When pressure injury prevention fails as a result of non-adherence, various comorbidities, or gaps in care, it makes a major impact on the nation’s economy and has estimated costs of more than $100 billion in the United States.
By Aletha Tippett MD
I am often asked this common question: “how do you select the right mattress or support surface for a patient?” Despite the plethora of information on how to do this, I am going to give a very simple answer: lay on it yourself. It amazes me how few caregivers have ever lain on a bed that they prescribe for a patient. It always shocks me to visit a nursing home patient and sit beside them on their bed. The bed is hard as a rock. When I ask if their bed is comfortable, the answer is a resounding NO. I always think: would YOU want to lay on this bed, would you want YOUR GRANDMOTHER (or GRANDFATHER) to lay on this bed?
The other day I was unpleasantly surprised when I visited a patient in the hospital. The family had asked me to look at him and give an opinion on the care of his feet and legs. The patient was on a ventilator but being weaned. He could only lie on his back, and had no spontaneous movement of his limbs. He had a pressure ulcer on his buttocks from his hospitalization prior to transfer here, and the family told me the surgeons “cut a big hole” to debride the wound. His feet have mummified dry gangrene, left more than right. I am thinking: here is a patient who cannot move, who has impaired sensation, who already has a severe wound with seriously impaired circulation. He needs to be floated, correct? When I feel his bed, it is hard as can be. It is locked out at the highest firmness. He also has a large square, firm pillow under his lower legs and feet. While his left heel is beyond redemption, his right heel still could develop a pressure ulcer, and it is lying on this pillow.
Is he on the right support surface? NO. We changed the lockout on the bed and moved it to a much lower firmness. We lowered the foot of the bed to reduce pressure on his buttock area. The patient noticed the changes and said he was more comfortable, with visible relaxation in his face. The pillow still needed to go, and this was discussed with his nurse. The family was amazed that such simple changes could make such a difference in how their loved one felt. Hopefully, changes will be made to off-load his heels so he does not develop a heel ulcer on the right foot. Reducing or relieving the pressure from his mattress will help his sacral ulcer to heal.
Going back to our opening statement, lay on the surface yourself, feel the surface and evaluate its firmness. Remember, you want the lowest pressure possible, with a sensation of floating. Regardless of bed surface, the heels need to be floated off the surface, either with pillows under the calves or special boots. I will avoid talking about particular brands here, but “lay on it” is always the best way to evaluate a surface. And just as in our case here, do not be afraid to make adjustments or use only part of the specialty tools offered with the bed, like turning off the alternating air feature and just using the static air mattress. When Possible, lay on the mattress to help assess the situation and make your decision.
Proper support surfaces that “float” your patients will result in more comfortable patients, improved healing rates, and fewer acquired wounds.
About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.