Prescriber Manual Beds and Mattresses - SWEP

Transcription

Prescriber Manual
Beds and
Mattresses
A Manual devised by the SWEP
Clinical Advisory Team to assist
SWEP registered prescribers
Acknowledgments for information and use of images go to:
Independent Living Centre; Endeavour Industries; Yooralla AT Learning
Table of Contents
Background
Summary of Evidence
Recommended Assessments and Measures
3
3
3
1. OT Assessments/Bed Assessments ..................................................................... 3
2. Entrapment............................................................................................................ 4
3. Restraint and seclusion ......................................................................................... 5
4. Pressure care considerations ................................................................................ 5
5. Clinical risk assessment and pressure injury risk assessment scales .................. 6
6. Trials: Testing the user on the mattress and the bed ............................................ 6
7. Equipment: Product review ................................................................................... 6
8. Considerations for Non Standard body size bed users, including children ........... 7
9. Sleep behaviour of a bed user .............................................................................. 7
10. Relevant Characteristic Considerations .............................................................. 7
Relevant bed user characteristics .................................................................... 7
Relevant support person characteristics .......................................................... 8
Relevant characteristics in the environment .................................................... 8
Relevant equipment considerations ................................................................. 8
Description of Equipment
10
A. BA - Beds
10
BA1A - High/Low ............................................................................................ 10
BA4A - Low to floor bed ................................................................................. 11
BA4A1 - Column bed ..................................................................................... 11
BA4A2 - Trendelenberg function.................................................................... 12
BA2A - Self Help Pole ................................................................................... 13
BA2B - Bed blocks......................................................................................... 13
BA5A - Bed stick/pole .................................................................................... 14
BA10A - Bed rails .......................................................................................... 15
BA10B - Rail protectors ................................................................................. 16
BA10C - Sleep systems for pressure care .................................................... 16
Additional Non-funded items .......................................................................... 17
B. Mattresses
19
BA3 A&B - Basic Mattress—Pressure Redistribution (PR) ............................ 19
BA6 - PR Mattress Replacement (non-powered) ........................................... 20
BA7 - PR Mattress Overlay ............................................................................ 21
BA8 - Other Pressure Ulcer prevention items ................................................ 21
BA11 - Full PR Mattress replacement ........................................................... 22
References, Further Readings and Resource Links
23
Bibliography of current articles and standards.................................................. 23
Appendix 1 - Scope: Occupational Therapy Assessment for Bed Systems Safety . 26
Appendix 2 - Pressure Redistribution Mattresses and Overlays ............................. 38
Appendix 3 - Pressure Redistribution Support Surfaces Checklist.......................... 57
2
Background
To enhance prescription capability among prescribers, the SWEP Clinical Advisors
have developed a resource manual to provide links to evidence, recommended
assessments and measures, potential risks related to client, support person and
environment, and links to a range of product types.
Summary of evidence
Incidents have been reported that ‘patients’ have been injured by having their head,
neck or chest caught in bed rails (cot sides, bed side rails or safety rails) causing
minor injuries (abrasions) to major injury or death (partial to complete restriction of
respiration) to the ‘patient’. (Powell-Cope, et al)
It is important for the safety of the bed users, and those who care for them, to
consider safer bed ‘set up’ so that when any extra item(s) are added to the basic
bed frame and mattress, there is clinical justification for these ‘extra items’ and all
areas of safety are taken into account in relation to the bed user's needs.
When prescribing a bed and mattress for a particular individual the clinical
evaluation includes: the bed user's needs, those who support them, the
environment the bed is used in, and the specifications/properties of the bed and
mattress.
A support surface is a surface on which the patient is placed to manage pressure
load, shear, friction and microclimate. This includes bed, trolley and operating table
mattresses; integrated bed systems; and seat cushions (Pan Pacific Clinical
Guideline 2012). This manual will only address beds, mattresses and extra
pressure care items for use on the bed support surface.
Recommended Assessments and Measures
1. OT assessments/Bed Assessments
Considering the persons physical needs, health, and understanding of the bed
user’s situation, is important when recommending beds and extra items added to a
bed frame.
 Scope’s Bed Assessment Tool - relates to bed users with higher support
needs (www.scopevic.org.au )
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 SA Bed Rail Information
http://www.sa.gov.au/upload/entity/1646/DS%20documents/informationsheets/bed-rails.pdf
2. Entrapment
Considerations of possible entrapment areas for the individual bed user
should be taken into account. Entrapment areas can occur due to mattress
style; if bed rails or bed sticks are used; as well as the position of the bed in
the room, with walls creating spaces. The use of bedding, wedges or sleep
systems included within the bed area require care in placement so that the
bed user does not become caught up in these items.
 Check that the bed, mattress and any extras meet the Australian standards for
the items being recommended.
Ref: FDA Guidance, Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment (March 10, 2006)
4
Information on entrapment areas for an adult can be found in:
 Australian Standards AS/NZS 3200:2.38:2007
 Scope’s Bed Assessment Tool (pages 8-10) - Appendix 1.
3. Restraint and seclusion
Understanding and undertaking a risk assessment in relation to possible
restraint and seclusion should be included when extra items are added to
the bed frame, including styles of mattress and position of bed within the
bedroom.
 Restraint in bed is when the bed user wishes to leave the bed but is prevented in
doing so due to the extra item added to the basic bed.
 Seclusion is when the bed user is isolated from others when normally they would
be interacting with them.
 Extra items including bedrails, bed rail covers, concave mattress, sleep systems
require a risk assessment with consideration for restraint and seclusion.
The Office of the Senior Practitioners provides definitions of mechanical restraint
and seclusion.
http://www.dhs.vic.gov.au/for-individuals/your-rights/offices-protecting-rights/office-of
-the-senior-practitioner
Restraint and seclusion does not include devices for therapeutic purposes and thus
for therapeutic reasons extra items can be used for specific bed users that restrict or
subdue their movements.
4. Pressure care considerations
Pressure Injury (PI) risk assessment includes consideration of both the bed user
and the environmental factors that are associated with development of PI.
All added equipment that interfaces with the individual on the support surface must
be assessed for potential to increase pressure, shear, friction, moisture and
temperature.
Pressure injury development is influenced by the magnitude and duration of
unrelieved pressure, and the individual’s tissue tolerance to pressure.
The clinical question of how long and how much pressure an individual is exposed
to, and the skin’s response to pressure, shear, friction, and moisture is useful to
include in this assessment.
 Immobility, inactivity and sensory deficit all impact on pressure duration.
5
 The magnitude of pressure is impacted by body asymmetry, changes in body
position, and the degree of, and surface contact with, the user (potential for pressure redistribution).
 The impact of pressure is increased when shear, friction, moisture and temperature change are present.
5. Clinical Risk assessment and Pressure Injury Risk Assessment Scales
Use a pressure injury risk assessment scale in conjunction with a
comprehensive clinical risk assessment to determine the bed user’s risk of
pressure injury and to inform the development of a prevention plan and
selection of a support surface. (Pan Pacific Guideline 2012)  A risk assessment scale offers a structured approach to assessment, but does
not replace a comprehensive clinical risk assessment. (Pan Pacific Guideline
2012)
 A comprehensive clinical risk assessment should include: clinical history,
pressure injury risk scale, skin assessment, mobility and activity assessment,
nutritional assessment, continence assessment, cognitive assessment, and
assessment of extrinsic risk factors (Pan Pacific Guideline 2012)
 The Braden Scale, Norton Scale or Waterlow Score are validated and reliable
scales for assessing pressure injury risk in adults. (Pan Pacific Guideline 2012)
http://www.bradenscale.com/images/bradenscale.pdf
http://www.health.vic.gov.au/older/toolkit/09SkinIntegrity/docs/Waterlow%
20Scale.pdf
6. Trials: Testing the user on the mattress and the bed
 Wherever possible, air mattresses and other multi- layered mattresses need to be
trialled in the home setting, for one week minimum, on the prescribed bed base.
 Assess all bed transfers and bed mobility.
 Test for “bottoming out” potential in all relevant bed profile positions, eg. sitting up
with head raised, lateral lying, supine, knee bend, leg raise.
 Heel protection needs to be considered separately to mattress prescription.
