What to consider when purchasing pressure ulcer products
Dr. James G. Spahn
Pressure ulcer occurrences are continuing to increase, with more than 2.5 million individuals developing them each year and roughly 60,000 of these incidents resulting in fatality. For this reason, proper product utilization in the pressure ulcer arena must address not only clinical efficacy but also cost reasonableness. A “not too little” and “not too much” approach must be adopted by the caregivers in this ever-changing medical climate.
The proper selection of products cannot be based solely on hypothetical concepts, promotional materials or a “the more, the better” philosophy. Proper product utilization combines clinical effectiveness and reasonable cost so the product usage outcomes match the clinical and financial expectations. In short, product selection should be based on scientific and clinically substantiated outcomes, utilizing the most cost-effective product that will deliver equivalent results.
With the above as the mindset for product selection, one can address the support surface usage in a more rational fashion. The understanding of how various technologies work is of great importance. This understanding, based on scientifically proven facts of physics, chemistry, anatomy and mechanics, will help caregivers select products that meet their needs and thus match their expectations.
Defining the difference between comfort needs and pressure ulcer prevention/intervention needs is very important. Comfort products deliver different outcomes than pressure ulcer related products. The products used for comfort only are less expensive (i.e. egg crates, foam overlays without friction reducing covers, and contouring mattresses without pliable friction reducing covers). In the same light, usage of the expensive surface products (i.e. mechanized surfaces utilizing low air loss, alternating and fluidized technologies) make little economic sense when the utilization of mid-cost products [static fluid (air or liquid)] can give equivalent clinical results. This demonstrates how underutilization can be clinically dangerous and overutilization can be financially foolish.
The key to success in the prevention and treatment of pressure ulcers is to utilize protocols that identify product categories based on clinical outcome goals. The clinical outcome goals and corresponding product categories are as follows:
* Comfort only (convoluted foam and foam overlays without friction-reducing covers)
* Minimal pressure ulcer risk in the uncomplicated patient (foam overlays with pliable friction reducing covers, or static fluid system)
* Prevention and treatment for all levels of risk and stage I, II and shallow III pressure ulcers (static fluid—air or liquid)
* Prevention and treatment for all levels of risk and stage III, IV, eschar and non-responsive stage I and II pressure ulcers (static air systems with natural temperature control properties)
* Treatment of post-flap and non-responding stage III and IV pressure ulcers (low air loss and air fluidized products)
This approach of ramping up to and down from the more expensive products is simple for caregivers to follow and will give better clinical outcomes with marked cost savings.
In order to effectively prevent and treat pressure ulcers, the following factors, in addition to support surfaces, must be addressed:
* Complete assessment should be done at least upon admission and weekly thereafter, or as per facility policy. If progress in healing is not being made within two weeks of product selection, advance to the next level of care. If at any time, it is not noted that goals have been met, move back to the prior level or care.
* Use of accepted risk scale is suggested as basis for prevention, early intervention, treatment goals and product selection (i.e. Braden Scale, Norton Scale).
* A separate risk scale must be used for prevention and treatment of pressure ulcers on the ankle, foot and heel, due to the fact that support surfaces alone cannot adequately address this problem, along with foot drop and lateral rotation.
* Proper wound care must be addressed.
* Turning and mobilization schedules must be developed and followed.
* Pressure and shear relief on all surfaces must be addressed (i.e. O.R. tables, wheelchairs, geri-chairs, transportation carts, etc.).
* Nutritional status must be addressed.
* Incontinence and moisture must be addressed.
* Infection control must be considered with use of forced convection therapy (i.e. low air loss) where potential exists for cross contamination via airborne or droplet particles (originating from respiratory, digestive or soft tissue) blowing into the environment.
* Any patient with previous pressure ulcer experience should be considered moderate to high risk for pressure ulcer development.
* PUSH Tool or Barbara Bates-Jensen pressure sore status tool is suggested for pressure ulcer monitoring.
In conclusion, it is integral for caregivers to implement products for pressure ulcer prevention and treatment that will produce positive clinical outcomes and provide cost-effective solutions for the facility. The vast array of support surface products addresses different needs when it comes to comfort and pressure ulcers. For this reason, caregivers must conduct in-depth assessments to make sure the proper pressure relief products are implemented.
Dr. James G. Spahn is the founder of Indianapolis-based EHOB, Inc., a manufacturer of products for the prevention and treatment of pressure ulcers. EHOB was founded in 1985 with a special interest in soft tissue research, education and product development.