Patent Publication Number: US-2021169401-A1

Title: Wireless pressure ulcer alert methods and systems therefor

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This is a division patent application of co-pending U.S. patent application Ser. No. 16/848,323 filed Apr. 14, 2020, which a division patent application of U.S. patent application Ser. No. 14/936,596 filed Nov. 9, 2015, now U.S. Pat. No. 10,638,969 issued May 5, 2020, which claims the benefit of U.S. Provisional Application No. 62/077,393 filed Nov. 10, 2014. The contents of these prior patent documents are incorporated herein by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     The present invention generally relates to equipment and procedures for use with health care patients. More particularly, the present invention encompasses methods and equipment for monitoring soft tissue pressure to which a patient may be subjected, with the intent of reducing the risk of soft tissue damage. 
     Pressure (decubitus) ulcers, commonly known as bedsores, present a serious problem to bedridden and wheelchair-confined patients. Prolonged pressure from a patient&#39;s body weight upon bony prominences is the most common cause of pressure ulcers. Prevention of and care for a preexisting pressure ulcer typically include treatment plans that involve relieving pressure on the exposed area by positioning and maintaining the patient off susceptible areas and any preexisting pressure ulcers, and minimizing localized pressure through the use of gel pads and similar types of products capable of absorbing and/or distributing pressure. However, such approaches can be insufficient if caregivers are unaware that a patient has shifted his/her weight onto prominences that are prone to pressure ulcers. 
     There are a wide variety of pressure sensors in the industrial and medical markets, some of which have found use in monitoring pressure ulcers. Notable examples include those that use air and fluid displacement techniques, as well as electromechanical analog devices. Many of these sensors are very portable and can be used to measure pressures at various locations of a patient at any point in time. There are also sheets of pressure sensors used primarily for research that give color-coded results from computer programs. The latter sensor type has been particularly used by manufacturers and some healthcare facilities to identify maximum tissue pressures under bed and wheelchair patients&#39; skin areas. There are also a number of pressure monitoring devices, for example, the Oxford Pressure Monitor MKII with 12 Sensor system available from the Talley Group, Ltd., and the Pressure Alert system available from Cleveland Medical Devices, Inc. 
     U.S. Pat. No. 8,535,246 to Drennan et al. discloses a pressure monitoring system for warning a patient or caregiver that soft tissue pressure has exceeded some predetermined level that over time would warrant moving the patient to prevent or at least reduce a risk of soft tissue damage. The system entails the use of a pressure sensing unit that generates electrical outputs corresponding to soft tissue pressure sensed at a surface of the patient&#39;s body. In preferred embodiments, the system monitors the electrical outputs over a preselected time period and generates a cumulative output signal based on the electrical outputs and corresponding to whether or not the soft tissue pressure has exceeded a predetermined pressure level during the preselected time period. The system may generate audible and/or visual warnings if the cumulative output signal exceeds a predetermined cumulative threshold until the soft tissue pressure drops below the predetermined pressure level. 
     Although the Drennan et al. system provides many benefits, further improvements in pressure monitoring systems would be desirable. 
     BRIEF DESCRIPTION OF THE INVENTION 
     The present invention provides pressure monitoring methods and systems suitable for providing a warning to a patient or caregiver that soft tissue pressure has exceeded some predetermined level that, over a sufficient period of time, would necessitate that the patient should move or be moved to prevent or at least reduce the risk of soft tissue damage. The method and system may include improved sensors, warning systems, and/or data recording systems over existing pressure monitoring systems. 
     According to one aspect of the invention, a pressure monitoring system includes a pressure sensing unit adapted to be applied on or near a surface of the patient&#39;s body that is susceptible to damage from soft tissue pressure. The pressure sensing unit comprises at least one sensor that generates electrical outputs corresponding to soft tissue pressure sensed by the sensor at the surface of the patient&#39;s body. The system includes means for wirelessly monitoring a plurality of the electrical outputs generated by the sensor. A counter associated with the monitoring means generates a counter value that increases from an initial value while the soft tissue pressure exceeds a predetermined pressure level, and decreases toward the initial value while the soft tissue pressure does not exceed the predetermined pressure level. According to certain preferred aspects, the counter value increases at a first ratio relative to actual elapsed time and the counter value decreases at a second ratio relative to actual elapsed time, and the second ratio is less than the first ratio. The system also preferably has means for generating an alarm while the counter value exceeds a predetermined counter value. 
     According to another aspect of the invention, a method of monitoring pressure and reducing the risk of soft tissue damage to a patient includes applying a pressure sensing unit to or near a surface of the patient&#39;s body that is susceptible to damage from soft tissue pressure. The pressure sensing unit comprises a sensor that generates electrical outputs corresponding to soft tissue pressure sensed by the sensor at the surface of the patient&#39;s body. A plurality of the electrical outputs generated by the sensor is wirelessly monitored. According to certain preferred aspects, a counter value is generated that increases from an initial value while the soft tissue pressure exceeds a predetermined pressure level, and decreases toward the initial value while the soft tissue pressure does not exceed the predetermined pressure level. The counter value increases at a first ratio relative to actual elapsed time and the counter value decreases at a second ratio relative to actual elapsed time, and the second ratio is preferably less than the first ratio. An alarm is preferably generated while the counter value exceeds a predetermined counter value. 
     A significant advantage of this invention is that pressure monitoring systems and methods of this invention are adapted to provide a warning to a patient or caregiver that specifically takes into consideration the actual risk of soft tissue damage to the patient based on the soft tissue pressure level, the duration the pressure has been applied, and any interruptions of the applied pressure. In particular, the system is adapted to warn the patient and/or caregiver if a sensed soft tissue pressure level exceeds a predetermined level and whose cumulative effect would warrant if not necessitate that the patient should move or be moved to prevent further soft tissue damage. In addition, pressure monitoring systems wireless sensor arrangement in which multiple sensors may be secured to a patient without restricting movements of the patient in a bed, and would not be required to be removed prior to moving the patient to or from a bed. Another significant aspect of the invention is the ability to monitor pressure, generate a signal or alarm (e.g., audible, visual, or vibration) in the event that pressure exceeds a pressure threshold, particularly for a predetermined period of time, and continue such a signal or alarm until the cause of the excessive pressure event has been appropriately addressed by the patient or a caregiver. In some cases, an audible, visual or vibrational signal or alarm can inform the patient of the specific anatomical location that must be moved. Also, the system may notify the caregiver of the warning on a mobile device, in which case the caregiver may be notified even if not currently in the room with the patient. 