7. Equipment: Product Review
 ILC - Pressure Care Matrix - Appendix 2
 Product Checklists - Pressure redistribution support surfaces (Young and Dean
2011) - Appendix 3
Can be used to gather relevant product specification information to compare products.
Suppliers may not readily have this information but will usually source this from the
manufacturer.
6
 Specifications of foam mattress http://www.dunlopfoams.com.au/frequently-asked
-questions
8. Considerations for non-standard body size bed users, including children
The current Australian Standard for beds is relevant for an average adult body size
only. When looking into a bed and mattress for a child or a non-average sized adult
their actual size needs to be taken into account.
 For children the use of Cot Standards could be referred to for a child’s
finger and limb sizes.
 For adults consider possible entrapment with care.
9. Sleep behaviour of a bed user
It is important particularly for children, who in some cases require support and
learning to know when it is time to sleep.
Resources including but not exclusive to:
 Sleepwise – A Resource Manual from SA
10. Relevant Characteristic Considerations
Relevant bed user characteristics
Bed Users most at risk of injury, entrapment or death from ‘bed extra items’ are
those users who have:
 a history of falls
 cognition issues
 decreasing insight into their situation
 inability to seek assistance if they require it
 movements they are unable to control.
Bed users most at risk of restraint or seclusion are those with:
 cognition deficits and decreased understanding of their situation
 inability to communicate their needs or desires
 behaviours of concern, with specific reference to sleep patterns.
Bed users most at risk of pressure injury are those who have:
 existing pressure injury
 history of Stage 3 or 4 pressure injury particularly over pelvic girdle and lower
limb/heels.
 multiple pressure injury risk factors.
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 limited ability to move or change position independently and who do not have
carers assistance during the night or a turning regime implemented
 asymmetrical body posture
 peak pressures over bony prominences due to reduced surface contact,
resulting in poor distribution of body weight over the mattress surface.
 non-fading redness of skin over body prominences with particular reference to shoulder hips, bottoms and feet.
 extended periods of time in bed, eg. greater than eight hours of sleep time.
 it is important to consider future functional decline and/or possible improvement
of the bed user’s level of disability.
 Acute illness (eg: chest infection/UTI) can increase a person’s potential to
develop a pressure injury in a very short period of time (hours) - therefore
clinicians may need to upgrade mattress equipment at these times.
 Level of mobility is increased after immobilisation due to a fracture.
Relevant support person characteristics
 Carers need to be physically and cognitively able to assist the bed user as they
require, eg. roll side to side.
 Carer fitness to assist with transfers of bed user.
 Features of equipment need to meet the requirements of the support person, eg.
bed height appropriate for carer as well as lower bed height for bed user’s
transfer or safety needs.
 Bed user’s requirements are the determining factor for the support person’s
requirements, expensive bed verses a cheaper one that can still meet bed user’s
needs?
Relevant characteristics in the environment
 All equipment that interface with the bed user and the bed need to be compatible,
eg. including bed user’s wheelchair, hoist, environmental control etc.
 Appropriate circulation space that allows for positioning of equipment for
functional use, eg. wheelchair access to the bed, floor hoist fits under bed, etc.
 Consideration of possible future requirements of the bed user, eg. High-low bed
with head adjustment and knee bend for future support to sit up in bed.
 Consider the impact of environment on microclimate at the skin’s surface.
Relevant equipment considerations
 Product assessment: Match product specifications against identified clinical
needs of the user.
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 Equipment trials, in local home/local community – conduct these for one week,
where possible, with more complex conditions and backgrounds.
 Cleaning: check manufacturers recommendations (supply client with this written
information).
 Maintenance: Consider alternative product, if client and carer are unable to
manage the maintenance schedule.
 Powered units: discuss emergency plan in case of power failure, eg. foam
mattress as alternative to user lying on deflated powered mattress
replacement.
 Life of the product: specify this timeframe to user and recommend review prior to
this date.
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Description of Equipment
A.
BA1 - Beds
A basic bed is a supportive flat surface with two ends, which holds the surface that supports a person off the floor.
When additions to a basic bed are necessary, considerations of what and why items are adding is required, with clinical reasons and safety
considerations for the Bed User and those supporting them.
Items to consider:
Name
Bed types and features
BA1A - High/Low
Head adjustment
Knee Bend
Description
Use
Safety concerns
Assists bed user
• to sit up
• to raise chest and head due
to respiratory concerns
• Care needs to occur where the bed
user has issues relating to
pressure.
Assists bed user to support
lower limbs.
pressure.
Height adjustable beds
Top section of bed is raised or lowered
to the horizontal mid-section of bed base
(eg. Range 0-60o)
The lower section of the bed rises in a
scissor action allowing the knee to bend
and have the calf supported, the foot is
angled down.
Can assist to reduce pressure
on the heels.
• Mattress used needs to profile
(bend) to the hinge points on the
bed.
bed.
10
Name
Leg Raise
Description
The lower section of the bed rises in a
scissor action that flexes the hip and
knee joints, supporting the calf.
Use
Assists bed user to support
lower limbs.
Safety concerns
pressure.
bed.
BA4A –
Low to floor bed
Goes close to floor, minimum foot
clearance required as per Australian
Standard.
For use if bed user is likely to • Consideration of higher heights
fall from bed.
required as high range may be
compromised as bed starts at a
lower point.
BA4A1 –
Column bed
Goes close to floor using height
adjustment at head and foot end of bed.
For use if bed user is likely to
fall from bed
• Care needs to be taken that bed
user is unlikely to move under bed.
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Name
BA4A2 - Trendelenberg
function
Description
This function provides flat positioning of
the bed user so that their head is raised
and feet lowered (reverse
Trendelenberg) or vice versa
(Trendelenberg).
Use
Prescribed in situations
managing respiratory issues,
swallowing issues and
pressure area care.
Safety concerns
• Care needs to be taken so that the
bed user does not slide down/up in
bed when used.
Choosing size of bed requires
consideration of bed user’s
body size, position they sleep
and their ability to move
around the bed to transfer
on/off.
• Be aware of the environment in
which the bed is to be located, so
that circulation space and access
by the bed user and support people
are taken into account.
• Wider beds require support person
to reach further to assist bed user.
A board at ends of the bed is normally
required - known as a head and foot
board, to prevent the pillow and
mattress from slipping off the bed.
Bed sizes
The most common sizes are:
• Single
• Wide single – same length as single
just wider
• King Single – wider and longer than
single
• Narrow Single - can be added
together to make a double
• Bariatric King Single – allows for bed
users of greater weight
• Length and width extensions are
available on some standard size
beds
• Customised sizes to suit bed users
requirements
Wider beds can give a bed
user space to roll in bed
without coming out of bed.
Note: actual bed sizes vary between
manufacturers.
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Name
BA2A –
Self Help Pole
Description
Also known as over-head bar, monkey bar
or goosenecks, these are items that hang
over the bed user’s upper body/head whilst
in bed.
These items can be free-standing or
attached to bed frame
BA2B –
Bed blocks
Used to raise bed height.
Use
The bed user needs to have
the ability to reach up and
hold their own body weight so
that they can re-position
themselves in bed.
Safety concerns
• When free standing the Self Help
Pole must be stable and positioned
appropriately with consideration of
load capacity and intended use
• Upper body strength and shoulder
girdle stability needs to be
assessed as shoulder pain and
damage is a high risk of use
• Entrapment needs to be assessed
when positioning the upright pole
To increase bed mattress
height for bed user’s transfer
or so equipment can be used
under bed, such as floor hoist.
• When raising the bed care is
required so that the bed does not
become unstable.
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Name
BA5A –
Bed stick/pole
Description
Used to assist with transfer/sitting up:
• Fold down attached to bed frame
• Attached to side of bed frame
• Slide in, either double or single style
Use
Safety concerns
Assist bed user to transfer • Straight bed sticks have been known
to/from bed.
to impale a bed user so should not
be recommended. Alternative bed
Assist bed user to move
sticks that are curved at the top are
when in bed.
available
• The position of the bed stick
in the bed under the mattress
is important as if not
positioned appropriately it can
cause entrapment and
possible hanging
• Slide in bed sticks rely on the weight
of the person and mattress. They
can move and require regular
reviews and re-positioning.
