basis, consider joining the Connector or Alliance membership. So I'll drop the links in the show notes. Not only are there full webinars on topics like pressure care, client education, and equipment prescription, but there are also related journal club recordings on AT outcome measures and 24-hour positioning, and regular sessions where you can come along and ask questions or discuss tricky client scenarios directly with me and any other members who happen to be there. In the next episode, we'll be shifting our focus to a communication skill that is essential in any OT caseload, in any setting. And you'll probably even find the framework that I teach you could apply in non-clinical aspects of your life. We'll be covering how to deliver an effective clinical handover. Take care and I'll talk to you again soon. The information shared on this podcast is for general educational use only, so please always use your own clinical reasoning and seek appropriate professional supervision for any individual client situations. If you'd like to learn more with your OT tutor so that you can be a better OT who loves what you do, check out the EuroTutor website. The links will be in the show notes. There are free resources in the Learning Library, paid CPD memberships, online courses, supervision and mentoring opportunities, and options for your team to all learn together with me.