     Other aspects and advantages of this invention will be better appreciated from the following detailed description. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  schematically represents components of a pressure monitoring system in accordance with an embodiment of this invention. 
         FIG. 2  represents sensors and a carrier of a pressure sensing unit of  FIG. 1 . 
         FIG. 3  represents a setting in which a patient may be wirelessly monitored with the pressure monitoring system of  FIG. 1 . 
         FIGS. 4A and 4B  represent graphic user interfaces providing for the input of patient information and alarm time, respectively, in accordance with a nonlimiting aspect of this invention. 
         FIGS. 5A and 5B  represent a graphic user interface displaying a status of activated pressure sensing assemblies in accordance with a nonlimiting aspect of this invention. 
         FIG. 6  represents a report displaying historical data pertaining to a patient based on a recording taken while the patient was wirelessly monitored with the pressure monitoring system of  FIG. 1 . 
         FIG. 7  represents a patient in a wheelchair being wirelessly monitored with the system of  FIG. 1 . 
         FIG. 8  represents wireless communications between the pressure monitoring system of  FIG. 1  and remote devices. 
         FIG. 9  represents an outcome entry that may be completed by a caregiver or patient after the patient has been monitored with the system of  FIG. 1 . 
         FIG. 10  represents an architectural schematic representation of a pressure monitoring system in accordance with another embodiment of this invention. 
         FIG. 11  represents a carrier for another embodiment of a pressure sensing unit suitable for use with the systems of  FIGS. 1 and 10 . 
         FIG. 12  represents a pressure sensing unit comprising sensors assembled with the carrier of  FIG. 11 . 
         FIG. 13  represents an exploded view of the carrier of  FIG. 11 . 
         FIG. 14  graphically represents a nonlimiting example of a method for correlating pressure and time to provide alarms during patient monitoring processes that can be performed with the systems of  FIGS. 1 and 10 . 
         FIG. 15  represents an embodiment of a login page displayed on a graphic user interface suitable for use with the systems of  FIGS. 1 and 11 . 
         FIG. 16  represents an embodiment of a welcome screen displayed on the graphic user interface of  FIG. 15 , including administrative, patient information and monitoring tabs. 
         FIG. 17  represents an embodiment of an administrative (“Admin”) screen accessed through the administrative tab of the welcome screen of  FIG. 16 . 
         FIG. 18  represents an embodiment of a facilities module screen accessed through the administrative screen of  FIG. 17 . 
         FIG. 19  represents an embodiment of a user&#39;s module screen accessed through the administrative screen of  FIG. 17 . 
         FIG. 20  represents an embodiment of a settings module screen accessed through the administrative screen of  FIG. 17 . 
         FIG. 21  represents an embodiment of a reports module screen accessed through the administrative screen of  FIG. 17 . 
         FIG. 22  represents an embodiment of a patient history report accessed through the reports module screen of  FIG. 21 . 
         FIG. 23  represents an embodiment of a patient screen accessed through the patient information tab of the welcome screen of  FIG. 16 . 
         FIG. 24  represents an embodiment of patient information details screen accessed through the patient screen of  FIG. 23 . 
         FIG. 25  represents an embodiment of a PU (pressure ulcer) status screen accessed through the patient information details screen of  FIG. 24 . 
         FIG. 26  represents an embodiment of a monitor screen accessed through the monitoring tab of the welcome screen of  FIG. 16 . 
         FIG. 27  represents an embodiment of automated sensor detection displayed on the monitor screen of  FIG. 26 . 
         FIG. 28  represents an embodiment of automated sensor detection user-configurable variables displayed on the monitor screen of  FIG. 26 . 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The present invention provides a pressure monitoring system whose primary function is to monitor a patient that is reclined or otherwise in a position that may result in the patient&#39;s weight applying pressure to an area of the patient&#39;s body that is susceptible to pressure ulcers, such as soft tissue overlying a bony prominence. The pressure monitoring system further operates to correlate soft tissue pressure levels with time to warn if an applied pressure has met certain pressure and time thresholds that, in combination, are likely to result in or exacerbate a pressure ulcer. Because a soft tissue pressure level of 30 mmHg (about 4000 Pa) has become universally accepted as a critical threshold pressure level in the development of pressure ulcers, a particularly suitable target value for the threshold pressure used by the system is believed to be about 30 mmHg, though more broadly threshold pressures within a range of about 30 and about 40 mmHg (about 4000 to about 5300 Pa) are believed to be practical and acceptable, and future medical research may suggest that critical pressure levels exist outside this range. A variety of time periods may be utilized as suitable time thresholds (for example, ten, thirty, or sixty minutes) that can be selected by a caregiver. The selected time threshold serves as a time period during which the number and duration of pressure excursions above the threshold pressure level are used to perform an assessment. If warranted, the assessment concludes with an alarm (e.g., audible, visual, vibration, etc.) that alerts caregivers and, if conscious and sufficiently alert, the patient so that the patient can be repositioned in a timely manner to avoid or at least reduce the risk of a pressure ulcer. The type and level of the alarm can be selected to induce a conscious patient to move themselves in order to relieve the soft tissue pressure and stop the alarm, saving both tissue damage and the valuable time of a caregiver. As such, the monitoring system can also be viewed as a training device for patients who are cognitively aware and capable of repositioning themselves without assistance. 
     A significant feature of the invention outlined above is believed to be the correlation of pressure and time, combined with an alarm that is responsive to this correlation in order to reduce the likelihood that a patient will remain on fragile tissue or a pre-existing ulcer longer than is deemed to be clinically allowable. A preferred feature of the system is the ability to accurately detect soft tissue pressure above the threshold pressure level, monitor the duration over which the pressure is above this threshold, and then either sound the alarm if the pressure remains above the threshold for the preselected time period or reset the time period if the soft tissue pressure is adequately relieved before the preselected time period is exceeded. 