• Slide in bed sticks are not
recommended for profiling powered
beds.
• Slide in bed sticks are NOT
recommended because of
entrapment and hanging risks.
14
Name
BA10A –
Bed rails
Description
Also known as cot sides and bed sides.
Types of bed rails include:
• Full length – full side of bed from head
board to foot board
• ¾ length- allowing small gap at each
end
• ½ length-these can be used in different
configurations with two per side
• Split rail – usually two half rails with a
space between and connected to bed
frame
• Slot in – requiring removal by non-bed
user
• Fold down – usually ¾ or split rail
• Fold into bed frame style – usually split
or half rail style
Use
Bed rails are placed on the
sides of the bed to prevent the
bed user from coming out of bed
either intentional or
unintentionally.
•
•
Bed rails can be used by bed
user to reposition themselves
when in bed.
Bed rails can limit access by
others to bed user
•
•
Slide in rails – care is require if used,
however it is not recommended to use this
style of rail at anytime.
Safety concerns
Any bed rail has to be
assessed in relation to restraint
of the bed user, if it prevents
them from exiting the bed.
Entrapment needs to be
assessed when positioning bed
rails with care in relation to
space between rails, between
mattress and rail, rail ends and
bed ends, between rails and
under rail and bed base.
Australian Standard (AS/NZS
3200.2.38 – 2007). Zone 1 to 7
provide space requirements
and limitations in relation to
possible entrapment areas for
an average adult body size.
Consideration of alternatives to
bed rails is encouraged due to
the severe consequences of
entrapment and asphyxiation
that have been reported in the
Coroners Court when bed rails
have been used.
Slide in bed rails of any type
are considered unsafe as they
can move and can entrap the
bed user or come away from
the bed altogether and allow
the bed user fall out on top of
the rail.
15
Name
Description
Bed wedges or postural positioning devices
Use
Wedges to minimize Bed
User rolling. Can also use
concave style mattress to
provide soft edge to bed (see
mattress section) and sleep
systems to minimise movement
of Bed User.
Safety concerns
• Consideration of restraint
of bed user is required with
these options.
BA10B –
Rail protectors
Placed on bed rails as padding.
Used to minimise injury to limbs
(if the bed rail is knocked) and
entrapment.
• Great care is required with
consideration of compression
of any padding which could
allow entrapment rather than
prevent it.
• Breathable padding surface
should be considered.
BA10C –
Sleep Systems for pressure care
Positioning items added to or as part of the
For support to bed user
mattress of the bed to support the bed users
body when lying in bed
• Clear written instructions on
correct use and length of use
are required to maximise care
the system will provide.
• Any item that prevents the bed
user from exiting the bed can
be considered as a restraint, so
a clear understanding of the
systems use is very important.
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Additional non-funded items
The items below are NOT FUNDED through SWEP but are items that can be used in relation to beds and so have been added to this manual for
therapists to consider as possible options even when they are not funded through SWEP.
Name
Bed cradle
Description
Holds blankets off bed user’s feet and legs
IV Pole
Is an accessory to attach to the bed that is
higher than the bed user in the bed
Floor mats/Fall out mats
Used beside bed to cushion a fall from bed
and/or to decrease carpet scratching bed
users skin.
Use
Provides pressure relief from
blankets to lower limbs
Safety concerns
• Consideration of entrapment
needs to be assessed prior to
positioning items such as bed
cradles and IV poles although
these are usually placed where
a bed user does not access.
• If the item is a slide under
mattress style it can easily
move position, so careful
consideration is required as to
outcomes if it moves.
Used for PEG feed bottle or
similar use.
Great care needs to be taken
with OH&S perspective if Fall
Out mats are used as staff can
trip on edge.
• These can soften a roll out of
bed, but bed needs to be low to
floor to minimize any fall
distance
• Staff needs to be aware these
mats are being used as they
can be a trip hazard.
17
Name
Description
Bed mat alarms which react to pressure
alerting to:
• Pressure being applied, ie. stood on –
eg. floor mats
• Pressure being removed, ie. person
getting up/out of bed – so when no
pressure alarm activates
Light beams activated by movement
• Under bed so when a bed user exits bed
the light is ‘cut’ and alarm occurs
• End of bed or on wall behind bed, when
user sits up or exits the bed the beam is
broken triggering the alarm
• At door to note bed user is leaving the
room
Use
Safety concerns
Great care needs to be taken
with OH&S perspective if any
style of mats or item around
bed that is not easily noticed
by support person when
attending bed user.
• Needs to be a support person
who is able to attend quickly if
alarm is activated.
These items have a place, however they
only alert after a person has come out of
bed and are only of value if there is
someone to respond
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B. Mattresses
It is very important that the Mattress fits the bed base correctly, therefore using the same supplier for bed base and mattress is usually the
most appropriate, but if a different mattress is required, make sure the bed base fits the mattress.
If the mattress is too big or small for the bed base then entrapment issues can arise, even if extra items on a bed are correctly assessed for
minimizing entrapment.
Name
BA3 A & B
Basic Mattress Pressure
Redistribution (PR) Mattress,
foam or inner spring or
combination
Description
•
•
•
•
•
•
Specifications density/firmness - see Pan Pacific
Guidelines 2011, page 41)
Minimum depth of mattress to be 15cm.
Consideration of firmness of edges if bed user sits on side
of the bed for transfers
Consideration of mattress bending for head and knee
bend options on bed frame
Two-way stretch and moisture resistant/breathable
covering
Inner spring mattress has more rebound and can be used
to assist the bed user to mobilize on the mattress.
Safety concerns
•
•
•
•
Restriction of a bed users movement within the
bed can increase pressure risk if bed mobility is
reduced by this mattress design
Compression of mattress edge will impact on
entrapment concerns
Inner spring combination mattresses need to
meet the features and size of bed base correctly
as an inner spring does not move for head and
knee bend adjustments.
Inner spring mattresses may not provide
sufficient immersion and pressure redistribution
for higher risk users. Foam multi-layered
combination mattresses should be considered for
these users.
19
Name
BA6
PR mattress replacement (non
Powered)
Description
•
•
•
•
•
•
Concave Mattress that has higher edges providing a soft
edge and directs bed user to remain in the middle of the
mattress
Pressure redistribution mattress replacement foam and
adjustable air, gel or visco-elastic foam/low resilience
foam (memory foam) inserts.
Minimum insert depth 7.5cm
Foam Minimum standard (Pan Pacific guideline 2011).
Consideration of mattress bending for head and knee
bend options on the bed frame if a bed has these features
Two way stretch and moisture resistant/breathable
covering
Safety concerns
•
•
•
Consider restraint potential with raised edges on
a mattress.
Restriction of a bed user’s movement
within the bed can increase pressure risk if
bed mobility is reduced by this mattress
and/or insert design, however usually
these mattresses provide pressure
redistribution due to the bed user’s
pressure requirements.
entrapment concerns
20
Name
BA7
PR mattress overlay to be
positioned over a PR Mattress,
either non-powered or active
(powered)
Description
•
•
Min cell depth 10cm
Ensure under mattress is the same size as overlay or that
adjustments are provided
Safety concerns
•
•
•
BA8 - Other Pressure Ulcer
prevention items
•
•
Foot/heel pressure relieving devices including products of
fibre, foam, gel and air
Foot and Body wedges
Any edge to a mattress has to be considered in
relation to restraint of the bed user, if it prevents
them from exiting the bed.
Restriction of a bed user’s movement
within the bed can increase pressure risk if
bed mobility is reduced by this mattress
and or insert design.
entrapment concerns but this is particularly
relevant for active overlays as entrapment can
occur during the cycle and so a full assessment
is required.
• When a bed user uses an item in bed with them, a
risk assessment if the item comes loose or is
caught up needs to occur. Use of clear written
instructions and regular review of the items use
would assist in determining benefits of using the
devices.
• Any item, including wedges, being used to restrain
the bed user, if it prevents them from exiting the
bed, needs consideration in relation to restraint
versus postural support needs.
