Pressure-relieving Equipment Research Articles

Prize-winning articles lead the way — now tell us what you want in the Journal

This month we highlight the second prize winners of the Journal of Wound Care awards. The original research category (pages 52-55) produced a study that compared two pressure-relieving systems and investigated whether the availability of extra pressure-relieving equipment would reduce the incidence of pressure ulcers in an acute setting.

A clinical evaluation of an alternating-pressure mattress replacement system in hospital and residential care settings

An observational study was carried out to compare wound healing on alternating-pressure mattress replacement systems (APMRS) and other surfaces in an elderly population in acute and residential care settings. Subjects were assessed for the reduction in their pressure ulcers at approximately two weeks and per day, and a visual analogue scale was used to record the patients' comfort. Seven and ten subjects were allocated to the Nimbus III APMRS (Huntleigh Healthcare Ltd) in the hospital and residential care settings respectively. There was no significant difference in the healing of the subjects' sores in the two areas either at two weeks or per day. Five people were allocated to control surfaces in the hospital setting (mainly APMRS; Pegasus Airwave, Pegasus Egerton) and ten in the residential care setting (mainly alternating-pressure overlays; AlphaXcell, Huntleigh Healthcare Ltd). There was no significant difference in the healing of subjects' sores in the two areas, either at two weeks or per day. The trial APMRS was found to be equally comfortable in either setting, and in both settings the control surfaces were not regarded as significantly different in terms of comfort. These findings, from a small sample, promote discussion about the use of pressure-relieving equipment in settings where there are older people who may be at particular risk from pressure damage and where nursing interventions are less intensive and routine.

Total bed management: the way forward in pressure sore prevention.

King's College Hospital, London, is the first trust to implement total bed management (TBM) to assist in the reduction and prevention of pressure sores. TBM is a new concept, whereby the tissue viability, manual handling and therapy needs of the trust are met at reduced costs through a partnership with a contractor. The introduction of a large number of electric bed frames and foam mattress replacements, with the availability of dynamic pressure-relieving equipment and a service agreement, has led to an expected trust saving of 86,000 Pounds in 1998/1999 and 100,000 Pounds in 1999/2000 onwards. This article outlines the perceived benefits of this approach.

Pressure sore care.

Christopher Shiels and Brenda Roe report on a survey into the prevalence and care of pressure sores among older people living in residential care and nursing homes in Liverpool. Setting up appropriate information systems and auditing available pressure-relieving equipment are just two of a number of important recommendations arising from the survey.

Pressure area management in an orthopaedic setting.

Pressure area care for patients who have undergone a hip replacement is extremely difficult as patients' mobility tends to be restricted because of fear of dislocation. Orthopaedic surgeons influence the positional changes and techniques utilized by nurses in the postoperative period. This article reviews factors that prevent early rehabilitation and highlights methods of pressure relief for this patient group. Alternating-pressure mattresses are a main source of pressure-relieving equipment. A pilot study using the Nimbus II mattress was carried out to establish the role of alternating-pressure mattresses in the postoperative management of patients undergoing elective/emergency hip replacement surgery. None of the patients in the pilot study suffered prosthetic dislocation and 87% did not develop pressure sores. Three patients did develop a grade 2 pressure sore postoperatively. The results reinforce the use of alternating-pressure mattresses in the postoperative management of patients undergoing hip replacement surgery.

Guidelines for pressure sore prevention and management.

A discussion on how an NHS community trust developed guidelines to assist in the allocation of pressure-relieving equipment.

Pressure-relieving equipment: criteria and selection

The selection of equipmnt for pressure sore prevention and management is extremely complex, with many variables to consider. There is a considerable lack of data to support the use of individual pieces of equipment, and so additional criteria need to be considered. A logical approach, taking into account the objectives of treatment, the modality of action, and the resources available, enables an optimal choice to be reached which should satisfy both the patient and the staff involved.

Establishing a hospital-based pressure care service.

The emphasis on pressure area care in all nursing specialties and the need to reduce actively the incidence of pressure sores, means that pressure areas must be monitored from the time the patient arrives in hospital to the time of discharge and afterwards. The use of effective pressure-relieving equipment plays a major part in the prevention of pressure sores (Hitch 1995). This paper examines the way Salisbury Health Care NHS Trust tackled this problem in hospitals and, in doing so, established an in-house pressure care service.