     In particularly preferred embodiments, the system utilizes a counter that is initiated to generate a cumulative output whose initial value is zero (e.g., time units such as seconds or minutes), begins to increase once the pressure threshold is exceeded, but decreases back toward zero time units if the soft tissue pressure drops below the threshold. A preferred aspect of the invention is that the counter value increases at a first ratio relative to actual elapsed time, and decreases at a second ratio relative to actual elapsed time, and wherein in preferred embodiments the second ratio is less than the first ratio. For example, an increase in the counter value may occur at a first predetermined ratio of 1:1 relative to actual elapsed time, whereas a decrease in the counter value occurs at a second predetermined ratio of less than 1:1 relative to actual elapsed time, for example, at a ratio of 1:4, in other words, one counter minute for every four actual minutes that have elapsed after the soft tissue pressure has dropped below the threshold. In this manner, the system operates to avoid soft tissue damage by taking into consideration not only how long the soft tissue pressure persisted above the pressure threshold, but also the elapsed time following a corrective measure taken prior to the end of the preselected time period if the corrective measure results in the soft tissue pressure dropping below the pressure threshold. Preferably, the counter immediately resumes and its value again increases at the first predetermined ratio (e.g., a 1:1 ratio to actual time) if the patient moves to a position that resumes the excessive soft tissue pressure condition. Suitable electrical circuitry and timers for performing the counter function are commercially available and well within the capabilities of those skilled in the art, and therefore will not be discussed in any detail here. 
     In view of the above, it can be appreciated that optimal performance of the monitoring system will be achieved if the preselected time period is based on pressure ulcer risk assessments made by appropriately trained medical personnel. The monitoring system may also be equipped to retain clinical information regarding recent soft tissue pressure levels and durations, which can be useful to more fully assess a patient&#39;s history relating to the risk of soft tissue damage. Such historical data, which may further include patient clinical information and alarm events, can be retained by the system, such as with a memory card or memory device of a type commonly used in consumer electronics, or through a wireless or cable network connection to an external database. This information can then be downloaded to a personal computer or the like, printed and made a part of a patient&#39;s medical record, as well as downloaded onto electronic media for inclusion in a patient&#39;s hard or electronic medical record. 
       FIG. 1  is a schematic representation of one nonlimiting embodiment of a pressure monitoring system  10  of the present invention. The system  10  is shown as including a converter  12 , a tablet  13  (with a partial cutaway view showing internal components), and two pressure sensing units  14  adapted to monitor soft tissue pressure at one or more surface regions of a patient&#39;s body that are susceptible to damage from soft tissue pressure. At least two sensing units  14  are preferably provided to allow multiple areas of concern to be simultaneously monitored, though it is foreseeable that a single sensing unit  14  may be sufficient under some circumstances. The sensing units  14  are connected to the converter  12  through wireless connections. The sensing units  14  may be applied directly to a patient&#39;s skin, integrated into a patient&#39;s clothing, and/or integrated into the bedding on which the patient lies, for example, into a large bed pad that covers a portion of the patient&#39;s bed. The system  10  is shown as including a power converter  20  of any suitable type capable of delivering an appropriate power level for electronics within the converter  12 . The system  10  is also preferably capable of operating from battery power, such as for mobile uses (e.g., wheelchairs, bicycles, etc.) or in the event of a power outage. For this purpose, the converter  12  may contain a backup battery or may be adapted to run off a battery of a self-propelled wheelchair or other powered device. 
     The converter  12  is preferably configured to wirelessly connect to the tablet  13  or similarly capable device, such as a personal computer, mobile phone, or types of mobile devices that might be referred to as personal digital assistants (PDA). The tablet  13  may be any type of tablet computer device suitable for wirelessly connecting with and sharing data with the converter  12 . The tablet  13  may use any operating system, for example, Google Android® or Apple iOS®, operating a software application installed thereon configured to interface with the converter  12  and interpret data provided therefrom. The tablet  13  also preferably displays and provides functionality suitable for an operator to interact with the software application. The tablet  13  of  FIG. 1  is represented as having a display  26 , preferably a touchscreen as common with current tablets in the art. With the software application installed on the tablet  13 , the display  26  may provide a status of the system  10  which can be conveyed to an operator, and with which the operator can configure the operation of the converter  12 , including the selection of the time period as discussed above. The tablet  13  is preferably configured with a graphical user interface (GUI) that guides the user from screen to screen on the display  26  during setup of the system, such as when entering patient information and setting warning levels and thresholds, as well as for the purpose of controlling the download or transfer of information to or from the converter  12  ( FIGS. 4A-5B ). The display  26  preferably displays the preselected time period, whether the pressure being sensed by one or more of the sensing units  14  exceeds the pressure threshold, and optionally the actual pressure being sensed. According to a particularly preferred aspect of the invention, the software application is also adapted to display an elapsed time progress bar  52  ( FIGS. 5A and 5B ) on the display  26 , which displays the total accumulated elapsed time that any one or more of the sensing units  14  has sensed a pressure exceeding the pressure threshold. The elapsed time progress bar  52  displayed on the display  26  also preferably ramps upward and backward at the same rate as the counter, providing a visual signal that alerts a caregiver as to any accumulating time condition that may exacerbate the pressure ulcer. 
     A more detailed view of an embodiment of a pressure sensing unit  14  is shown in  FIG. 2 , and represents the unit  14  as having a sensor  30  centrally located within a carrier  32 , for example, fabricated from one or more dressing materials. The carrier  32  may be formed of a foam, hydrocolloid, alginate self-adherent dressing or other suitable material, and is preferably sized and shaped for the particular anatomic location on the patient where the pressure sensing unit  14  will be located. As such, alternative shapes may be used and preferred for the pressure sensing unit  14  and/or its carrier  32 , for example, to cover curved body structures such as the heel. The pressure sensing unit  14  is depicted in  FIG. 2  as including three pressure transducers  40  located on a printed circuit board (PCB)  34 . The PCB  34  and pressure transducers  40  are represented as being placeable within a pocket formed in the carrier  32 . The sensor  30  may further comprise a battery and components (not shown) suitable for communicating with the transducers  40  and wirelessly communicating with the converter  12 . According to a preferred aspect of the invention, the sensor  30  includes a replaceable battery in a holder (not shown) providing the ability to recycle the transducers  40  rather than discarding them. 