21
Name
BA11 - Full PR mattress
replacement
Description
•
•
•
•
•
•
Active (powered) systems that fits the bed size
Alternating air large single cell or dual layers
Combination of active upper layers and foam or static air
lower layer
Single zone or multi zoned cells
Low air loss
Alternating air mattress replacement – 8”or 20cm min
depth
Safety concerns
• Compression of mattress and the cycle of variable
air cells will impact on entrapment concerns but
this is particularly relevant for active overlays as
entrapment can occur during the cycle: a full
assessment is required.
22
References, Further Readings and Resource Links
Bibliography of current articles and Standards
1. Australian & New Zealand Standard:3200:2.38:2007
2. AS/NZS 2130:1998 – cot standards
3. AS/NZS 4220:1994 - Bunk Beds
4. ‘Bed safety off the rails’ by T Nowicki, P Fulbrook & C Burns – Australian Nursing
Journal – July 2010 Vol 18 pages 31-34. Provides some entrapment space
information and restraint.
5. A Guide for Modifying Bed Systems and Using Accessories to Reduce the Risk
of Entrapment Hospital Bed Safety Workgroup (HBSW) in partnership with FDA,
June 21st 2006
6. ‘Bedrails, risk and safety’ from Nursing & Residential Care, October 2008 Vol 10,
No10 – Good description on Restraint but UK Journal.
7. ‘Reducing the risk of accidental hangings, entrapment’ by B.MacLaughlin
Frandsen, April 2010
http://www.ltlmagazine.com/article/reducing-risk-accidental-hangings- entrapment
8. ‘Clinical Guidance For the Assessment and Implementation of Bed Rails In
Hospitals, Long Term Care Facilities, and Home Care Settings’ North American
Study Clinical Guidance For the Assessment and Implementation of Bed Rails In
Hospitals, Long Term Care Facilities, and Home Care Settings Hospital Bed
Safety Workgroup in partnership with FDA
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/
GeneralHospitalDevicesandSupplies/HospitalBeds/ucm123676.htm
9. Hospital Bed System Dimensional and Assessment Guidance to Reduce
Entrapment Guide to Bed Safety Hospital Bed Safety Workgroup (HBSW) in
partnership with FDA Brochure
www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/ GuidanceDocuments/ucm072662.htm
23
10. ‘Preventing Bed Entrapments: A Report from the Hospital Bed Safety Working
group’ – by E Bills – Biomedical Instrumentation & Technology page 227 – 229.
Details entrapment zones in detail.
11. HBSW/FDA Frequently Asked Questions (FAQ) on Entrapment Issues
Hospital Bed Safety Workgroup (HBSW) in partnership with FDA, October
9th, 2007
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/
GeneralHospitalDevicesandSupplies/HospitalBeds/ucm123467.htm
12. Hospital Bed Safety Evaluation in Hospital & Nursing Homes.Investigators: G.
Powell-Cope, Nelson, S. Hoffman, M. Tate, L.
13. SA BedRail
http://www.sa.gov.au/upload/entity/1646/DS%20documents/informationsheets/bed-rails.pdf 14. Scope Vic – Equipment www.scopevic.org.au
15. NSW Department of Health – Bed Users
16. Australian Bariatric Innovations Group (AusBIG) Director: Janet Hope
www.ausbig.com.au
Pressure Care Assessment and Equipment Prescription
1. International Review. Pressure ulcer prevention: pressure, shear, friction, and
microclimate in context. A consensus document London: Wounds International
2010. http://www.woundsinternational.com/pdf/content_8925.pdf
2. Pan Pacific Pressure Clinical Practice Guideline for prevention and
management of pressure injury: 2012.
http://www.awma.com.au/publications/
2012_AWMA_Pan_Pacific_Abridged_Guideline.pdf
3. National Pressure Ulcer Advisory Panel. (2007). Support Surface Initiative
www.npuap.org/NPUAP_S3I_TD.pdf
4. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory
Panel. Prevention and treatment of pressure ulcers: clinical practice guideline.
Washington DC: National Pressure Ulcer Advisory Panel: 2009.
24
5. European Pressure Ulcer Advisory Panel. Pressure ulcer prevention guidelines.
http://www.epuap.org/guidelines/Final_Quick_Prevention.pdf
6. Norton, L., Coutts, P., Sibbald, G. (2011). Beds: Practical management
for Surfaces/mattresses. Advances in Skin and Wound Care. Vol 24(7)
324- 332
7. Braden Scale: pressure ulcer risk assessment tool for Adults –
http://www.bradenscale.com/images/bradenscale.pdf
8. Braden Q pressure ulcer risk assessment tool for children:
http://www.health.qld.gov.au/psq/pip/docs/braden.pdf
9. Waterlow Pressure Ulcer risk Assessment tool
http://www.health.vic.gov.au/older/toolkit/09SkinIntegrity/docs/Waterlow%
20Scale.pdf
10. Pressure ulcer prevention and management guideline.
Specialty fact sheet for practical considerations for clients in the community.
Developed by the Pressure Ulcer Prevention Collaborative, Queensland Health.
May 2012
http://www.health.qld.gov.au/psq/pip/resources.asp
11. Wounds West Education Program
http://www.health.wa.gov.au/woundswest/education/index.cfm
12. Department of Human Services – Consumer Information
http://www.health.vic.gov.au/pressureulcers/
Department of Human Services – Online Educational Course for Clinical Staff
http://www.health.vic.gov.au/pressureulcers/education.
Module 1 – Understanding Pressure Ulcers
(Duration: approx. 45 mins)
Outlines the occurrence of PUs and describes the impact they have on patients, carers and
the health care system.
Module 2 – Risk Assessment
Describes the importance of assessing PU risks and outlines the use of risk assessment tools.
Module 3 – Developing a Prevention Management Plan
25
Occupational Therapy Assessment for Bed Systems Safety
To be completed by OT in conjunction with Bed User and the people who support them.
General Information:
Bed User: _________________________ Age: ________Assessor: _________________________
Address of Bed User: __________________________ Date Assessed: ___________________
______________________________________________________________
Significant Others: ________________________________________________________________
Relationship to Bed user: __________________________________________________________
Primary Disability: _________________________________________________________________
Other Conditions: _________________________________________________________________
Health Issues:
History of Seizure activity ?
No / Yes
If Yes note
•
Frequency __________________ and Type ______________________________
•
Implications
____________________________________________________
Has the Bed User recently had a health issue?
•
If Yes please note ____________________________________________________
Does Bed User have oedema in lower limbs ?
•
No / Yes
No / Yes
If Yes please note reason ____________________________________________
Is the Bed User under weight or obese?
No / Yes
•
If Yes please detail ________________________________________________
Does Bed User have any Pressure issues/Pressure Ulcers ?
•
If Yes please note where ____________________________________________
Does the Bed User have sensation issues?
•
No / Yes
If Yes please describe ________________________________________________
Does the Bed User have limited insight?
•
No / Yes
No / Yes
If Yes in what areas related to bed use ________________________________
_________________________________________________________________________
Is the Bed User able to call/ seek assistance if required
No / Yes
•
If No please comment _______________________________________________
•
If Yes describe
____________________________________________________
Is there someone who can provide assistance during the night
No /Yes
•
If No please comment _______________________________________________
•
If Yes who __________________________________________________________
August 2011
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26
Health Issues (continued):
Does the Bed User have habits that are unsafe or behaviours of concern?
No / Yes
(example does the person smoke in bed or have a behaviour support plan in relation to night time activities)
•
_________________________________________________________________________
Does Bed User have Asthma, history of aspiration, pneumonia, ventilator support or
other respiratory issues
•
No / Yes
If Yes please describe _______________________________________________
Does the Bed User have involuntary movements?
•
No / Yes
Is the bed user able to move in the bed independently
No / Yes
(roll from prone to supine, move up down bed and or to edge of bed)
•
If No describe
____________________________________________________
•
If Yes describe
____________________________________________________
Information on Bed Use:
What is the bed used for:
Comments
Recommendations
for the situation **
Sleeping, note times (eg 8pm to 6am)
Stretch out/ relax space, note times
Changing, does the User assist
Dressing, does the User assist
Other comments
** On last page of Assessment please re write what equipment if any is required for each use of the bed
Bed Use Routine:
Bed routine is important and should be considered as should factors that relate to sleep
time.
