Table of Contents:
Kevin Y. Woo, BSc, MSc, PhD, RN, GNC(C), ACNP, FAPWCA
Pressure ulcers are a significant problem across the continuum of health care settings, especially in vulnerable populations such as individuals at the end of life. In 2009, the overall prevalence was 12.3% (N=92,408) in the United States, according to a national survey.1 The burden of pressure ulcers is significant; the average cost associated with the treatment of deep pressure ulcers and related complications is US $129,248 in acute care. People with pressure ulcers are beset by limited mobility, social isolation, depression, and persistent pain. In reviews of 53 studies, support surfaces (e.g., medical-grade sheepskin, high-specification foam mattresses) have been recognized as reducing the incidence of pressure ulcers. Appropriate surfaces or mattresses facilitate pressure redistribution, remove pressure to injury-prone areas (especially bony prominences) and spread weight evenly to avoid pressure buildup. Foam, gel-filled, water-filled and low air loss mattresses are commonly used. They are considered "reactive" because the effect of pressure redistribution is determined by the surface area of the body in contact with the mattress; the larger the area of the body that is supported by the mattress, the lower the pressure at any given point of contact.
The majority of specialty surfaces are expensive, but taking into account the number of ulcers that can be prevented, the calculated cost of using therapeutic surfaces and other preventive measures is approximately 1/40th that of the standard care approach.2 Amid the wide variety of options, clinicians should understand how to make the selection of the right mattress/surface for the individual (which?), the right clinical indication/circumstances (when?) and the right length of time (how long?) to get the right health outcomes (what to expect?). The mnemonic MATTRESSES highlights 10 key factors that should be considered prior to using a support surface to ensure the cost-effective use of resources to prevent pressure ulcers. The comfort and management of wound symptoms of individuals receiving palliative care should weigh heavily in the selection of support surfaces for these people.
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