Bare-Non Modesty Apron: protecting patients modesty and dignity (#3061)

Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
Many physical examinations require patients to undress. The Bare-Non Modesty Apron protects patients modesty. This single use, cost effective, dignity restoring garment reduces feelings of vulnerability & embarrassment for clinicians & patients.
Overview of Innovation:
NHS policies on Dignity & Respect state that patients have the absolute right to be treated with dignity & respect in a way that suits their needs & that patient modesty must be protected at all times by the provision of suitable garments & drapes.

The use of a Bare-Non® Modesty Apron in an examination allows the patient to feel more comfortable & empowered rather than experiencing what is usually considered an uncomfortable & awkward experience. This helps to create a more harmonious environment between the patient & the practitioner.

Single use disposable, hygienic & hypo-allergenic, the Bare-Non Modesty Apron has a front split & extensible neckline, meaning one size fits all. It is simply placed over the patient’s head prior to examination or treatment & covers the front torso to mid-thigh level.

Each Apron comes individually packed with a ‘Proof of Use’ sticker which can be signed & inserted into the patients notes or attached to other documentation such as an ECG tracing. Lightweight, comfortable & moisture resistant it allows quick unhindered access to the patients’ chest & abdomen should the need arise.

Over time, clinicians can become desensitised to patient’s in a state of undress, a condition Bare-Non identify as “Nudity Blindness”. This can leave patient’s feeling vulnerable & embarrassed & unable to participate fully in important aspects of their consultation such as shared decision making whilst they focus on their state of undress. Patients who have worn the Bare-Non Modesty Apron have reported feeling less inhibited, more empowered & more able to participate in their treatment or consultation without feeling the need to rush to put their clothes back on.

Current garment offerings have to be completely removed in a variety of settings, leaving the patient inadequately protected in terms of modesty & dignity. Sometimes clinicians are only provided with drapes, which have a tendency to fall off. Cases of compromised patient modesty can lead to patient distress & formal complaints, the impact of which can be personal, organisational & financial with devastating & long-lasting consequences for both patient & clinician.

The Bare-Non Modesty Apron is relevant for examination applications across multiple clinical areas. These include, but are not limited to; pre-op assessment clinics, outpatients, breast clinics, cardiac function suites, radiology & interventional radiology, cosmetic & reconstructive surgery & General Practice e.g. ECG testing.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
Similar Content2
Innovation 'Elevator Pitch':
Prep Shield has a gentle, non-restrictive central aperture to protect patient’s skin & tourniquet from damaging preparation solution leakage. Made from medical grade material & suitable for all size limbs.

Overview of Innovation:
Prep Shield is a disposable drape with central apertures for use in minor and major operations. Prep Shield protects the patient and tourniquet from potentially corrosive skin preparation solutions, blood, pus and other fluids.

Prep Shield is easy to use and prevents pooling of the prep solutions around or under the torniquet that could be a potential fire risk or irritant. The soft seal technology prevents seepage through to the drapes, protecting friable skin and rheumatoid patients from a potential reaction to adhesives or prep solutions.

Prep Shield can be easily removed by snipping the edge and tearing to the central aperture. 

Prep Shield is made from a flexible, lightweight, blue latex-free medical grade material, CE attested.

To view a demonstration visit:
To view the website visit: 

With an increasing ageing population, replacement knee surgery and lower limb amputations are becoming more prevalent.

Examples of where Prep Shield can be used:

1. 'The number of hip replacement operations on people aged under 60 has risen 76% in the last decade, NHS figures for England reveal. ... Demand for new hips across all ages has risen - there were 89,919 of the operations in 2004-05 and 122,154 in 2014-15.​'

2. 'Diabetes UK has shown that there were 26,378 lower limb amputations related to diabetes in England from 2014 to 2017, an increase of 19.4% from 2010-2013.​'

3. 'There are approximately 5-6000 major lower limb amputations undertaken per year in the UK.'​
Prep Shield is available in sizes 20 to 90cm. Clean room prepared in boxes of 25 & 50, Prep Shield is significantly cheaper than other drapes @ £2.40 each, adhesive paper drapes cost £5.40 each.
Disposable: size 40 x 40cm non-restrictive and non-adhesive.
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Innovation and adoption / Person centred care
Benefit to NHS:
NHS Benefits:

Prep Shield is easy to use and store. It is more cost effective and less bulky than traditional drapes. Prep Shield will keep the tourniquet protected for possible re-use.

