The value of systematic evaluation in determining the effectiveness and practical utility of a pressure-redistributing support surface

Abstract

Introduction Up to 20% of hospital patients will have pressure ulcers; more than half will be nosocomial and are associated with high treatment cost, increased morbidity, complaints and litigation. Consequently, patient safety programmes may include the provision of pressure-redistributing mattress replacements (PRM). However, despite the different functionality of PRMs, there is often little information to support clinical prescription; with some mattresses potentially unsuitable for a busy acute care environment: this is particularly true for mattresses which require manual adjustment each time the patient changes position. Methods A systematic prospective investigation of a new PRM was conducted over a 5-month period; following a convenience sample of high-risk hospital patients. The device automatically detects the angle of back rest, optimises cell inflation and reduces the risk of user error and sub-optimal support. Outcomes reported: ulcer prevention, healing, usability. Results A convenience sample of 60 patients were included; 39 (65%) had existing wounds. A single patient developed erythema to the sacrum (1.6%) while the majority of existing wounds (69%), including full thickness injury, improved or healed. The utility of the device was well received by staff and patients. Conclusion Although ideal, effectiveness studies (such as RCTs) are difficult to control in wound care and seldom reflect the natural challenges encountered in a busy hospital. By contrast the data arising from this pragmatic evaluation showed the mattress to be compatible with the care setting and also suitable for the vulnerability of the population and so provided the necessary information to inform subsequent clinical practice.