Managing pressure relief in a special needs nursing scheme

People admitted to the Royal Devon and Exeter Hospital, who require continued long term nursing care and fulfil at least one of seven identified criteria, can be referred to a special needs scheme for placement in a private local nursing home supported by education, free loan of electronic pressure-relieving equipment and visits to monitor progress. A clinical nurse specialist in tissue viability is also available for advice and the supply of equipment to any residents with tissue viability problems who are referred by nursing home staff. From a total of 293 referrals during the first four years of this scheme, 155 patients have been supported in nursing homes through the scheme. At the time of placement, 71 patients (46%) had pressure sores, all of whom received the free loan of an electronic mattress. A further 21 patients, whose skin integrity was at high risk, also received mattresses. The sores ranged from Grade 2 to Grade 4 (Stirling grading scale). During the study period, only four patients placed under the scheme suffered deterioration in their sores (all immediately prior to death). Over the three years before the scheme began, 14 patients per year were admitted from private nursing homes to an acute hospital with a primary diagnosis of pressure sore. Since the introduction of the scheme this figure has been reduced to nil.

Pressure-relieving equipment: criteria and selection.

The selection of equipment for pressure sore prevention and management is extremely complex, with many variables to consider. There is a considerable lack of data to support the use of individual pieces of equipment, and so additional criteria need to be considered. A logical approach, taking into account the objectives of treatment, the modality of action, and the resources available, enables an optimal choice to be reached which should satisfy both the patient and the staff involved.

Pressure sore management in the independent sector: 2.

This is the second of two articles looking at pressure sore prevention and treatment in the independent sector of a large northern city. Part one presented background information, details of data collection and analysis, baseline data on current practice and initial conclusions which included an assessment of the extent of evidence-based practice, equipment use, educational needs, patient and informal carer involvement and quality of care maintenance. Part two considers these findings in greater depth. Both positive and negative aspects of pressure sore management in the independent sector are explored. Factors such as the number and types of pressure-relieving equipment used and the lack of independent evidence regarding product efficacy are considered. The survey highlights gaps in educational provision, and the lack of research evidence on certain aspects of care. The article concludes with a detailed series of recommendations with regard to practice, education and research.

Types of pressure-relieving equipment available: 2

This is the second article in a two-part series. The first article reviewed the mode of action of the different types of equipment. This article examines some of the evidence behind the design and suggests selection criteria to assist when choosing individual items of pressure-relieving equipment. By presenting a broader view it is hoped to guide the reader through a logical approach considering all of the variables, thus enabling the selection of the optimum piece of equipment.

Types of pressure-relieving equipment available: 1.

This is the first of two articles which consider the practical difficulties in selecting pressure-relieving devices for patients. The selection of pressure-relieving equipment has become increasingly difficult as the number of commercially available products rises. This article reviews the modes of action of the equipment, including alternating pressure and constant low pressure, outlining the differences between individual pieces of equipment. It will also include a brief summary of the factors which are important to acknowledge when selecting seating.

Pressure sore care in Clwyd nursing homes.

A study of 2 245 people resident in 95 nursing homes (general elderly and elderly mentally ill) was carried out to look at the prevalence of pressure sores and the percentage of sores which had developed in the homes or had been present on admission. The study also examined the quality of pressure area care provided by the nursing homes, indicated by the use of risk assessment scales, the availability of pressure-relieving equipment and the training undertaken by both trained and untrained staff. The prevalence was found to be 7.5% and sores were concentrated in the hip, buttock and sacral areas. Fifty-seven per cent of patients' ulcers had developed in the homes and 3 2% occurred following admission to hospital. Seventy-seven homes reported training of some type. There was a range of equipment available and various assessment scales were in use. The prevalence and site of the ulcers were similar to those found in hospital studies and were in line with the Department of Health's estimate of national prevalence (6.7%) K The number of ulcers which had developed in the homes, however, does show that more preventive measures could be taken in nursing homes.

The size of the pressure‐sore problem in a teaching hospital

A series of three prevalence surveys were undertaken in a teaching hospital (where medical students are taught) in the West Midlands of England to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure-relieving equipment. All in-patients were assessed using the Waterlow score. Full details of all pressure sores and any pressure-relieving equipment in use was recorded. There was a mean pressure sore prevalence of 7.32%, the prevalence for each survey being 8.77%, 5.1% and 8.1% respectively. Grades 2 and 3 were the most commonly reported grades and the sacrum was the most frequent position. It was anticipated that there would be a difference in dependency between the patient populations in each of the three surveys. This was not so and, when using the Waterlow score, the numbers of patients found to be at no risk, at risk and at high risk remained remarkably stable. Only those in the very high risk category fluctuated. It is postulated that the difference between the prevalence in the three surveys is related to the difference in the numbers of patients seen to be at very high risk. These surveys have provided a basis for selecting pressure-relieving equipment and baseline information for monitoring the efficacy of the prevention programme.