Development of an Internet of Things System for Measuring

the Direction of Use of Body Pressure Dispersion Cushions

using Radio Frequency Identifier

Ryoma Seto

, Hirona Okudaira

and Toshitaka Inoue

Healthcare Informatics, Faculty of Healthcare, Tokyo Healthcare University, Tokyo, Japan

Faculty of Sports and Health Science, Daito Bunka University, Saitama, Japan

Faculty of Health and Social Welfare Sciences, Nishikyushu University, Saga, Japan

Keywords: Pressure Ulcer Prevention, Pressure Distribution Cushion, IoT (Internet of Things), RFID (Radio Frequency

Identifier), NIS (Nursing Information System).

Abstract: Pressure ulcer prevention guidelines recommend repositioning within 4 hours. For encouraging

implementation, IoT technology was used to design a pressure distribution cushion with an embedded radio

frequency identifier (RFID) tag and a prototype Android smartphone application to read the tag. As a result

of the RFID tag reading experiment, 83% without blanket and 13% with blanket could read the correct posture

successfully. In addition, the position was correctly read by the system. With this prototype, the body position

could be detected appropriately.

1 INTRODUCTION

Prevention of pressure ulcers as part of long-term

nursing care is extremely important in ensuring the

quality of life of the elderly. It has various

precautionary measures; one of them is pressure

dispersal, which is crucial. Pressure ulcer prevention

guidelines recommend that postural change be

performed every 4 hours or less (The Japanese

Society of Pressure Ulcers Guideline Revision

Committee, 2016).

For the proper distribution of body pressure, the

date and time of the postural change and the person

performing the postural change should be recorded as

accurately as possible. The use of ICT to prevent

pressure ulcers has been extensively investigated.

Several studies perform the following: (1) Detecting

pressure ulcer risk factors using electronic medical

record data and communicating them to nurses (Park,

2019) (Davidson, 2019), (2) Gathering information

on pressure ulcer occurrence and using it as an index

for quality evaluation.

In recent years, with the spread of machine

learning, research integrating (1) and (2) have been

https://orcid.org/0000-0002-6154-9342

attempted (Cramer, 2019). Thus, pressure ulcer

prevention based on data is progressing.

Meanwhile, only few research use such

information technology for body pressure

distribution, which is a more basic means of

preventing pressure ulcers. The reason is that postural

variance is excessively analogous and requires less

ICT participation.

Therefore, from the viewpoint of the Internet of

things (IoT), we report on the development of a

system that implants an IC chip in a postural change

cushion and enables detection and recording of the

postural position.

2 METHODS

2.1 Aim for Development

We aimed to develop this system to be able to

automatically record the position, date, and time of

the position change, and the nurse who performed the

position change. Hence, we have developed a postural

change cushion with an embedded IC chip.

Seto, R., Okudaira, H. and Inoue, T.

Development of an Internet of Things System for Measuring the Direction of Use of Body Pressure Dispersion Cushions using Radio Frequency Identiﬁer.

DOI: 10.5220/0009567200990102

In Proceedings of the 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2020), pages 99-102

ISBN: 978-989-758-420-6

2.2 Design of the Body Pressure Partial

Pressure Cushion

The body pressure distribution mattress has a

structure in which a scapula is lifted to distribute the

weight of a patient. The angle at which the scapula is

lifted is 30°, so the cross section of the mattress is a

right triangle of 30°-60°–90°.

Therefore, we could specify whether the patient

was in the right or in the left lateral position according

to the base of the right triangle, which is either above,

or below the body. To specify such position, we

assigned a function in radio frequency identifier

(RFID).

The performance and position of the RFID tag

were designed so as not to affect the abovementioned

positional relationship.

2.3 Design of the Position Detection

System

The information system for reading the body pressure

dispersion cushion with the RFID tag was designed

for Android.

At present, according to reviews in other clinical

fields, many mobile terminals used for observing

symptoms are for Android smartphones (Choi, 2018).

Hence, the environment used by the authors for

design was Android, and the software used for

reading the IC chip was a highly versatile

middleware.

2.4 Method for Evaluating the

Prototype of This System

For this prototype of the body pressure dispersion

cushion and the body position detection system, we

constructed a sleeping environment virtually. The

validity of reading the IC chip and the absence of

malfunction were verified.

Considering that this verification is performed in

a virtual environment, government approval based on

the Pharmaceutical Machinery Act or approval of the

ethics committee at the university is unnecessary.

3 RESULTS

3.1 Outline of the Newly Developed

Body Pressure Dispersion Cushion

and Body Position Detection

System

The body pressure dispersion cushion was made of

urethane sponge, and its length was 40 cm. The cross

section was a right triangle, with the hypotenuse at the

bottom. RFID tags were attached to both ends of the

cross section. This RFID tag measured 22 mm in

diameter and 0.6 mm in thickness (Figure 1).

The format of the RFID tag is NTAG213, which

is a 13.56 MHz-band passive tag. An RFID tag of this

standard has an effective distance of 10 cm, with 144

bytes of user memory.

Figure 1: Cross section of the body pressure dispersion

cushion (circle in the center represents the RFID tag).

The reading system employs a general-purpose

RFID tag reading system that runs on an Android

smartphone; when a user touches a tag attached to a

cushion, the body position is displayed in a pop-up

(Figure 2).

3.2 Reading Result of the RFID Tag

Attached to the Cushion

We placed the humanoid model in the right lateral

recumbent position and inserted a body pressure

dispersion cushion equipped with an RFID tag to

maintain this posture.

