Pressure-relieving Equipment Research Articles

Managing fire risk in housebound people who smoke and require air-alternating pressure-relieving equipment

Air-alternating pressure mattresses are advised for housebound patients with poor mobility and at risk of developing pressure ulcers. However, those patients who smoke are under significant dangers of fire risks, especially as the pump to provide alternating pressure requires oxygen. This article describes the development and introduction of a comprehensive risk assessment to help guide community nurses' discussions with any patient on their caseload who smokes and also requires air alternative mattresses. A questionnaire was developed by the Task and Finish Group comprising of nurses from the community and tissue viability teams, members from South Yorkshire Fire and Rescue and a trust fire officer. This questionnaire was developed to guide clinicians when discussing the problem of smoking and the risk of fire with patients, their families and general practitioners. The questionnaire was shared with all teams who visited patients at home, who met the criteria to promote its use. Further work is planned to audit the use of this questionnaire and to ascertain how it can help the decision-making process when discussing risks with this vulnerable and at-risk group of patients.

Preventing pressure ulcers in emergency departments: four simple and effective nurse-led changes.

Patients can develop pressure ulcers within a few hours of entering an emergency department (ED). However, despite the critical role of EDs in reducing the incidence of pressure ulcers, few have protocols in place for prevention. This article describes the prevention emergency project (PEP), a quality improvement project undertaken in the ED at Karolinska University Hospital in Sweden to reduce the incidence of pressure ulcers. The article demonstrates how four simple nurse-led changes - early risk assessment, pressure-relieving equipment, intentional rounding, and using prophylactic dressings and incontinence pads - can reduce the incidence of pressure ulcers significantly when integrated into ED workflow.

Wound care in patients with perineal reconstruction

Nurses play an essential role in monitoring and managing wounds after any surgery. This article focuses on how to optimise perineal wound healing after an extra-levator abdominoperineal excision of the rectum (ELAPE) or a pelvic exenteration for locally advanced rectal cancer. After radical rectal surgery, a perineal defect may be created that requires perineal reconstruction to fill the remaining cavity. Reconstruction of these defects is essential to restore form and function and reduce patient morbidity. A range of reconstructive options are available for perineal reconstruction. This includes inferior or superior gluteal artery perforator (IGAP/SGAP) flaps, which are fasciocutaneous flaps that provide robust, well-vascularised tissue to fill the perineal defect in a V-Y configuration while significantly reducing donor-site morbidity. The inferior gluteal artery perforator (IGAP) is most suitable when stoma formation is being considered. Possible complications after flap reconstruction include wound infection, abscess, flap necrosis, full-thickness dehiscence, bone exposure, delayed healing and persistent perineal sinus. Prevention is key to wound management; this encompasses regular monitoring, careful positioning and use of pressure-relieving equipment until the flap tissue is well perfused and healing well. Negative-pressure wound therapy is a therapeutic technique that uses a vacuum dressing to promote wound healing and enhance the formation of healthy granulation tissue and it can be useful to promote the healing of surgical wounds. Good nursing care is vital in optimising wound healing.

Evaluation of a multifactorial approach to reduce the prevalence of pressure injuries in regional Australian acute inpatient care settings.

The aim of the study was to compare the changes in the prevalence of pressure injuries from 2008 to 2014 in relation to staff behaviour in acute/subacute inpatient care settings. In 2008, the large regional health district Hunter New England Local Health District implemented an initiative called the Crystal Model which resulted in changes in their policy and an e-learning education program for all nursing staff. A retrospective cross sectional study compared data from the 2008, 2010 and 2014 point prevalence surveys of PI in acute services. These were collected as part of an annual pressure injury prevention and management quality audit for adult inpatients. The total number of participants included 1407 participants in 2008, 1331 participants in 2010 and 1199 participants in 2014. From 2008 to 2014 there was a 15.7% decrease in percentage of patients with hospital-acquired pressure injuries and the percentages of each stage of pressure of injury 1-4 decreased. From 2008 to 2014 the completion and documentation of risk assessment, the documentation of repositioning and the implementation of pressure-relieving equipment increased. A multifactorial model can reduce the prevalence of pressure injuries in acute inpatient settings. The theories of knowledge translation and the modified Theory of Planned Behaviour can be utilised to analyse changes in health professionals habituated pressure injury prevention practice.

Strategies to support prevention, identification and management of pressure ulcers in the community.

Pressure ulcers are classified as serious incidents, cause pain and distress, and are a source of infection. Unlike patients in hospital, those in the community spend only a small amount of time with healthcare practitioners, so strategies are required to ensure they remain protected against pressure damage when community nurses are not with them. A risk assessment should be carried out to outline a patient's risks and used to develop a strategy for that person. Patients have different risks so prevention strategies need to be tailored individually. Strategies, which cover issues such as pressure-relieving equipment, mattress type, mobility aids and nutrition, should be monitored to ensure they continue to meet patients' needs, as their health, carers and other matters may change. Patients and their carers may need education on ulcers, including on myths, as it is essential they are involved.

Evaluating an alternating mattress on an elderly rehabilitation ward.