What are the rituals that allow the bed user to relax and sleep, eg read a book or listen
to music, but also, what things do they do as routine to get ready for bed & sleep.
August 2011
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27
Bed Use Routine (continued):
Note important facts in relation to sleep time and use of bed
Bed Users History of Bed Use:
Has Bed User had piror incidents of falls from bed
•
If Yes describe
____________________________________________________
Has Bed User been caught in Bed Rail, Bed stick &/or Bedding
•
If Yes describe
If Yes describe
If Yes describe
No / Yes
____________________________________________________
Has Bed User had any injuries from their bed / related to their bed
•
No / Yes
____________________________________________________
Has Bed User had pillows or items within the bed fall over their face
•
No / Yes
No / Yes
____________________________________________________
Other comments that can have influence on Bed Users situation.
Eg: Used to sleep in same bed as partner/parent until moved to CRU 6 months ago.
Information on Equipment:
This section allows for comment on current equipment used together with comments as
to the proposed equipment that would be suggested and why.
1. Bed
a) Brand and model:
•
Consider risk factors of proper installation has according to manufacturer’s
instructions
•
All parts of equipment are compatible
•
If pieces that have been added or replaced do not alter overall integrity of
Bed
August 2011
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28
Information on Equipment continued ….Bed:
Current Bed
Proposed Bed
Comments
Reason
b)
Size of Bed:
•
Add measurements to assist with decisions.
Consider Single, Wider Single (wider only), Longer Single (just longer),King Single (wider &
longer) or customised size
Current Bed
Proposed Bed
Comments
Reason
c) Features of Bed:
•
Current
Bed
Consider, height adjustment (manual or electric), head elevation and knee bend/break as
well as caster locking.
Height
Proposed Height
adjustment
adjustment
Bed
Head
Head
elevation
elevation
Knee
bend/break
Wheels/cast
ers
Comments
Height
adjustment
Head
elevation
Knee
bend/break
Wheels/cast
ers
Reason
Knee
bend/break
Wheels/cast
ers
Height
adjustment
Head
elevation
Knee
bend/break
Wheels/cast
ers
2. Mattress (note mattress needs to fit the bed frame and not move as bed user transfers to from bed)
a) Type:
•
•
Flat, concave pressure redistribution foam, inner spring, mattress overlay and
mattress replacement, mattress inserts, etc ………………………………………..
Include dimensions (length, width & depth) if required for ordering purposes
Current
Mattress
Comments
Proposed
Mattress
Reason
Information on Equipment continued……mattress
August 2011
Page 4 of 12
29
b) Pressure redistribution features:
•
Comment on what is required for appropriate pressure care for bed user.
•
What assessments have been used to determine risk _________________________
Comments__________________________________________________________________________
3. Extra’s used when bed is in use
a) Rails – ½ rails, ¾ rail, full length rail.
•
Risk factors to consider in relation to bed rails would include are they
mechanically sound, firmly attached to the bed and are all latches in
working order.
•
Entrapment possibilities are very important to consider please use pages 10
to 11 to evaluate entrapment risk.
Current Bed Rails
if used
Comments
Proposed Bed
Rail use
Reason
In what bed use
situation
b) Rail covers used or not and if so what type
•
Risk factors to consider in relation to covers would include are they
breathable, washable and padded covers need to be soft enough to
prevent trauma, but rigid enough to prevent entrapment. (eg like a mess
slung seat on wheelchair)
•
Entrapment possibilities are very important to consider
Current Covers
for Bed Rails
if used
Comments
Proposed Covers
for Bed Rail use
Reason
In what bed use
situation
August 2011
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30
Extra’s used when bed is in use (continued)
c) Bed Pole/Bed Stick
Risk factors to consider in relation to bed stick/pole would include position
so the Bed User can reach and use as well as not affect transfers
•
Entrapment possibilities are very important to consider unless the bed
pole/stick can be removed/dropped
Current bed stick
Proposed bed
used
stick use
Comments
Reason
•
In what bed use
situation
d) Monkey bar
Risk factors to consider in relation to monkey bar would include position so
the Bed User can reach without harm to shoulder/arm of Bed User
Current bed
Proposed bed
extra item used
extra item use
Comments
Reason
•
In what bed use
situation
e) IV pole
Risk factors to consider in relation to IV pole would include position so it can
deliver the fluid required at the required rate
Current bed
Proposed bed
extra item used
extra item use
Comments
Reason
•
In what bed use
situation
f) Fall out mats beside bed
•
Factors to consider in relation to fall out mats would include
does the bed lower to a reasonable height to make fall out mats a
safer option from the Bed Users point of view
are the edges visible at night, not a trip hazard , are there other
safety considerations for carers.
Current fall out
mat used
Comments
Proposed use of
Fall out mat.
Reason
In what bed use
situation
August 2011
Page 6 of 12
31
Extra’s used when bed is in use (continued)
g) Pillows:
Factors to consider in relation to pillows would include
what numbers are used verses required.
have there been any incidents of pillows falling over the bed user’s?
Current number
Proposed
of pillows used
change to use.
Comments
Reason
•
In what bed use
situation
h) Wedges/postural items/splints/sleep systems
Factors to consider in relation to these items would be the reason are they used, has fire
safety been considered and are they able to stay in position during when in use
•
Current what is
used
Proposed
change to items
used
Reason
Comments
4. Overall look of bed to be ‘home like’
Yes / No
Comments: ____________________________________________________________________
Definition of ‘home like’
5.
Domestic design, which does not resemble a hospital style bed (i.e. hospital style beds often consist of a metal
frame, metal/plain head and foot boards).
Location of Bed in Bedroom:
•
Consider position for access on either side and location near wall with
possible entrapment issues
**Use Bed Rail Evaluation on Pages 10 to 11 of this Assessment as wall can act as an entrapment zone **
Sketch room and position of furniture when bed is in use.
6.
Carers needs:
Comment on specific requirements of the Bed User’s carers, being aware of height
range of bed required to achieve and consideration of equipment use.
August 2011
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32
Guide to Evaluating Bed Rail Safety
These pages are to be used when Bed Rails, Bed sticks are indicated or the bed is pushed
against a wall.
WHERE DO THESE GUIDELINES COME FROM?
At the end of 2007 AS/NZS 3200.2.38:2007 - Medical Electrical Equipment Part 2.38:
Particular requirements for safety – Electrically and manually operated medical beds
for Adult use, were released. The Bed Rail zones in these Standards have been taken
from the IEC 60601-2-38 Ed.1.0 (1996) MOD.
The following Guide has been developed over time with Scope therapists’ input and
from Scope’s work with Yooralla.
WHAT DO YOU NEED?
You will need a tape measure to measure the critical areas of each entrapment
zone (refer to pages 10 & 11)
In some areas, it will also be necessary to have the bed user or another person (of
similar size to the bed user) available who can lie on the bed whilst measurements
are being taken
These measurements are guidelines only for preventing an adult person’s head neck
or body becoming accidentally entrapped. A smaller gap may be necessary to
prevent entrapment if the bed user is smaller than average. Check compatibility
between bed user’s size and weight with the bed and bed rails’ capacity or
dimensions.
WHAT IS INVOLVED IN THE PROCESS?
A. Measure the Bed Users head circumference, neck and chest as a guide
Standards consider
sizes to be approx
Head Depth
Neck Depth
Chest Depth
(face to back of head)
Greater than 60mm
(anterior to posterior of chest)
Greater than 120mm
Greater than 235mm
B. Is other equipment used with this person compatible eg hoist goes under bed.
Yes / No
If No, comment ______________________________________________________________
C. After identifying the initial risk factors in preceding pages of Assessment, proceed to
measuring the entrapment zones, using the evaluation process and the pictures as a
guide.
August 2011
Page 8 of 12
33
Guide to Evaluating Bed Rail Safety (continued)
EVALUATION PROCEDURES
ENTRAPMENT
ZONE
(1) Rail to
mattress,
horizontal
measurement
•
•
•
•
(2) Board to
mattress,
horizontal
measurement
•
•
•
•
Place bed in flat position, elevate side rails.
(Elevate head end rails only for split rails.)
