How to do it... Support surfaces

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The proper acquisition of pressure support surfaces has never been more important for long-term care providers. With the cost of treating some pressure ulcers ranging into the tens of thousands of dollars, not counting liability concerns, the tolerance threshold for errors is low. With pressure surfaces, various factors must be taken into account, notes Dr. James G. Spahn. "No one product type is appropriate for every patient's needs," he says. "This requires knowledge about how products work and how they affect the at-risk patient."



1 Providers should assess surface features and benefits to match clinical needs, advises Nancy Strzelecki, RN, director, clinical solution marketing, of surface maker Hill-Rom, Batesville, IN.
"Ask your sales representative to demonstrate the surface, including opening it up so you can 'check under the hood,'" she says. This allows you to examine the quality of the internal surface construction."
And ask whether the "ticking and internal" components are modular so that each piece can be replaced individually if only one component is damaged, and learn whether the warranty period is prorated.

2 Quite often, legs or feet are put at great risk. That, in turn, may bring equipment beyond support surfaces into play, says Spahn, M.D., FACS, CEO and founder of EHOB Inc.
"The lower extremity cannot be protected from pressure ulcer development, nor relied on for treatment of an existing pressure ulcer with use of a support surface alone at all times. This is not to say that the support surface is bad," Spahn noted. "Additional devices may be required, depending on various factors such as mobility and ambulation, along with other general medical problems such as the cardiovascular health of the patient."

3 Keeping legcare in mind is a good idea, agrees Denis B. Drennan, M.D., president of DM Systems Inc., Evanston, IL.
"The pillow placed beneath the calf is the standard of care in the U.S. and most of the world. This 'inexpensive technique' has provided heel-ulcer prevalences of twelve to twenty-five percent. Currently, there are a number of devices available to the caregiver of high-risk patients for thirty dollars that stay in place on a patient's leg, totally eliminate pressure on the heel and malleoli, offer forefoot support and good mobility."

4 Seek others' qualified opinions before you make an investment, says Laurie Rappl, PT, CWS, clinical support manager, Span-America Medical Systems.
"Consider effectiveness in patient treatment," she says. "Are there published studies in peer-reviewed journals that document the effectiveness of this mattress during the treatment of pressure ulcers? Or are there clinicians who have used the product that you can call to about their first- hand experiences? Many manufacturers can provide slick literature or colorful pressure mapping, but what you really need is published proof of outcomes. This will show your surveyors that you have chosen carefully, and have based your support surface selection on credible evidence."

5 Complicated is not always better. Controls should be minimal and well marked.
"Make sure it's easy to use, and difficult to misuse. Surveyors are checking to be sure that all staff are familiar with operation, and that how they are using the product follows the manufacturer's directions," Rappl said.

6 Make sure the mattress you are using fits the bed frame correctly. This will ensure there are no gaps which could cause injury to the patient, says Trip Handy, national sales manager, Blue Chip Medical Products, Suffern, NY. Hospital Bed Safety Workgroup guidelines aimed at decreasing entrapment injuries can be found at www.fda.gov/cdrh/beds. In addition, clean your mattress and replace parts as advised by the manufacturer.

7 You also should have a comprehensive wound treatment plan in place to care for the resident, Handy notes. EHOB's Spahn agrees proper assessment must take place before, during and after support-surface use.
"Every resident, no matter how life-threatening or routine the problem may be, must be evaluated for pressure ulcer risk factors," he says. "A risk analysis should address each one separately."

Don't forget when selecting a support surface:

Life expectancy of the surface
Skin moisture
Temperature control
Pressure redistribution
Product service requirements
Infection control measures
Flammability
Friction

Source: Paula Gruccio, RN, MSN, CWCN, COCN, CCCN, clinical support associate, Huntleigh Healthcare, 2006
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