Pressure ulcer prevention is a primary requirement for the NHS. Robust nursing procedures and the provision of pressure-relieving equipment is vital in meeting this requirement. However, the Department of Health also regards making considerable financial savings as a fundamental requirement. There is a firm clinical consensus among national and international bodies that patients at a high risk of developing pressure ulcers, or with existing tissue damage, should be cared for on an alternating (pressure-relieving) mattress system. This evaluation process looks at the performance of the lower cost Air-Flo(®) 8 Acute alternating (pressure-relieving) mattress system to see if it is effective in meeting the needs of patients. The outcomes suggest that when combined with a pressure ulcer management plan and turning schedule the Air-Flo(®) 8 Acute performed well, giving an option to continue to care for high-risk patients with an empirically proven effective therapy, while making considerable financial savings.

Evaluating a pressure-redistribution mattress replacement system.

Pressure ulcer prevention is high on the quality agenda and provision of pressure-relieving equipment to meet patients' needs is an essential part of this process. This can be challenging in today's NHS and this article explores the evaluation process that supported the procurement of the AtmosAir™ 4000 pressure-redistributing mattress replacement system. Outcomes suggest that, when combined with a robust repositioning and skin assessment regime, the AtmosAir 4000 performed well and dynamic mattress usage was reduced. Further evaluation over a longer period of time will be undertaken in future.

Pressure ulcer grading and appropriate equipment selection.

This article explores the process and rationale for designing a poster to support community nurses in selecting appropriate pressure-relieving equipment based on accurate risk assessment and correct pressure ulcer grading. The project was prompted by the requirement to update community nurses' knowledge and ensure pressure-relieving equipment selection was evidence-based and not reliant on personal preference. The 2012 NHS Midlands and East 'Stop the pressure' campaign provided community nurses with a framework for pressure ulcer prevention and management. The attention to support surfaces highlighted the need for appropriate equipment. However the tissue viability team found that the introduction of this pathway alone did not help with the practical issues of appropriate equipment selection. The poster was designed with consideration as to how adults learn, and by looking to the Plan, Do, Study, Act (PDSA) cycle. This provided the framework for enabling new ideas and changes to practice to be tested on a small scale before full implementation.

A static-led approach to effective equipment management

Ashton, Leigh and Wigan Primary Care Trust has a static-led approach to the provision of pressure-relieving equipment in the community. This means that product selection must result from an individualized clinical assessment of the patients needs and not reliant on a blanket approach. The limitations of dynamics should be considered and the delivery of essential nursing care should be deemed paramount, rather than products. The emphasis within the PCT is on holistic assessment and informed clinical decision-making, combined with education of patients and carers in use of equipment. This article sets out the rationale for a static-led approach, and reports the results of a survey of district nurses which looked at their practice in this area.

A practical guide to the provision of mattresses and cushions to relieve pressure

Pressure damage is largely preventable, but if allowed to develop, individuals have the potential to suffer pain, indignity and even death. Pressure-relieving equipment is available to people at risk of pressure damage. Selection of suitable support surfaces must be based on identified criteria following holistic assessment. This article aims to provide the reader with a general guide to the provision of pressure-relieving support surfaces. As pressure damage can occur both in the bed and the chair, the qualities of both mattresses and cushions will be discussed.

Evaluating selection and efficacy of pressure-relieving equipment.

The drive towards evidence-based practice has highlighted the lack of randomized controlled trials that compare interventions such as pressure-relieving medical devices. This may influence practitioners, particularly purchasing practitioners, to consider other types of evidence when appraising literature to determine clinical practice and support recommendations and local guidelines. This article will illustrate the development of an audit tool used to evaluate nurses' knowledge and skills in patient assessment, selection and installation of appropriate pressure-relieving equipment. The tool also assists in assessing clinical effectiveness and user satisfaction of equipment. This article focuses on a small audit of the Karomed Ltd Transair 1500 (also known as the 3-Comm) mattress replacement system.

Cost-effective management of pressure-relieving equipment in a large teaching trust

A pressure area care equipment service was initiated in a large teaching trust (approximately 1000 beds). A stock of over 200 mattress overlays and replacements was purchased and a mattress coordinator was appointed. The coordinator supplies and retrieves pressure-relieving equipment to and from wards, monitors the equipment daily when in use and records all occurrences of malfunction and mismanagement. Out of hours, mattress provision is the responsibility of the night nursing service. Equipment purchase is guided by interpretation of published controlled trials and the Trust's internal data on equipment reliability. Maintenance support is provided on-site by a half full-time equivalent medical technical officer. This approach was associated with a reduction in cost to the Trust and a consistent reduction in pressure ulcer incidence in those areas of the Trust which use it (not in those who do not). The cost of approximately 157,000 Pounds per annum compares favourably with expenditures reported in the past for some other (generally smaller) trusts of the order of 500,000 Pounds to 900,000 Pounds for rental of pressure-relieving equipment alone.

Pressure relieving equipment selection in the community: rising to the challenge.