Push mattress against opposite side rails.
With tape measure, measure the horizontal
distance between the side of the mattress
and the inside surface of the side rail.
Repeat with head elevation and knee bend
of bed elevated
Place bed in flat position.
Ensure bed ends are properly installed.
Push mattress to opposite end for each
measurement
With tape measure, measure the horizontal
distance between the end of the mattress
and the inside surface of the bed end at
head and foot end.
MEETS
AUSTRALIAN
STANDARDS
FIGURE 114
Distance is
less than
60 mm
YES OR NO
COMMENTS
60MM OR
LESS
Recommend:
Distance is
less than
60 mm
60MM OR
LESS
Recommend:
Note this measurement is important even if no
rail is being used
(3) Within rail and
to top of rail
•
•
Place bed in flat position, elevate side rails
Measure horizontal or vertical distance
between the 2 closest rails
Distance is not
greater than
120 mm
SPACE
BETWEEN
RAIL
120MM OR
LESS
Recommend:
Rails can be either vertical or horizontal
(4) Top of rail to be
uncompressed
mattress
•
Height of top edge of side rail above the
mattress without compression.
Important if Mattress Overlay is being used
August 2011
Page 9 of 12
Mattress to top
of side rail top
to be equal to
or greater than
220mm
220MM OR
GREATER
Recommend:
34
Guide to Evaluating Bed Rail Safety (continued)
EVALUATION PROCEDURES
ENTRAPMENT
ZONE
(5) Rail to bed end
(board), both
ends at foot
and head of
bed.
(6) Between split
rails
(7) For Split rails:
Top of
compressed
Mattress to
bottom of rail,
at ends of rail**
•
•
•
•
•
•
•
•
•
(8) For full length
rails: Top of
compressed
Mattress to
bottom of rail,
between rail
supports
•
•
•
•
Measure that the distance between the rail
and end board
Measure both ends of bed
MEETS
AUSTRALIAN
STANDARDS
FIGURE 114
Distance is
less than or
equal
to 60 mm
or equal to or
greater than
235 mm
Distance is
less than or
equal to
60 mm
or
equal to or
greater than
235 mm
Distance
is
Place bed in flat position, elevate side rails,
less than
push mattress towards opposite side.
60 mm
Have a person (equivalent to client’s size)
lie on his/her side on top edge of mattress.
Have person’s shoulder positioned at end
of rail.
With tape measure, measure the diagonal
distance from the top of the compressed
mattress to bottom of rail at the end of the
rail.
Repeat with head elevated.
Measure that the distance between the
split rails is less than or equal to 60 mm or
greater than 235 mm
Place bed in flat position, elevate side rails, Distance is
less than
push mattress towards opposite side.
120 mm
Have a person (equivalent to client’s size)
on top edge of mattress. Have person’s
shoulder positioned between rail supports.
With tape measure, measure the diagonal
distance from the top of the compressed
mattress to bottom of rail between rail
supports.
Repeat with head elevated.
August 2011
Page 10 of 12
YES OR NO
COMMENTS
LESS THAN
60MM OR
GREATER
THAN
235MM
Recommend:
LESS THAN
60MM OR
GREATER
THAN
235MM
Recommend:
60MM OR
LESS
Recommend
120MM OR
LESS
♦ Flat:
___________mm
♦ Head elevation:
___________mm
Recommend
35
Recommendations of Bed Care Plan for _____________________________ (name of bed user)
Short Term: _____________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Actions that need to occur:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Long Term: _____________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Actions that need to occur:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Above is to detail how the Bed User’s bed is best suited for them to use with the least risk for their
situation.
Regular reviews of the Bed User’s, bed use is required including when there have been any
significant changes in the Bed User’s physical abilities when using their bed.
This’ Bed Care Plan’ has been recommended on the information provided and outlined in this
document in relation to the Bed User’s current situation. No responsibility is taken for improper /
unreasonable use or maintenance of the equipment or procedures.
Please contact the Occupational Therapist
who has completed this Bed Care Plan if there are any questions.
August 2011
Page 11 of 12
36
How would it be recommended that __________________________ have their Bed ‘set up’ when they use their bed?
♦
Bed Size
Single
Single (different length or width)
King single (wider and longer)
♦
□
□
□
□
Comment: _______________________________
Comment: _______________________________
Comment: _______________________________
Other _________________
Comment: _______________________________
Bed Height when sleeping
_____________ cm off floor to top of mattress (not compressed)
Is this the lowest the bed will go
□ Yes □ No. Comment __________________________________________
‘High/Low’ standard bed plus mattress (approx 420mm floor to top of mattress)
‘To floor/column’ bed plus mattress (approx 380mm floor to top of mattress)
♦
Bed Height when transferring
_____________ cm off floor to top of mattress (not compressed)
Comment:_____________________________________________________________________________________
♦
□
Bed Ends in position (Both head & foot ends)
Yes
Is there a space greater than 60mm between mattress & bed end when bed is flat?
□ No
♦
Mattress Type
□ Yes, there could be a RISK to the bed user
flat mattress
Concave mattress
Variable mattress replacement/overlay
♦
□ Yes
Foam/inner spring/ other _________
□ Yes
Note mattress thickness _______ cm
□ Yes there could be a RISK to the bed user if bed rails used
Adjustments of Bed
□ Yes there could be a RISK to the bed user
□ Yes there could be a RISK to the bed user
Head adjustment (is this used)
Foot adjustment (is this used)
□
If used there could be a RISK to the bed user
Yes
Half rail / Three Quarter Rail / Full length Rail / Other _____________
Fold down / fold into bed frame / lift out / Other __________________
♦
Bed Rails Used
Note type
Way the Rails moves out of the way
♦
Bed Rail Covers Used
♦
Fall out mats Used
Type and when put down ________________________________________________________________________
□ Yes - Comments __________________ If used there could be a RISK to the bed user
If used there could be a RISK to carer/staff
□ Yes
Once the bed ‘set up’ is determined it is important that,
Demonstrate to bed user and representative of carers, how to correctly use bed ‘set up’.
Observe the bed user and carer representative performing a least risk use of bed and its selected features.
Explain to the bed user, carer representative and family the risks involved in using recommended bed features.
A signature is required (below) to acknowledge that this has been explained and understood by the bed user or their representative, and
carer’s representative.
Bed User and/or carer (or representative) Name: ________________________________________________________________________
Signature:
________________________________________________________________________
Occupational Therapist Name:
________________________________________________________________________
Signature:
________________________________________________________________________
Date:
_________________________________________________________________
Picture of final ‘set up’ of bed system is very useful
August 2011
Page 12 of 12
37
APPENDIX 2
Pressure Redistribution Mattresses and Overlays
Introduction
The goal of a pressure redistribution mattress and overlay is to reduce pressure from bony prominences and to lower interface
pressures (the pressure between the person’s skin and the surface of the mattress).
This handout is a work in progress and is not an exhaustive list of considerations for choosing a pressure redistributing product. It
aims to provide generic features, but will differ from product to product.
Please note that many of the terms and definitions may not be consistent with other organisations nationally and internationally.
Where possible, definitions have been used from the Australian Wound Management Association (AWMA), National Pressure Ulcer
Advisory Panel (NPUAP)- Terms and Definitions Related to Support Surfaces -2007 , and preferred terms from the Independent
Living Centre’s cataloguing structure. It is understood that terminology is constantly under review, and this resource aims to use
language understandable by all. It is aimed to give a general outline of features regarding equipment for pressure redistribution.
The Independent Living Centre gratefully acknowledges the assistance provided by Catherine Young (Occupational Therapist) in
developing this resource.