In this environment, the RFID tag on the head

(written information: postural change to the right

recumbent position) was read in an environment

without a blanket. Consequently, 25 out of 30 trials

(83%) were correctly read.

When a similar reading test was performed with

a blanket placed on the humanoid model, reading was

successful only four times (13%) and failed 26 times

(87%).

In both situations with and without a blanket, the

RFID tag placed on the foot (written information:

repositioning to the left lateral position) was never

read by mistake (Table 1).

ICT4AWE 2020 - 6th International Conference on Information and Communication Technologies for Ageing Well and e-Health

100

Figure 2: Pop-up screen when reading an RFID tag attached

to a cushion with Android smartphone.

Table 1: Success rate of reading an RFID tag attached to a

cushion (number of trials: 30).

Head side tag Foot side tag

Without blanket 25 (83%) 0 (0%)

With blanket 4 (13%) 0 (0%)

4 DISCUSSION

4.1 Availability of the Position

Detection System

This system is the first to record postural change

using IoT technology for postural dispersal cushions

among bedridden patients.

In a virtual environment experiment using a

humanoid model, reading can be possibly correct

80% of the time in an environment without blankets.

This percentage may be insufficient, but at least, false

readings may not occur in general.

Conversely, when a blanket was used, the

reading success rate decreased to approximately 10%.

Peeling off the blanket is indispensable to perform the

repositioning; however, this reading success rate is

appropriate for a system that records the proper

performance of repositioning.

Next, the validity of the RFID tag is considered.

Regarding NTAG213 (ISO14443 type-A) used this

time, related literature cannot be found in PubMed.

Therefore, comparing it with other cases is difficult,

but it is still appropriate because of the absence of

false reading of RFID in this experiment. Given that

the effective distance of NTAG213 is approximately

100 mm, the tag of the foot is not read when reading

the tag of the head.

According to a previous study of pressure ulcer

prevention using IoT technology, a device can detect

excessive body pressure by attaching it at the center

of a wheelchair (Tavares C, 2019).

I have no intention to deny such a sophisticated body

pressure detection tool. However, extremely simple

tools, such as those proposed herein, are also useful,

and we suggest that they will be used for pressure

ulcer prevention.

4.2 Considerations for Implementing a

Posture Detection System

This system is the first to record postural change

using the IoT technology for postural dispersal

cushions in bedridden patients.

In this experiment, we only developed a postural

change cushion equipped with an RFID tag, and we

verified the effectiveness of reading by using a

general-purpose software. To implement this system

in an electronic medical record system or the like, we

need to consider a message format.

Thus, we will discuss the message format by

using the Master of Nursing terms certified by the

Ministry of Health, Labor, and Welfare of Japan. This

master consists of nursing observation and nursing

action, both of which have the expressions “right side

supine” and “left side supine.”

In any case, the information to be written to the

RFID tag is either “right side supine” or “left side

supine,” and this master can express it with one code.

Therefore, in this study, we leave judgment on

whether to use the Master of Nursing observation or

nursing action. Hence, writing a code that specifies

left and right on the RFID chip is necessary, so that it

can be used for three-point authentication (Figure 3).

Development of an Internet of Things System for Measuring the Direction of Use of Body Pressure Dispersion Cushions using Radio

Frequency Identiﬁer

101

Figure 3: Image of an RFID tag with left side-lying

information (L symbol).

5 CONCLUSIONS

In this study, a prototype of a postural change cushion

and a reading system using the IoT technology were

developed to accurately record postural changes

necessary for pressure ulcer prevention.

By devising the effective range of the RFID tag,

we verified that constructing a system that enables

position detection is possible. The developed system

can also be applied to other nursing situations. For

example, the date, and time of changing clothes can

be recorded by attaching an RFID tag to a hospital

garment. We will continue to consider various uses.

This model has been registered as a utility model

in Japan (registration number:3225058) by Japan

Patent Office.

ACKNOWLEDGMENTS

This work was supported by Japan Society for the

Promotion of Science; Grant-in-Aid for Scientific

Research (C) 19K11180.

REFERENCES

Choi, Y.K., Demiris, G., Lin, S.Y. et al. 2018. Smartphone

applications to support sleep self-management: review

and evaluation. J Clin Sleep Med.; 14(10):1783-1790

Cramer, E.M., Seneviratne, M.G., Sharifi, H., et al. 2019.

Predicting the incidence of pressure ulcers in the

intensive care unit using machine learning, EGEMS

(Wash DC).; 7(1):49

Davidson, C., Loganathan, S., Bishop, L., et al. 2019.

Scalability of an IT intervention to prevent pressure

ulcers in nursing homes, J Am Med Dir Assoc.;

20(7):816-821

Park, S.K., Park, H.A., Hwang, H., 2019. Development and

evaluation of electronic health record data-driven

predictive models for pressure ulcers, J Korean Acad

Nurs.; 49(5):575-585

Tavares, C., Domingues, M.F., Paixão, T., et al., 2019.

Wheelchair pressure ulcer prevention using fbg based

sensing devices, Sensors (Basel).;20(1). pii: E212.

The Japanese Society of Pressure Ulcers Guideline

Revision Committee. JSPU Guidelines for the

Prevention and Management of Pressure Ulcers (4th

Ed.), Japanese Journal of Pressure Ulcers 2-16; 18(4):

455-544

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