Due to changes in health care provision district nurses are increasingly called on to assess for more specialized pieces of equipment from an ever-increasing choice of products. Eligibility criteria for the ordering of equipment have been developed in Leeds to assist district nurses in ensuring that the equipment they assess for is the most appropriate and suitable for its purpose and that it will be used safely and correctly. The use of the criteria is demonstrated through their application to pressure-relieving equipment. Use of the eligibility criteria will hopefully improve the overall quality of service for the patient and carers throughout the process of equipment provision, from assessment through to delivery and its subsequent use.

Pressure area management: a static-led approach.

An increase in expenditure and inappropriate use of pressure-relieving equipment, along with high-prevalence figures, initiated the evaluation of current practice of pressure damage prevention in an acute general hospital. This evaluation started with the organization of a project group, who (after a baseline audit) identified and procured the resources required to introduce and manage an effective pressure damage prevention programme. The investment in high-quality static mattresses for all patients including those who are at high risk of developing pressure damage was based on available clinical evidence. This investment meant a reduction in the amount of dynamic systems needed as many of those patients are at high risk of pressure damage, and are now successfully managed on a static system. The development of a local policy including documentation facilitated regular reassessment of risk level based on a risk assessment tool and clinical rationale. This static-led approach has reduced not only costs but also improved the appropriate allocation of pressure-relieving/reducing equipment. The approach has also simplified the choice of equipment for staff who were previously expected to match patients' needs with varying levels of dynamic mattress efficiency. This article highlights the action taken from the initial identification of a specific need through to the effective implementation, management and monitoring of this innovative practice.

The project nurse and pressure-relieving equipment.

This article describes the work of a project management nurse in improving accessibility and appropriate use of pressure-relieving equipment in an integrated (acute and community) trust. It examines key issues for future service development in the management and appropriate use of pressure-relieving equipment. The importance of education in maintaining the accuracy and process of recording pressure damage at ward level is also highlighted. One recommendation is that employing a pressure equipment assistant might improve the control and management of pressure equipment availability.

Developing an equipment library: the solution to increasing demand.

Within the clinical practice arena there appears to be an increasing reliance on the use of dynamic pressure-relieving mattress systems to prevent and treat pressure damage. This has increased the financial burden for many trusts despite the efficacy and effectiveness of such products being largely unknown. Cullum et al (2000) suggest that studies that evaluate specific products or types of products to prevent or cure pressure ulcers are limited in size and quality. This article describes the experiences of an acute NHS trust in managing the increasing demand for pressure-relieving equipment. By setting up an equipment library, resources have been effectively managed, traditional cultures regarding ownership of equipment have been challenged, and financial benefits have been demonstrated.

Overview of research to investigate pressure-relieving surfaces.

Pressure-relieving equipment plays a key role in the prevention and treatment of pressure ulcers. Every year an increasing amount of equipment is launched on to the market. The efficacy of this equipment is traditionally qualified with interface pressure and case studies, but rarely with randomized controlled trials. With the advent of The New NHS: Modern, Dependable (Department of Health (DoH), 1997) and Pressure Ulcer Risk Assessment and Prevention (National Institute for Clinical Excellence (NICE), 2001), a clinical governance system has started to be put into place and hopefully more evidence will be produced by the manufacturers and the NHS. With some 200 different types of mattresses on the market, emphasis needs to be placed on good quality randomized clinical trials to establish effectiveness of what can be costly equipment. This article gives an overview of how, historically, pressure-relieving mattresses were marketed on case studies and interface measurement. Recently, randomized controlled clinical trials are being used to demonstrate the efficacy of the mattress and reduction in the incidence of pressure ulcers. Seating is also an important aspect in continuing 24-hours pressure area prevention and treatment. Patient posture in a chair needs to be fully understood by the practitioner and key strategies are made in this article. Little research into seating has been undertaken and is urgently required.

A nurse's aid to clinical selection of pressure-reducing equipment.

The selection of appropriate pressure-relieving equipment for individuals in the community is an important process in the prevention of pressure ulcers. The clinical decision is made by community nurses who are accountable for their actions and who therefore have to have clear rationale for the decisions they make. Risk tools are not a completely reliable or valid method of assessing patients. The current national guidelines (National Institute for Clinical Excellence (NICE), 2001) are not specific in relation to the selection or choice of equipment. This article explores how these decisions are made.

Centralising supply of a trust's pressure-relieving equipment.

This paper discusses the development of a centralised service by one large acute teaching hospital over a three-year period and the new system's impact on incidence and types of pressure ulcers.

Prevention of pressure damage at the Queen's Medical Centre.

The Wound Management Policy Group is a sub-committee of the Nursing and Midwifery Development Group and has an important role at Queen's Medical Centre, both in providing support to the tissue viability clinical nurse specialist and in providing a multiprofessional perspective on the development and evaluation of policies, protocols, strategies and guidelines in all aspects of tissue viability. The four major recent projects are: the Nottingham Wound Care Formulary and wound management guidelines; the strategy for the prevention and management of pressure damage; the policy and procedure for obtaining pressure-relieving equipment; and the development of group protocols. These projects are described below. The Wound Management Policy Group promotes the use of evidence-based practice across Queen's Medical Centre to ensure the provision of high-quality care in all aspects of wound management.