     The sensor  30  is adapted to generate electrical outputs corresponding to pressure, and particularly to soft tissue pressure to which the transducers  40  are subjected when placed on or near a patient&#39;s body. In order for the system  10  to provide a reliable risk assessment, a feature of the invention is the type of transducers  40  used and their accuracy at the relatively low pressures of interest. While embodiments of the present invention may use variable output pressure transducers, including FlexForce® load sensors available from Tekscan, Inc., transducers comprising pressure-sensitive contacts, effectively operating as binary (on-off) switches, have also been determined to be well suited for use in the pressure monitoring system  10  of this invention. In embodiments of the transducers  40  utilizing a force or pressure-sensitive contact, for each occurrence in which the pressure (or equivalent force) sensed by a transducer  40  exceeds the pressure threshold, an electrical contact will close and complete (short) an electrical circuit therein, causing the transducer  40  to generate an identical output level regardless of what extent the soft tissue pressure may exceed the pressure threshold. The sensor  30  produces an electrical output signal generated by the completed electrical circuit that can be wirelessly transmitted to the converter  12 . If any one of the transducers  40  in the sensor  30  exceeds the pressure threshold, the electrical output signal is preferably transmitted to the converter  12  to indicate a risk of an ulcer forming. 
     While the pressure sensing unit  14  is represented as comprising a single sensor  30  containing three transducers  40  that define a triangular pattern, it is within the scope of the invention for any one or more of the sensing units  14  of the system  10  to comprise any number of sensors  30  and/or transducers  40 , which may promote the reliability and accuracy of the system  10 . As nonlimiting examples, two or more transducers  40  may be used to define a linear pattern, three or more transducers  40  may be used to define a triangular pattern, etc. Preferably, the sensor  30  may also comprise a vibration device for alerting the patient to the sensor  30  causing an alarm and encouraging the patient to move in such a way as to relieve pressure from that sensor  30 . Finally, it should be noted that the components of the sensing units  14  may be constructed to be sufficiently thin to reduce pressure on and provide greater comfort for the patient. Such components may include multi-layer thin film sensors, thin-film PCBs, thin-film batteries, etc. 
     In view of the foregoing, it should be apparent that the construction of the sensor  30  and transducers  40  largely determines the sensitivity and pressure threshold of the pressure sensing units  14 . Though various configurations are possible, in practice suitable results have been obtained with the RK series of dome sensors commercially available from Snaptron, Inc. A particularly suitable dome sensor is believed to be part number RK50040, which is reported to have a maximum trip force (Fmax) of about 40 grams. In investigations leading to this invention, a 40-gram trip force applied to the RK50040 dome has been correlated to a minimum pressure level of about 32.5 mmHg (about 4330 Pa). 
     The construction of the sensing units  14  preferably allows each sensing unit  14  to be applied and secured to a patient&#39;s body, such as to one or more bony prominences that are susceptible to damage from soft tissue pressure. The sensing unit  14  may be located within a disposable sleeve that can be slipped over the carrier  32  to allow reuse of the sensing unit  14 . 
     The converter  12  preferably contains circuitry (not shown) capable of wirelessly monitoring electrical outputs generated by each pressure sensing unit  14  over whatever time period has been selected by a caregiver. The converter  12  also preferably contains circuitry (not shown) adapted to record locations, identifications, and pressure data of the sensors  30  of the pressure sensing units  14 . For example, the converter  12  may be configured to accept Bluetooth® low energy (BTLE) data streams from the pressure sensing units  14 . The converter  12  also preferably contains circuitry (not shown) adapted to wirelessly connect to the tablet  13  in order to transfer data collected by the converter  12  from the pressure sensing units  14 . For example, the converter  12  may send a WiFi® signal to the tablet  13  to download a single stream of data into the application software residing on the tablet  13 . 
     The converter  12  is preferably configured to receive BTLE signals from the sensors  30 , preferably at least up to six sensor signals, and convert these BTLE signals into a single WiFi® signal that includes at least the identity of each sensor and the data corresponding to each sensor. The converter  12  transmits the WiFi® signal to the tablet  13  and the software application on the tablet  13  processes the WiFi® signal, identifies each sensor  30  and its corresponding data, analyzes and provides the data to the caregiver via the display  26  and GUI. The tablet  13  may further transmit the analyzed data to other devices, such as a nurses&#39; station, a mobile device, or a remote database. 
     A nonlimiting method of using the system  10  is represented in  FIG. 3 . As represented, the converter  12  may be located near a patient  24  with its power converter  20  plugged into an outlet  21 . The pressure sensing units  14  are shown as located over one or more anatomic sites on the patient  24  by a caregiver  25 . The tablet  13  may be located in any position within range of the wireless connection to the converter  12 . 
     The caregiver  25  may use the touchscreen capability of the display  26  of the tablet  13  and its GUI to guide the caregiver  25  during an information input phase of the setup for the system  10 , for example, to input an identification of the patient  24 , input clinical data and site locations of the pressure sensing units  14 , and select a time threshold designating the amount of time in which the number and duration of pressure excursions may be above a threshold pressure level during an assessment prior to an alarm. 
       FIGS. 4A and 4B  are representative of an exemplary graphical user interface for the information input phase of the system  10 . Each pressure sensing unit  14  is preferably identified in the application software as to its individual anatomic placement. Each of the sensing units  14  may also be physically marked on a backside of the sensing unit  14  by the caregiver  25  as to its anatomic placement. As represented in  FIG. 5A , individual monitor screens on the tablet  13  may show each of the locations of the sensing units  14  so the caregiver  25  will know which location will have caused an alarm. The patient  24  may also see or hear the alarm, but preferably will also feel vibration if the sensor  30  of a pressure sensing unit  14  is equipped with a vibration device. 
     During an initial hardware setup phase, the tablet  13  may wirelessly send patient data, for example, by WiFi®, to the converter  12 . The converter  12  may then record the locations and identifications of the pressure sensing units  14 . As indicated in  FIG. 1 , the converter  12  may include LED lights  16  corresponding to each sensing unit  14  that indicate when the monitoring function of each sensing unit  14  begins (for example, three connected sensing units  14  equal three green LEDs). The LED lights  16  may also indicate if one or more of the sensing units  14  has malfunctioned, for example, due to battery life. Preferably, the converter  12  has at least two days of stored battery life and an additional LED light  18  to warn of battery failure of the converter  12 . 
