To better quality care in relation to the prevention and treatment of pressure ulcers, long-term care providers must pay close attention to the products they are utilizing. The proper selection of products cannot be based solely on hypothetical concepts, promotional materials, or “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, which 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 which 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 (For example, egg crates, foam overlays without friction reducing covers, and contouring mattresses without pliable friction reducing covers). In the same light, unquestioned usage of the expensive surface products (For example, 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 follow:
- Foam overlays without friction reducing covers should be used when the goal is to provide only comfort and pain management.
- Static fluid devices, either air or liquid, should be provided to patients for prevention of all risk levels, as well as for treatment of all stages of pressure ulcers, including deep tissue injuries (DTI).
- Low-air loss and air-fluidized products should be used for the treatment of post-flap and non-responding stage III, IV and unstageable pressure ulcers.
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.
To ensure equalized load redistribution is provided at all times, long-term care providers must implement the proper products on all surfaces including wheelchairs, geri-chairs, transportation beds, etc. Addressing outside factors can also prove beneficial in prevention and treatment. These factors include but are not limited to nutrition, incontinence, moisture and the general physiologic state of the patient. Knowing a patient’s history is critical when deciding on a proper support surface. When patients have had previous pressure ulcers, caregivers must always consider them moderately or highly at risk for future pressure ulcers.
In summary, product education and knowledge can greatly aid in the reduction of pressure ulcer incidence throughout the long-term care setting. With the availability of equalized load redistribution products, it is important for caregivers to utilize the scientifically proven solutions that provide the most clinical and cost-effective patient care.
James G. Spahn, MD, FACS, is the founder of Indianapolis-based EHOB, Inc., manufacturer of the WAFFLE® Brand Products for the prevention and treatment of pressure ulcers. WAFFLE Brand Products have been used effectively for pressure ulcer prevention and healing therapy for more than two decades.