Independent Living Centre
705 Princes Hwy, Brooklyn, 3012 Telephone 03 9362 6111 Facsimile 03 9314 9825
PO Box 1101, Altona Gate, 3025
www.yooralla.com.au
ABN 14 005 304 432
P:\Features Matrices\Beds & Mattresses\Features Matrix - Pressure Care 2010.doc
38
Contents
Section
Topic
Section 1:
Section 2:
Section 3:
Background Information
1.1
Definitions
1.2
Important general considerations
Dynamic: (Active –Powered) Options
2.1
Dynamic mattress replacement or overlay - Alternatives
2.1.1 Alternating air mattress replacements
2.1.2 Alternating air mattress overlays
2.1.3 Genuine low air loss
2.1.4 Micro air loss
2.1.5 Turning mattress replacement
2.2
Dynamic (Active) mattress replacement or overlay - General considerations
2.2.1 Strength of pumps and bellows
2.2.2 Pump control method
2.2.3 Hoses between pump and mattress replacement or overlay
2.2.4 Cell cycle time related to pressure relief index
2.2.5 Malfunction features
2.2.6 Cell movement
2.2.7 CPR facility
2.2.8 Transport facility
2.2.9 Load capacity of the product
Static (Reactive) Options
3.1 Static/ Reactive mattress replacement or overlay - Alternatives
3.1.1 Foam mattress replacements
3.1.2 Foam mattress overlays
3.1.3 Air mattress replacements and overlays (static)
Page
4
5
6
9
11
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ABN 14 005 304 432
39
3.1.4 Fibre filled
3.1.5 Gel pads
3.1.6 Sheepskin
3.2 Static (Reactive) mattress replacement or overlay - General considerations
3.2.1 Maintenance
3.2.2 Type of material
3.2.3 Cost
3.2.4 Load capacity
14
Section 4:
Covers
15
Section 5:
Other general considerations for all dynamic and static options
16
Section 6:
References
18
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ABN 14 005 304 432
40
Section 1: Background Information
1.1 Definitions
Please refer to the National Pressure Ulcer Advisory Panel (NPUAP)- Terms and Definitions Related to Support Surfaces
(2007) for additional terms and definitions.
•
•
•
•
•
•
•
•
•
Pressure Redistribution – For the purpose of this resource, pressure redistribution is used as an umbrella term for all pressure
relieving and pressure reducing devices
Mattress Replacement – The entire mattress is replaced and put on the bed base.
Mattress Overlay – An overlay is placed on top of an existing mattress.
Dynamic (Active) Options – These mattress replacements and overlays have moving parts and require an electrical or battery
power source (AWMA, 2001, p27). Dynamic options can alter the user’s load distribution independent of external forces
(AWMA, pp27).
Static (Reactive) Options – Non-mechanical support surfaces that remain motionless except in response to the user’s
movement. (AWMA, 2001, p26). The mattress replacement or overlay is not regulated by electric or battery power. Static
options alter the user’s load distribution in response to external forces, and are generally constant low pressure devices
(AWMA, pp26). The material (such as foam, gel, fibre filled or air) is not adjusted or regulated automatically.
Constant Low Pressure Device – These conform closely to the body’s contours and aim to redistribute the body weight over a
wider area, thereby reducing tissue interface pressure (AWMA, 2001, p25). Both dynamic (active) and static (reactive) options
can operate as constant low pressure devices.
Bottoming Out – Where a part of the person’s body is in contact with the surface under the pressure redistribution product or
surface.
Interface pressure – The pressure between the user’s skin and the surface in contact with the skin.
Cell Pressure – Air pressure within a cell, thus affecting its inflation level and consequent hardness.
www.yooralla.com.au
ABN 14 005 304 432
41
1.2
•
•
•
•
•
•
•
•
Important General Considerations for All Dynamic (Active) and Static (Reactive)
Options
Users always need to be assessed for an appropriate turning regime and for suitable body turning surfaces available for
repositioning (for instance can they lie in supine, prone, on both sides laterally) by a nurse or other qualified health professional.
It is important to trial a user of any pressure redistribution mattress replacement or overlay in multiple positions, including side
lying and sitting, to assess their potential for bottoming out.
Consider whether the product is to be used as a preventative device, or for treatment of an existing pressure ulcer.
Always check the manufacturer’s specifications regarding the product before trialling. An example is the user’s weight and
proportionate body shape, as each product will have a specified load capacity.
With all pressure redistribution mattresses, heels need to be considered separately due to high risk of pressure ulcer
development. Individuals at high risk and demonstrating skin changes will routinely require the use of separate devices.
This handout discusses mattress overlays and mattress replacements only. Careful consideration needs to be given to choosing
a bed base that meets the safety standards required for your facility (e.g: Standard AS3200.2.38- 2007 “Particular requirements
for safety-Electrically and Manually operated beds for adult use”) and the potential for client entrapment between mattress and
bed base sections eg: Some bed bases have a mechanism to turn the user. Features such as the knee break and the hinge
point of the head raise section should also be considered. When using the mechanism to assist the bed occupant into a sitting
position, some beds have a sliding hinge movement designed to reduce shearing.
Covers are discussed in more detail below, but are a major consideration. For instance, a tight, hammocking cover reduces the
effectiveness of the mattress. The number of extra layers on top of the mattress replacement or overlay (such as sheepskin,
continence pads, evacuation sheets or tight fitting bed linen) will negatively affect the pressure redistributing qualities.
Pressure redistributing mattress replacements and overlays are generally available for hire and trial.
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Section 2: Dynamic Options
2.1 Dynamic Mattress Replacements or Overlays - Alternatives
Dynamic(Active) Alternatives
Considerations
2.1.1
Alternating Air Mattress
Replacements
•
•
•
AWMA (2001, p25) defines an alternating
pressure device as a “device that
generates high and low pressures
between the body and the support
surface in a manner similar to that
employed in the healthy individual who
continually changes position in response
to pressure pain. This is universally
achieved by cyclically inflating and
deflating groups of air filled cells placed
traversely across the mattress surface.
The inflated cells support the body while
the deflated ones reduce contact
pressure to a greater or lesser degree.”
•
•
•
•
•
•
•
The number of cells, cell diameter and the shape of the cells can vary between products.
Cell cycle time is the amount of time the cell takes to inflate and deflate once. Varying cell cycle times will
offer longer and shorter periods of minimum and maximum cell pressures, which may provide their own
advantages and disadvantages. An average time is ten minutes.
Cell pressure differential range relates to how quickly and how much the cells deflate to remove any
interface pressure between the user and the mattress replacement cell. Some products deflate the cells by
vacuuming out the air while others allow it to deflate with the user’s weight.
- Vacuuming the air from the cell during the deflation part of the cycle can quickly remove cell
pressure and lower the interface pressure. This can also increase the amount of time interface
pressure is removed.
- If body weight only is used to remove the air, the interface pressures are likely to remain higher.
The degree and speed the air enters and is removed from the cell in that cycle will vary between
products and is dependent on the tubing diameter, (larger tubing – faster inflation and deflation).
Cell attachment can affect the likelihood of a gap opening between the cells, which can cause bottoming
out. Some mattress cells are joined with heat-welded seams, i.e. no gaps are present between cells. More
commonly the individual cells are attached to a base fabric on the mattress floor. This can also affect the
comfort and potential to slide down the bed.
Cell diameter may cause issues such as the up cell not being able to support the user’s weight and offer full
offloading to that part of the body. This requires checking for bottoming out in various positions.
Cell construction. This includes the cell shape, whether there are one or two layers of cells and whether the
cells on either layer are dynamic (active) or static (reactive).
Static cells can be used for the head section to prevent movement.
Cells around the pelvic region may be able to be deflated to allow a slipper bed pan to be inserted.
Movement of the mattress or noise of the pump may be disturbing for those who have confusion, perceptual
issues or pain.
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These mattress replacements are often a soft surface, which may affect transfers, bed mobility, or stability
for people attending to the user. The sides of the product can be firm and static to assist these issues.
• Reliant on mains power or battery power.
Temperature can feel cooler with active systems that use air unless the air is heated. This can be assisted by
increasing room temperature, rather than using an electric blanket
•
2.1.2
Alternating Air Mattress Overlays
•
•
•
AWMA (2001, p25) defines an alternating
pressure device as a “device that
generates high and low pressures
between the body and the support
surface in a manner similar to that
employed in the healthy individual who
continually changes position in response
to pressure pain. This is universally
achieved by cyclically inflating and
deflating groups of air filled cells placed
traversely across the mattress surface.
The inflated cells support the body while
the deflated ones reduce contact
pressure to a greater or lesser degree.”
These are more commonly thinner than
mattress replacements, so they may
bottom out more easily, particularly when
the occupant is sitting up in bed.