Patient Outcomes: 

The patient's skin is protected from preparation fluids which are potentially corrosive, reducing skin irritation.

Efficieny improvements:

Prep Shield is quick and easy to use and remove
Initial Review Rating
2.40 (2 ratings)
Benefit to WM population:
Figures show increased prevalence of diabetes and its consquences in Pakistani, Bangladeshi and Indian communities. The West Midlands has the largest population of this ethnicty.

There were 25,312 amputations and 136,215 revascularisations, and 7543 cases were linked. The prevalence rate per 100,000 (95% confidence intervals) for amputation was 26.3 (26.0–26.6) with rates significantly higher in Northern England (North: 31.7; 31.0–32.3, Midlands: 26.0; 25.3–26.7). The odds of having an amputation with a revascularisation remained significantly higher in the North (OR 1.22; 1.13–1.33) even after controlling demographic and disease risk factors.'

Current and planned activity: 
Protoype ready, successfuly used. Lead time for production 3 weeks.  
What is the intellectual property status of your innovation?:
Trade mark and design registered.  Licensed by Joanna Winslade to QOL Limited.
Return on Investment (£ Value): 
Return on Investment (Timescale): 
1 year
Ease of scalability: 
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Overview summary:
By negotiating a new business model with our laundry service provider, we were able to introduce a more dignified patient robe, as well as make a cost saving on laundry. This new arrangement could now be exploited by other organisations wishing to improve on patient dignity.
Challenge identified and actions taken :
Patients undergoing imaging are asked to undress and wear a traditional hospital robe. This ensures no metal is present in the MRI scanner, and that quality images can be achieved without any artefacts.
The robe ties around the patient, but does not completely cover the naked skin. Patients have complained about their loss of dignity. To address this, patients are offered two robes; one to tie around the front, the other round the back. However, this creates two new issues. Firstly, patients with restricted mobility find it difficult to tie fastenings around their back. Secondly, use of two robes per patient doubles our laundry costs.
As per our innovation development process, we searched the market to see what solutions may already exist. The 3-armed robe was identified as the best choice. This design ensures patients are completely covered. There are no fastenings; closure is provided by the garment having three arms (see attachements). Walsall Healthcare NHS trust had already introduced these robes and reported good patient feedback, so we decided to adopt the same. It was not viable for us to purchase the robes outright and then pay out again for the special return-to-sender laundry service.  Instead, we needed to negotiate a new business model with our laundry service provider. 
Impacts / outcomes: 
Since HEFT is a large trust, the large volumes required for the imaging services meant that it made good business sense for the laundry service provider to have the robes manufactured, and then provide them to us on the usual rental basis. The improved design enables us to provide each patient with one robe rather than two, and so as well as improving the dignity of our patients, we have also achieved a cost saving on laundry. We are waiting for delivery of the new robes and anticipate the same positive feedback experienced by our neighbour.
Which local or national clinical or policy priorities does this innovation address:
Adoption of innovation
Supporting quote for the innovation from key stakeholders:
Patients attending Walsall Healthcare NHS Trust have said they much prefer the three-armed gown because it allows their dignity to be preserved.
Plans for the future:
Our large volume requirement (purchasing power) has enabled the laundry service provider to source a manufacturer and provide the robes to us on a rental basis. Other trusts wishing to improve patient dignity can now benefit from this arrangement.
Tips for adoption:
Whilst the majority of patients put the robes on correctly, it may be useful to provide patients with photographic instructions. 
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