How to guidesHow to guide: Selecting a support surface

How to guide: Selecting a support surface

Pressure Ulcers | Liz Ovens, Clinical Service Lead Tissue Viability, Hillingdon Community Health and Central and North West London Foundation Trust

Factors to CONSIDER when choosing a support surface

  • Weight and size of the patient
  • The weight limit of the support system should not be exceeded. Obese patients may need a bariatric support surface.
  • Patients who are very light or small may not sink into a reactive surface sufficiently to produce adequate pressure redistribution.
  • Some air-filled surfaces can be adjusted for patient weight.


Ease of use

  • Is training required in the use of the surface?
  • The length of time before the support surface is ready to use (ie is there an inflation time?).
  • The support surface must fit the space for its intended use. Can it be transported to the space easily? Some integrated bed systems are unsuitable for home settings because of their bulk and weight and the need for a generator in case of loss of electrical power.


Maintenance

  • How easy is the surface to clean and decontaminate?
  • Does the support surface need specialist maintenance? Some support surfaces need to be taken off site for specialist cleaning between patients.


Impact on nursing procedures

  • Some integrated bed systems include a 'turn assist' feature that helps with repositioning, examinations and linen changes.
  • Overlays may raise a bed surface height to a level where bed rails no longer prevent falling, or cause difficulties for patients getting in/out of bed: if an overlay is required consider using a reduced-depth base mattress.
  • If the support surface lacks a firm edge, a patient previously able to transfer/stand from the bed may no longer be able to.
  • Some patients who are able to reposition themselves on a standard mattress might find that they are not able to do so on some support surfaces.
  • A patient with a high level of skin moisture or who has a highly exuding wound may be best nursed on a low air loss or air-fluidised surface.


Microclimate  
Support surfaces can influence the microclimate of a patient's skin (eg foam mattresses tend to increase skin temperature and gel-filled products initially have a cooling effect but this wears off over time) so this must be taken into account when choosing a patient's support surface.

Patient comfort and choice

  • Some support surfaces make a noise during operation that may disrupt sleep.
  • Some patients find the sensations produced by lying on some support surfaces disturbing or painful.


Once pressure redistribution strategies have been set in place, it is important to assess their effectiveness. Changes in the condition of the patient and their ongoing risk levels should be monitored as these may alter the prevention strategies required (International Review, 2010).


Role of a support surface in patient care
The use of a support surface is only one facet of the prevention and management of pressure ulcers. It is important that clinicians are fully trained in the use of any support surface and understand how its use fits into the wider care of a patient. Support surfaces should be used as part of a comprehensive care plan which incorporates ongoing reassessment and takes account of the patient's needs and preferences (NICE, 2005).

Patients who are being cared for on support surfaces continue to need repositioning. The repositioning regimen (ie positions used and frequency of repositioning) should be documented and appropriate for the patient's needs and ability to reposition themselves (NICE, 2005; International Review, 2010).

Quality drivers and pressure ulcers
Pressure ulcers are expensive to treat, with nursing time making up most of the cost. The other costs of treatment, eg dressings, antibiotics and pressure-relieving equipment, are relatively low (3.3% of the total cost) (Dealey et al, 2012).

As a result of the high costs of treatment, and because most pressure ulcers are avoidable, there is increasing emphasis by the UK government on prevention. One of the eight High Impact Actions for Nursing and Midwifery set out by the NHS Institute for Innovation and Improvement is 'Your Skin Matters'. This initiative aims for there to be no avoidable pressure ulcers in NHS care (NHS Ins

titute for Innovation and Improvement, 2009). As a result, many NHS trusts in England are emphasising pressure ulcer prevention and have Commissioning for Quality and Innovation (CQUIN) targets for reducing the number of pressure ulcers (Morton, 2012). However, consistency and standardisation of pressure ulcer reporting are required nationally if meaningful comparisons are to be made between different geographical areas.

There is a continuing need for education in all aspects of prevention, categorisation and management of pressure ulcers across the health service, and with the current resources and capacity within the NHS this will be an ongoing challenge.

References

  • Dealey C, Posnett J, Walker A (2012) The cost of pressure ulcers in the United Kingdom. J Wound Care 21(6): 261-266
  • European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel (EPUAP/NPUAP) (2009) Prevention and treatment of pressure ulcers: quick reference guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009. Available at: www.npuap.org/Final_Quick_Prevention_for_web_2010.pdf
  • International Review (2010) Pressure ulcer prevention: pressure, shear, friction and microclimate in context. A consensus document. London: Wounds International. Available at: www.woundsinternational.com
  • National Institute for Health and Clinical Excellence (2005). Pressure ulcers. The management of pressure ulcers in primary and secondary care. NCG 29. Manchester: NICE. Available at: www.nice.org.uk/cg29
  • NHS Institute for Innovation and Improvement (2009) Your Skin Matters. Available at: www.institute.nhs.uk/building_capability/hia_supporting_info/your_skin_matters.html
  • NHS Quality Improvement Scotland (2009) Best practice statement. Prevention and management of pressure ulcers. Edinburgh: NHS Quality Improvement Scotland, 2009. Available at: www.nhshealthquality.org
  • Nixon J, Nelson EA, Cranny G, et al (2006) Pressure relieving support surfaces: a randomised evaluation. Health Technol Assess 10(22):iii-iv, ix-x, 1-163
  • Morton N (2012) Preventing and managing heel pressure ulceration: an overview. Br J Community S18-22


Further reading

  • Clark M (2009) Understanding support surfaces. Wounds International 2(3). Available at: http://www.woundsinternational.com/product-reviews/understanding-support-surfaces
  • Fletcher F (2009) Pressure ulcer management - how to guide. Wounds UK  7(1). Available at: http://www.wounds-uk.com/pdf/content_10475.pdf

 
Contributors:
Liz Ovens, Clinical Service Lead Tissue Viability, Hillingdon Community Health and Central and North West London Foundation Trust