     During operation, the pressure sensing units  14  individually sense a load applied thereto and send wireless signals to the converter  12 , which then communicates the data to the tablet  13 . In  FIG. 5A , the software application of the tablet  13  is in communication with the converter  12  and receives a cumulative output signal generated by the converter  12  of the counter based on the electrical outputs of each individual pressure sensing unit  14  over the preselected time period. As previously described, the output value of the counter is cumulative in that it takes into consideration whether the soft tissue pressure has exceeded the preselected pressure level established by the transducers  40  of the sensor  30  during the preselected time period, as well as whether the soft tissue pressure has dropped below the predetermined pressure level during the time period. In this example, the converter  12  is wirelessly in communication with five pressure sensing units  14 . The sensors  30  of three of the units  14  are not sensing a load that exceeds a threshold of, for example, 32 mmHg, as indicated by an upwards pointing arrows and their respective empty elapsed time progress bars  52 . The sensors  30  of the remaining two units  14  are represented as having sensed a load, as indicated by downwards pointing arrows and partially filled elapsed time progress bars  52 . In addition, these two sensing units  14  are distinguished by having different colored monitor windows as compared to the three sensing units  14  that are not sensing a load. As explained previously, if the patient  24  were to change position and thereby load or unload individual sensors  30 , the monitor screens would be updated accordingly. In the case of removing the load from one the pressure sensing units  14 , the partially-filled elapsed time progress bar  52  would begin to recede over time according to the conditions set by the caregiver  25  during the information input phase, with the rate of recession corresponding to a decrease in the counter value that occurs at a predetermined ratio relative to the actual elapsed time that the load has not been sensed or otherwise has not exceeded the preselected pressure threshold. 
     When the pressure level sensed by any one of the pressure sensing units  14  has exceeded the preselected pressure threshold for a time period that exceeded the preselected time threshold, as represented by the completely filled progress bars  52  for two of the sensing units  14  in  FIG. 5B , the corresponding monitor screen may activate an alarm. As an example, the monitor screen may flash a red visual alarm (as represented by the darker windows in  FIG. 5B ) and/or an audio alarm on the tablet  13  to warn the patient  24  and caregiver  25 . In addition, the vibration device in the individual sensing unit  14  which surpassed its time threshold may also be activated to directly notify the patient  24  what area of their body to move. In the event of an alarm being activated, wireless signals may be sent to other devices or displays, for example, wall monitor screens, nursing station personal computer screens (such as computer  27  in  FIG. 3 ), mobile phones, etc., in order to alert others to the situation. 
     The warnings generated by the tablet  13  and any one or more individual pressure sensing units  14  preferably continue until the soft tissue pressure sensed by the sensing unit  14  drops below the predetermined pressure level. At this time, the monitor screen elapsed time bar  52  may start receding over time, corresponding to a decrease in the counter value at the predetermined ratio. Preferably, the application software further displays a history light  50  or similar indicator on the tablet  13 , and is used as an indication of the accumulated alarm time on the counter. In a currently preferred embodiment of the invention, when the pressure sensed by a sensing unit  14  drops below the pressure threshold as a result of the patient being moved off the monitored pressure ulcer, the audio and visual alarms on the tablet  13  associated with that sensing unit  14  turn off. However, the history light  50  on the tablet  13  preferably remains lit to indicate to the caregiver  25  that an alarm has previously been activated, even if the alarm is no longer active. Preferably, the history light  50  remains lit until deactivated by the caregiver  25 . 
     The tablet  13  preferably records all monitoring activities by wirelessly communicating with a facility storage system and/or private or public cloud-based storage systems.  FIG. 6  represents an exemplary report format that may be accessible to the caregiver  25  or others both to provide improved care to the patient  24  and to provide historical data for industry or research. As represented, the recorded historical data may include the status of each individual sensing unit  14  over a predetermined period of time.  FIG. 8  represents wireless communications between the pressure monitoring system of  FIG. 1  and remote devices, such as tablets, databases, and a cloud-based storage system. As represented in  FIG. 8  (top left), the sensors  30  of the sensing units  14  may send signals to the converter  12 , which then communicates with a tablet  13  (two different types shown), which then may communicate further through a standard network system with remote devices such as computers, mobile phones, and databases. In addition,  FIG. 8  (bottom right) represents internal details regarding the tablet  13  relating to its communication with the converter  12  and remote devices. 
     When the monitoring process has stopped, ended, or been paused, the application software may require the caregiver  25  to complete an outcome report or survey. The outcome report may show the final status of the patient  24  and the wound or risk skin area at the time when the sensing units  14  are removed from the patient  24  and the monitoring process has ended. The outcome report may be recorded in the facility storage system, and/or private or public cloud-based server for review or research purposes tied to a unique identification tag but may no longer be attached to a particular patient. According to a preferred aspect of the invention, the report format ( FIG. 6 ) may include a link or virtual button for providing access to the outcome report.  FIG. 9  represents an exemplary outcome entry format that may be accessible to the caregiver  25  or others both to provide ulcer status reporting for each anatomic area and includes pressure ulcer grade. 
       FIG. 10  is an architectural schematic representation of an alternative pressure monitoring system  58 . For convenience, identical reference numerals are used in  FIG. 10  to denote elements that are the same or functionally correspond in at least some aspects to elements described for the system  10  of  FIG. 1 . The system  58  is shown as including multiple individual sensors  30  that may comprise one or more pressure transducers  40  (not shown) , a pressure sensing unit  14  in which multiple sensors  30  may be embedded, an onsite tablet  13 , an optional onsite converter or gateway  12 , an Internet cloud  62 , a web application  64  communicating with an interactive voice response (IVR) and Short Message Service (SMS) engine  65  that is connected to the cloud  62 , an online database  66 , an optional smartphone  68 , an optional offsite tablet  70 , and an optional offsite personal computer  72 . The engine  65  is preferably configured to verbally communicate with users and patients, particularly so that the latter maybe made aware of which sensor  30  is associated with a warning so that, if possible, the patient may then be able to take corrective action without the involvement or intervention of a caregiver. The web application  64  also communicates through Application Program Interfaces (APIs) with a patient monitoring system  73  and a medical knowledge-based system  75 , which are shown as being directly accessed through the web application  64  but could be web-based and accessed via the Internet cloud  62 . The sensing unit  14  with multiple embedded sensors  30  broadcasts sensor data periodically through BTLE signals to the optional gateway  12  (if present) and/or the onsite tablet  13 . Similarly, the sensing unit  14  also periodically broadcasts BTLE signals representing the sensor data to the optional gateway  12  (if present) and/or the onsite tablet  13 . The optional gateway  12  may also broadcast BTLE signals directly to the onsite tablet  13 . 
     The Internet cloud  62  is wirelessly connected to at least one of the onsite tablets  13  and the optional gateway  12  for two-way wireless communication between these devices and the cloud  62 . The web application  64  and the online database  66  are both in two-way communication with the cloud  62 , for example, through a wired connection. Finally, the smart phone  68 , the offsite tablet  70 , and the offsite PC  72  are also in two-way communication with the cloud  62  using any combination of wireless or wired signals. 
