Pressure Injury Prevention

Equipment Pressure Injury Conference Melbourne 2014

Sue Monaro

Clinical Nurse Consultant – Vascular Surgery

Concord Repatriation General Hospital

ACKNOWLEDGEMENT

Tracy Nowicki

The Prince Charles Hospital

Brisbane

Overview of equipment

1. Ward

• Beds

• Mattresses

• Seating options

• Heel devices

• Specialised devices

2. Emergency Department

3. Operating Theatre

4. Procedural Suites

5. Ambulatory Care

6. Patient’s residence

• Pillows

• Lifters

• Hover mats

• Slide Sheets

• Bed rails

• Grab rails

• Monkey bars

• Bed extensions

• Bariatric equipment

Standards

• International Standards • ICE606601-2-38

• Australian Standards • AS/NZS3200.2.38:2007

• State contracts

Risk reduction

• Pressure injuries

• Skin Tears

• Falls

• Entrapment

• Contractures

• Bed design

• Bed adjustment

• Appropriate

mattress

• Gap between

mattress and bed

• Compatibility of

equipment

Features1

Patient benefits:

• Participation in

repositioning

• Security in

transfers

• ↑Comfort

• ↓Patient safety

hazards

• Sit up to eat

Clinician benefits:

• ↓manual handling

• ↑patient

satisfaction/comfort

• ↓Nursing time

• ↓Clinical incidents

Data1

Equipment:

• In use

• In stock

• Audit

• Replacement

Clinical Indicators:

• Prevalence

• Incidence

Equipment indicators:

• Inventory

• Stocktake

• Audit

• Financial reports

• Patient satisfaction

Equipment1

• Scientific approach when implementing a bed as an integrated system within the health care setting

• Staff education

• Design – relationship: • Bed

• Mattress

• Rails

• Walkers

• Chairs + Wheelchairs

• Hoists

• Furniture

Beds

Mandatory and desirable bed

features

Safety Features Function Features Comfort Features

Mandatory Desirable Mandatory Desirable Mandatory Desirable

Bed

lowerable to

35cm

Solid side-

rails with

handles

Electrical Chair

position

Extendable Profiling

back

Split side-

rails with

handles

Cable

management

system

Auto CPR Angle

indicators

Knee brace

Centrally

locking

breaks

Patient lock-

out system

Trendelenbu

rg function

Radio

translucent

Easy patient

access to

bed control

Steering lock Egress

alarm

150mm

castors

Compatible

with patient

mover

Night light Light-weight Linen keeper

Easy to

clean

Profiling features1,2

• Knee bend as head of bed elevates

• ↓Friction and shear

• ↓need to lift the patient up the bed

• ↓risk of patient sliding down

= auto contouring frame action

= 5 simultaneous movements activated

by one button

Base Mattress2 Must:

• All new materials

• Classification should be H (conventional resilience, heavy duty),

HR (high resilience) and/or LR (low resilience)

• Density and hardness should be expressed together e.g. 35/130

• Density minimum 35kg/m3 for single layer and all layers of

multilayered mattress

• Hardness single layer 130 Newtons and multilayer may increase

for base layer and decrease for other layers

• Side walls of 50mm and of H or HR foam if multilayered

• Depth of 150mm for beds and 100mm for trolleys

• Support a load of 150kg

Preferred:

• Double or triple layered

• A profile or hinging system which adapts the mattress to a variety

of bed positions

• Castellations that assist with spread of pressure

Base Mattress: Cover2

• Two-way stretch

• Vapour permeability transmission rate

(MVTR)

• Waterproof

• Antimicrobial

• Fire retardant

• Welded

• Zip seams

Evidence2

Recommendation 11

Use a high specification reactive (constant low pressure) support foam mattress on beds and trolleys for patients at risk of pressure injuries.

Recommendation 12

No one specific high specification reactive (constant low pressure) support foam mattress is better than any other.