       FIGS. 11-13  represent a particular embodiment of the pressure sensing unit  14 . As represented in  FIGS. 11 and 12 , the sensing unit  14  of  FIGS. 11-13  has a round periphery, a central aperture  78  sized to accommodate a sensor  30  (e.g., one or more transducers  40  and a vibration device  33  mounted on a PCB  34 ), and an adhesive strip  80  that releasably overlies the aperture  78 , can be peeled back to allow placement of the sensor  30  in the aperture  78 , and then be reapplied over the aperture  78  to secure the sensor  30  within the aperture  78 . The sensing unit  14  is preferably sized and shaped for the particular anatomic location on the patient where the sensing unit  14  will be located. As such, alternative shapes may be used and preferred for the sensing unit  14 . 
     As seen in  FIG. 13 , the carrier  32  of the sensing unit  14  may be constructed to comprise first (inner) and second (outer) foam layers  74  and  76  embedded between inner layers  77  and interior layers  79   a - c  of additional dressing materials, which may be formed of a foam, hydrocolloid, alginate self-adherent dressing or other suitable materials.  FIGS. 11, 12, and 13  show the inner layers  77 , the innermost interior layer  79   c,  and the inner foam layer  74  as being approximately the same size, and the center interior layer  79   a  (between the inner and outer foam layers  74  and  76 ), the outer foam layer  76 , and the outermost interior layer  79   b  as being approximately the same size but smaller than the inner layers  77 , the innermost interior layer  79   c,  and the inner foam layer  74 . At least one additional layer  81  overlies and is larger than all of the layers  74 ,  76 ,  77 , and  79   a - c.  The aperture  78  seen in  FIGS. 11 and 12  can be seen in  FIG. 13  as being defined by a series of openings  78   a  formed within certain layers of the sensing unit  14  that are approximately equally sized to accommodate the sensor  30 , including its transducers  40  and PCB  34 . The openings  78   a  are formed in the inner and outer foam layers  74  and  76  and at least the outermost interior layer  79   b  and the center interior layer  79   a  between the inner and outer foam layers  74  and  76 . The openings  78   a  may also be defined in the innermost interior layer  79   c  of dressing material so that the sensor  30  can be placed in closer proximity to the patient&#39;s skin. In the case of open wounds, the openings  78   a  are preferably not present in the inner layers  77  of dressing materials so that dressing material is present between the sensor  30  and an open wound. The lowermost layer of the inner layers  77  of the dressing material directly facing the patient&#39;s skin is preferably a non-adhesive foam or absorbent material without an opening  78   a  formed therein. In addition, the skin-side surface of the lowermost inner layer  77  of dressing material directly facing the patient&#39;s skin may include an adhesive covering along a narrow border thereof to adhere the sensing unit  14  to the skin. 
     The systems  10  and  58  are not limited to the use of pressure sensing units  14  of the types shown in  FIGS. 2 and 11-13 . In particular, the systems  10  and  58  may include handheld probes integrating multiple sensing and data analysis capabilities relying on a variety of sensors including thermal, RBG, 3D, chemical, hyper spectral, and situational awareness sensors. 
       FIG. 14  schematically represents an example of the activity of a counter during a patient monitoring process including a series of events that correspond with a series of program responses. As with the system  10  of  FIG. 1 , the system  58  of  FIG. 10  preferably utilizes a separate counter associated with each pressure sensing unit  14 , and whose value increases once the soft tissue pressure detected by the associated pressure sensing unit  14  exceeds a predetermined pressure threshold, but decreases while the soft tissue pressure is below the threshold. In addition, the counter value may increase and decrease at different rates, for example, increase at a ratio relative to actual elapsed time (e.g., a ratio of 1:1 relative to actual elapsed time) that is higher than the ratio at which the counter decreases relative to actual elapsed time (e.g., a ratio of less than 1:1 relative to actual elapsed time). The counter value can be calculated by any suitable microcontrol, program, etc., and the increments at which the counter value is calculated can be intervals of minutes, seconds, or fraction thereof. In alternative embodiments of the systems  10  and  58 , the rate at which the counter value increases or decreases compared to elapsed time may be modified on the basis of different variables, including but not limited to variable pressure data obtained with the use of a variable output pressure transducers (instead of on-off switch-type transducers), elapsed time during an alarm event, the particular body part causing the alarm condition, alarm history, historical sensor data, and/or data relating to the patient, e.g., patient characteristics such as age, gender, health/medical condition, etc. Yet another alternative is for the counter value to simply reset to zero after a predefined number of minutes of elapsed time at a sensed pressure below the threshold. Such alternatives may be particularly of interest as the understanding of pressure ulcers evolves. Given that pressure ulcers are impacted by the amount of pressure applied over a period of time, the use of variable output pressure transducers may be preferred to implement an algorithm capable of computing a counter decrease ratio that addresses the effects of different levels of pressure over different levels of time, including peak, trough, average, and median pressures in relation to time, the specific part of the body subjected to that pressure, and patient data. For example, if a body region of a patient is subjected to a pressure of 32 mmHg over a period of 60 minutes, 240 minutes (corresponding to a counter decrease ratio of 1:4) may be an adequate duration of time to recover after the pressure has been relieved, whereas the same body region subjected to a pressure of 75 mmHg for 60 minutes may require a longer recovery duration, for example, 300 minutes (corresponding to a counter decrease ratio of 1:5). 
     As a nonlimiting example, on the basis of a counter increase ratio of 1:1 and a counter decrease ratio of 1:4, calculating the counter value may be as follows: 
       Current Counter Value=(Initial Counter Value)+(Time at Pressure Exceeding Pressure Threshold)−(Time at Pressure Below Pressure Threshold)/4
 
     According to this formula, the counter value in  FIG. 14  increases from an initial value of zero at a rate of 1:1 relative to actual elapsed time for a period of twenty minutes while the soft tissue pressure sensed by the associated pressure sensing unit  14  exceeds a predetermined pressure level, in this example, a threshold of 32 mmHg.  FIG. 14  represents that the system  10 / 58  has been programmed to include an alarm threshold, whereby an alarm (e.g., audible, vibrational, etc.) is activated once the pressure threshold has been exceeded for ten minutes, i.e., the counter value is ten. When the sensed pressure drops below the threshold at twenty minutes, the counter value is at 20 but begins to decrease at a rate of 1:4 relative to actual elapsed time. In  FIG. 14 , the pressure sensed by the associated pressure sensing unit  14  remains below the threshold of 32 mmHg for 120 minutes, and after eighty minutes of actual elapsed time below the pressure threshold the counter has decreased by twenty (80/4) to return to a value of zero. The counter value remains at zero until 120 minutes, at which time  FIG. 14  indicates that the pressure sensed by the associated pressure sensing unit  14  has again exceeded the threshold and the counter value begins to increase from zero at the 1:1 rate relative to actual elapsed time. As indicated in  FIG. 14 , the alarm is deactivated (turned off) once pressure is no longer sensed by the sensing unit  14 . Alternatively, the alarm may be deactivated when the soft tissue pressure no longer exceeds the threshold. To avoid unnecessary alarms, the system  10 / 58  may employ an algorithm that re-activates the alarm after a predetermined amount of time after the alarm was deactivated. For example, the predetermined amount of time may be based on the amount of time the soft tissue pressure exceeded the threshold. Alternatively, the algorithm may further take into consideration patient data (age, gender, health/medical condition, etc.), the location of the sensing unit  14  on the patient&#39;s body, and the soft tissue pressure (e.g., peak, trough, average, and median, etc.). 
     The systems  10  and  58  can also determine patient diagnosis and recommend treatment based on certain categories of variables. A doctor, nurse, facility or researcher can use a predefined customized classification system (for example, rated on a scale of 1-10) to specify a patient category for a given patient that is based on patient data such as age, gender, health/medical condition, etc. A Braden scale may also be used initially as an assessment tool for predicting the risk of pressure ulcers based on the total of scores given in categories of sensory perception, moisture, activity, mobility, nutrition, and friction or shear. Over time, the medical knowledge-based system  75  ( FIG. 10 ) will preferably accumulate information regarding specific patient and risk characteristics that can be used to refine the patient category assigned to a patient. In combination, the data obtained with the system  10 / 58  can be used by an algorithm to assign a diagnosis category (e.g., on a scale of 1 to 10) to a patient based on a predefined customized category that reflects the amount of pressure and the amount of time at one location of the patient&#39;s body that has specific location characteristics, which may also be rated on a scale of 1-10. 
     As a nonlimiting example of the above, X amount of pressure for 60 minutes on the sacrum of a patient may be assigned a 5 rating as a diagnosis category. A treatment category can then be based on the diagnosis category as well as the patient category for the patient. For example, based on the diagnosis category (e.g., the amount of pressure, the amount of time for a specific location) and the patient category, the treatment category may be used to specify how long the patient should not be on the particular part of the body, ranked on a scale of, for example, 1-10. For example, given a patient category 8 that has a sacrum rating of 5, the system 10/58 may immediately prescribe a treatment category of 3 on a scale of 1-10. 
       FIGS. 15-28  represent preferred embodiments of graphic user interface screens that may be displayed on the tablet&#39;s display  26  for use by a caregiver to monitor patients using the systems  10  and  58 , and particularly the system  58  depicted in  FIG. 10 . In particular, BLE signals broadcast from a sensor  30  of a sensing unit  14  to the Internet cloud  62  ( FIG. 10 ) are encrypted to HIPAA standards and include a sensor ID, battery status, pressure switch state, and signal strength along with potential additional data. As an example, data is sent from the sensing unit  14  via a configuration setting every 0.5 to every 5 minutes or every 1 to 5 minutes for preventative locations. In preferred embodiments, data can be achieved but not deleted from the system  10 / 58 . All data changes are synched with the cloud  62  when online. When the system  10 / 58  is offline, data is stored and synched at the first opportunity that the system  10 / 58  is back online. 
     As illustrated in  FIG. 15 , after a user directs a browser to the website login page of the system  10 / 58 , a screen  82  appears that includes a question mark icon  84 . The question mark icon  84  preferably appears on all interface screens displayed to users of the system  10 / 58 . A user enters a login into a login dialog box  86  and a password into a dialog password box  88 , then clicks a sign in dialog button  90  to gain entry into the software. 
     After a user successfully logs into the system,  FIG. 16  illustrates a welcome screen  92  that includes an administration (“Admin”) tab  94 , a patient information (“Patient Info”) tab  96  and a monitor (“Monitor”) tab  98 . Clicking the administration tab  94  brings the user to an administrative (“Admin”) screen illustrated in  FIG. 17  that includes additional links including a facilities module  100 , a users module  102 , a settings module  104 , and a reports module  106 . 
       FIG. 18  illustrates the facilities module  100  that can be accessed through the administrative screen of  FIG. 17  to allow users to add, change and/or delete organizations and sub-organizations, including details such as name, address, floor, and section descriptions. Only certain users such as super users with administrative rights are preferably allowed to add, change, and/or delete certain data in the system  10 / 58 . 
       FIG. 19  illustrates the users module  102  that can be accessed through the administrative screen of  FIG. 17  to allow users to add, change and /or delete users including details such as name, unit/floor, designation, phone, email, username, and password. 
       FIG. 20  illustrates the settings module  104  that can be accessed through the administrative screen of  FIG. 17  to allow users to add, change and/or delete certain parameters associated with certain sensors including an alarm threshold  108  (such as that discussed in reference to  FIG. 10 ) and an alarm clear time  110 . A set of alarm settings  112  are configurable including a sound option  114 , a volume option  116 , a duration option  118 , and an interval option  120 . 
       FIG. 21  illustrates the reports module  106  that can be accessed through the administrative screen of  FIG. 17  to allow users to choose different reports including an alarm report  122 , a pressure ulcer (PU) status report  124 , a usage report  126 , and a history report  128 . 
       FIG. 22  illustrates an example screen of the history report  128  that includes a listing of sensor descriptions  130  and a visual summary  132  associated with each sensor  30  displaying alerts based on time and pressure data. A set of visual status alerts  134  includes a no pressure status  136 , an overpressure status  138 , a pressure threshold alarm status  140 , a pressure alarm relieved status  142 , a low battery status  144 , and a stopped sensor status  146 . 
       FIG. 23  illustrates a patient screen that can be accessed through the welcome screen  92  of  FIG. 16  to allow users to add, change and delete patients in the system  10 / 58 . The patient screen includes detailed patient information such as name, unit/room, ID#, gender, and date of birth. 