Recommendation 13

Active (alternating pressure) support mattresses could be used as an alternative in patients at high risk of pressure injuries.

Mattress Replacement3

• User weight limit

• Mode of operation:

Specifications/Quality

• Depth Cell cycle time

• Type of cells

• Mattress construction

• Pressure differential

• Attachment to bed

surface

• Cover Pump:

pressure control

Pump

• Safety features

• Alarms

• Hosing Connections

• Warranty

• Set up maintenance/

service requirements

Audit & Replacement

• Initial

• Replacement strategy • Prioritise

• Risk management

• Financial considerations

RPAH Mattress Audit 2011

Mattress location (Ward/Unit)

Bed Number

Auditor Name

Criteria for mattress covers Yes No N/A

1. Is the mattress cover torn or damaged?

2. Is the mattress cover made of PVC material?

3. If the mattress is covered is the zip or fastening device broken?

4. Does the mattress cover have any soiling that cleaning cannot remove?

f the answers to any of the above questions are yes, the mattress cover has failed and must be replaced.

Fail Pass

Criteria for mattresses Yes No N/A

1. Undo the removable cover. Is the mattress soiled or stained? (not applicable to sealed mattress covers)

2. Does the mattress have an offensive odour?

3. Did the mattress fail the ‘Hand Compression Assessment’ (see below)?

If the answers to any of the above question are yes, the mattress has failed and must be replaced.

Fail Pass

Hand Compression Assessment 1. Where appropriate, adjust the height of the bed so that it is at the same level as the tester’s

head of hip. 2. Link hands to form fist and place them on the mattress. 3. Keep elbows straight and lean forward, applying the full body weight to the mattress 4. Repeat the hand compression at intervals along the entire length of the mattress. 5. The mattress should be condemned if the base of the bed can be felt at any point.

Note: If the mattress is torn or damaged an alternative mattress cover needs to be applied until the time of a new mattress is made available.

Seating Equipment2

• Specific to clinical needs

• ↑complexity = seating assessment by

specialist

Heel Equipment

1. Pressure must be completely offloaded from heels by lifting heels off the bed

2. Maintain offloading by using:

• A visco-elastic foam wedge

• A knee brace or knee break in an electric profiling bed to maintain knee flexion

↓

Specialised Equipment2

Business Plan1

• Product/Clinical Resource

• Workplace Health & Safety

• Patient Quality & Safety

• Infection control

• Engineering

• Biomedical Engineering

• Multidisciplinary Team

Sequential focus and education4

• Beds

• Mattresses

• Seating

• Heel protection • Bed cradle

• Heel offloading devices

• Preventative dressings

• Specialised equipment

• Device-related

• Repositioning

• ↓use of waterproof sheets

• Quality continence products

• Skin products

• Nutrition • Screening

• Referral

• Protected meal time

Summary

• Beds should be integrated • Safety features

• Performance

• Comfort

• Facilitate clinical care

• Equipment should be co-ordinated + centralised • Inventory

• Storage

• Infection control

• Replacement programme

• Monitoring should include: • Patient sensitive indicators

• Equipment audits

• Equipment needs to be available at point of entry and adjusted throughout the patient admission

• Awareness and education should focus on each intervention and should meet the needs of the target population

References

1. Nowicki, T., Fulbrook, P. & Burns, C. 2010 Bed safety off the rails.

Australian Nursing Journal 18, 1, 31-34.

2. Pan Pacific Pressure Clinical Practice Guideline for prevention and

management of pressure injury:

2012.http://www.awma.com.au/publications/2012_AWMA_Pan_Pacifi

c_Abridged_Guideline.pdf

3. Dean, S. & Young., C. 2004. Reduce the risk with the right

foundations- mattress guidelines. National Healthcare Journal, 45-46.

4. Miles, S.J., Fulbrook, P., Nowicki, T. & Franks, C. 2012 Decreasing

pressure injury prevalence in an Australian general hospital: a 10-

year review. Wound Practice & Research 21, 4, 148-156.