     If a user selects a particular patient after selecting the patient tab  96 , the user lands on the patient detail screen illustrated in  FIG. 24 , which includes additional data such as patient weight, diagnosis, mobility, bed type, Braden, PURS (Pressure Ulcer Risk Scale), existing PUs, and new PUs. If a user selects an existing or new PU,  FIG. 25  illustrates a PU status screen that includes dropdown menu options for specific PU status, location, stage/category, date and time. 
       FIG. 26  illustrates the monitor user interface that can be accessed through the welcome screen  92  of  FIG. 16  when the monitor tab  98  is selected. In particular, a visual indication of each sensor  30  and its location on the patient is illustrated on a human outline  148  in a patient sensor status window. The visual indication of each sensor  30  comprises a label  154  with information that identifies the sensor  30 . As shown, each label  154  also incorporates an elapsed time progress bar, which may display elapsed time and warnings in the same manner as described for the progress bars  52  discussed in reference to  FIGS. 5A and 5B . In particular,  FIG. 26  indicates each label  154  as reflecting the sensor status discussed in reference to  FIG. 22 , namely, color-coded visual status alerts  134  that include a no pressure status  136 , an overpressure status  138 , a pressure threshold alarm status  140 , a pressure alarm relieved status  142 , a low battery status  144 , and a stopped sensor status  146 . An alarm history window  150  lists a history of past sensor alarms. 
     As illustrated in  FIG. 27 , a sensor detection window  152  is displayed when the tablet  13  is located near a sensor  30  and a button on the sensor  30  is depressed (not shown) to automatically detect the sensor  30 . As illustrated in  FIG. 28 , if a user selects a sensor label  154  in the human outline  148 , a sensor window  156  is displayed to allow the user to enter additional information on the sensor  30  and alarm thresholds. The sensor  30  can be registered using QR Codes to associate the particular sensor  30  with a patient and with part of that patient&#39;s body. For this purpose, the caregiver places the sensor  30  adjacent to the tablet  13  or the smartphone  68 , which includes an application to read the QR label. In particular, the caregiver can use the smartphone  68  to take a picture of the QR label, which is read and processed by the application. The application then has a label with unique identification of the sensor  30 . The user then drags the label  154  to a specific part of the body illustrated in the human outline  148  that serves as a visualization of the patient. When the user is done dragging the label  154  onto the part of the body of the patient, the user releases the button and the label  154  is associated with the part of the body where the label  154  is released. 
     Additional registration of the sensor  30  in the system  10 / 58  includes measuring the signal strength to detect the proximity of the sensor  30 , a user pushing a button on the sensor  30  to initiate proximity detection of the sensor  30  so the sensor  30  can be registered in the system  10 / 58 , or a user pushing the button in a unique sequence over a predefined period of time to initiate registration. 
     In addition to locating pressure sensing units  14  on a human body, it is foreseeable that the systems  10  and  58  may be used on other objects depending on the application. For example, it is also foreseeable that a sensing unit  14  could be incorporated into a prosthetic worn by a person to monitor pressure between the prosthetic and the person&#39;s skin contacted by the prosthetic, or located on or in a surface that a person will sit or lie on, such as wheelchairs, chairs, vehicle seats, bicycle seats, etc., or covers for such devices. Additionally, the sensing units  14  may be located in furniture, clothing, sporting equipment, or any other location where tracking pressure over a period of time is desirable. For example,  FIG. 7  represents the system  10  being used with a wheelchair  56  and having pressure sensing units  14  located on or in a seat of the wheelchair  56 . 
     The pressure monitoring systems  10  and  58  could be combined with other known types of sensors and transducers in order to provide a more comprehensive status of a patient. For example, the systems  10  and  58  may be configured to sense the patient&#39;s heart rate and/or blood pressure and transmit this information to the tablet  13  to be displayed with the pressure information. Alternatively, the software application of the tablet  13  may be configured to communicate with existing heart rate and/or blood pressure monitoring devices and incorporate this information into the display. In either case, the software application on the tablet  13  may be configured with preset limits for the patient&#39;s heart rate and/or blood pressure in substantially the same manner as described above relating to the pressure monitoring. As such, the software application may display a warning if the patient&#39;s heart rate or blood pressure drops below or exceeds the preset limits. 
     While the invention has been described in terms of specific embodiments, it is apparent that other forms could be adopted by one skilled in the art. For example, the pressure monitoring systems  10  and  58  and its components could differ in appearance and construction from the embodiment shown in the Figures, the functions of each component could be performed by components of different construction but capable of a similar (though not necessarily equivalent) function, and various materials and assembly, calibration and test procedures could be used in the manufacturing and setup of the systems  10  and  58 . Other options include the use of different packaging, timer and pressure measurement modalities (including variable output pressure transducers), and the use of any number of pressure sensing units  14  and sensors  30 , including different types of sensor technologies to measure a range of specific pressures. In addition, various different threshold pressure levels could be used, though a pressure level of 30 mmHg is currently universally accepted as a critical threshold pressure level in the development of pressure ulcers. 
     The system can also be configured for use by home patients and wheelchair patients, as well as for placement in the shoes of ambulatory patients to measure and warn against excess foot pressure-time. The system can also be adapted for use in treating pre-existing wounds and to incorporate wound care dressings into the pressure sensing units  14 , for example, by impregnating a dressing layer of a pressure sensing unit  14  with topical antibiotics to aid in the treatment of bacterial infected wounds. The system may additionally include temperature sensors to detect if the skin is increasing the probability of a PU for alerting and time. Moisture sensors could detect if the skin is increasing the probability of a PU for alerting and time as well. 
     A variable pressure transducer could assist in relating a patient&#39;s weight and other health factors when configuring alerts and alarms. The system could also detect if a patient was out of the bed or a seat if all sensors are not reading any pressure. The system could further include skin capillary stimulation if the skin is increasing the probability of a PU for alerting and time. The system could detect softness and hardness of various beds and seats using a pressure sensor. A bed pad or chair pad could be embedded with sensors and time alerting, along with artificial limbs. The system could employ predictive analytics based on age, multi-sensor information and other metrics. Care of patients could be socialized to family members can remotely monitor the patients. 
     The system could further include a soil detection alert. Finally, a bacterial burden value could be calculated to alert a high probability of a PU. Accordingly, it should be understood that the invention is not limited to the specific embodiments illustrated in the Figures. It should also be understood that the phraseology and terminology employed above are for the purpose of disclosing the illustrated embodiments, and do not necessarily serve as limitations to the scope of the invention. Therefore, the scope of the invention is to be limited only by the following claims.