AWMA recommends these should be a
minimum of 100mm thick, but should still
be checked for bottoming out (AWMA,
pp30). If under this thickness, the
potential to offload pressure is greatly
•
•
•
•
•
•
•
•
A good quality mattress with a suitable cover is required under the overlay. This helps support a mattress
overlay in a flat position and enhance the operation of the alternating air cells. A sagging mattress may
cause the overlay to follow the sagging shape. This can also offer a good emergency option to use in the
case of a power failure.
Carefully check “bottoming out” potential in all turning positions and bed positions such as sitting up.
Number of cells, cell diameter and the shape of the cells can vary between products.
Cell cycle time is the amount of time the cell takes to inflate and deflate once. Varying cell cycle times will
offer longer and shorter periods of minimum and maximum cell pressures, which may provide their own
advantages and disadvantages. An average time is ten minutes.
Cell pressure differential range or amplitude relates to the difference between max and min pressure within
the cells. This then influences the max and min interface pressure at the skin surface, when the cells are up
and down.
The speed of inflation and deflation of the cells is another important factor. I.e. how quickly and how much
the cells deflate to remove any interface pressure between the user and the mattress replacement cell.
Some products deflate the cells by vacuuming out the air while others allow it to deflate with the user’s
weight.
- Vacuuming the air from the cell during the deflation part of the cycle can quickly remove cell
pressure and lower the interface pressure. This can also increase the amount of time interface
pressure is removed.
- If body weight only is used to remove the air, the interface pressures are likely to remain higher.
The degree and speed the air is removed from the cell in that cycle will vary between products.
Cell attachment can affect the likelihood of a gap opening between the cells, which can cause bottoming
out. Some mattress cells are joined with heat-welded seams; no gaps are present between cells. More
commonly the individual cells are attached to a base fabric on the mattress overlay floor.
Cell diameter may cause issues such as a cell to collapse depending on the user’s body shape. This
requires checking for bottoming out in various positions.
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reduced.
•
•
•
•
•
•
2.1.3
Genuine Low Air Loss
•
A pump is used to inflate a mattress and
suspend the occupant on the mattress.
Air permeates out of the entire mattress
top and the occupant immerses into the
mattress.
•
•
•
•
•
2.1.4
Micro Air Loss
•
•
Tiny pinprick holes can allow air to
escape from an active pressure reduction
mattress or overlay.
These options are very different to
genuine low air loss devices noted
above.
2.1.5
Turning Mattress Replacement
•
A mattress or bed that automatically
changes the position of the occupant,
rolling them slowly from side to side on a
•
•
•
•
•
•
•
Cell construction. This includes the cell shape.
Static cells can be used for the head section to prevent movement.
Movement of the mattress or noise of the pump may be disturbing for those who have confusion, perceptual
issues or pain.
These mattress overlays are often a soft surface, which may affect transfers and bed mobility. The sides of
the product can be firm and static to assist these issues.
Temperature can feel cooler with active systems that use air unless the air is heated.
Reliant on mains power or battery power.
This may provide an alternative active form of pressure reduction for those affected by movement.
As air permeates throughout the mattress top, a user’s body temperature and moisture may be affected.
The user may have issues with dehydration.
Heating can be included in the mattress replacement.
Layering of items such as continence pads on top of mattress will reduce the effectiveness of this product.
Consider breathable continence products.
As the pump needs to be more powerful than other dynamic options, it can often be noisier. This noise may
be disturbing for some.
Often combined with an alternative means of pressure redistribution, (alternating air or a turning mattress).
As air permeates throughout the mattress top, a user’s body temperature and moisture may be affected.
The user may have issues with dehydration.
Layering of items such as continence pads on top of mattress will reduce the effectiveness of this product.
Consider breathable continence products.
Noise of the pump may be disturbing for some.
It is important to carefully check “bottoming out” potential in all turning positions and bed positions such as
sitting up, as these mattresses can be thinner than the recommended 150mm depth.
Time taken for one turn is adjustable. Each full cycle to turn can take approximately six to fifteen minutes.
This time may vary.
Noise of the pump and movement may be disturbing for those who have confusion, perceptual issues, pain
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timed schedule.
•
2.2
Dynamic Mattress Replacements or Overlays - General Considerations
2.2.1
Strength of pumps and bellows
•
•
2.2.2
Pump control method
•
or issues related to movement.
Due to movement from side to side, this may completely remove pressure from body parts and may reduce
a turning regime physically done by attendants. Check that other body parts are not bottoming out.
•
How the pump adjusts the cells’ internal
pressure.
•
•
2.2.3
Hoses between pump and mattress
replacement or overlay
•
•
Air output is measured in litres per minute. This relates to how the occupant is suspended on the mattress
replacement or overlay. It also reflects the capacity of the pump to withstand backpressure (eg. the
mattress’ capability to support the user lying on the surface). Different pumps may provide different levels of
consistency of cell pressure along the entire length of the support surface. This may be particularly relevant
regarding the amount of time taken to achieve the minimum and maximum cell pressures during the cell
cycle time for the entire support surface.
Weaker pumps may not be able to achieve very low cell pressures. This will tend to result in higher
minimum interface pressure being delivered to the client resulting in a firmer interface.
Automatic adjustment may affect initial comfort and bottoming out during changes of position. This may,
however, be an advantage with unfamiliar carers who are not trained in the product’s use. Usually a whole
cycle is needed before auto adjustment to the individual’s weight is achieved. It remains important to check
for bottoming out on these auto adjustment surfaces.
Dial adjustment requires someone to program the occupant’s weight manually. The carer would need to
know how and when to adjust this. This may be an issue with unfamiliar carers who are not trained in the
product’s use. Difficulties may also occur where other residents who may have cognitive issues, such as
dementia, may alter the setting on a dial adjustment.
When the occupant is in a sitting position, the internal pressure adjustment will often require manual
adjustment to reduce the chance of bottoming out in this position.
Size / diameter of the hoses affect the pump’s potential to deliver a higher volume of air (and take it away) at
a faster rate. This will affect how fast the cell pressures can be changed to their minimum and maximum.
Method of attachment and whether or not they detach easily from the pump should be considered. This is
particularly important in environments where people may remove hoses without permission, eg. people with
cognitive impairments.
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2.2.4
Cell cycle time related to pressure
relief index
How often the cells change their inflation and
deflation, and how much time within the cycle
that the cells are either fully deflated or fully
inflated.
2.2.5
Malfunction features
2.2.6
Cell movement
Level of inflation and how the cells interact
with each other on alternating air options.
2.2.7
CPR Facility
•
Means are available to assist a user to
have CPR.
2.2.8
Transport facility
•
Means are available to allow an occupant
to be moved between power sources
•
Whether or not the hoses may kink and affect airflow should be considered. Some hoses have reinforcing.
•
The speed of inflation and deflation of each cell impacts on the amount of time the interface pressure will be
at its minimum level in mm/Hg during each cell cycle.
Cell cycle time may or may not be adjustable.
Length of time between cycles. A slower cell cycle time may suit users may prefer less movement.
•
•
•
•
•
Are there alarms to indicate malfunction, and over what period of time will these will continue to alert?
Is there battery back up?
This may be an important consideration in environments where people may alter controls or remove hoses,
e.g. where people have cognitive impairments, there are multiple carers, or children are present.
•
•
•
1 in 2 means one cell is inflated while one is deflated.
1 in 3 means one cell is inflated, one is of medium inflation and one of a lower inflation. This may allow a
greater area for distribution of weight, and may impact on interface pressures. If the occupant feels
uncomfortable on a 1 in 2, the 1 in 3 option may be trialled to increase comfort.
Other inflation movements may be used.
•
•
•
The method by which the mattress replacement or overlay could be moved and deflated to allow CPR.
Ease of noticing where and how to quickly activate the CPR facility. This may include labelling provided.
Ease of accidental activation of CPR release valve.
•
•
•
Length of time this may last before deflation may occur.
Ease of use.
Whether the mattress replacement or overlay becomes passive or remains active.
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while lying on an inflated mattress
replacement or overlay.
2.2.9
Load capacity of the product
•
•
Maximum weight limit, eg. Bariatric users
Minimum weight limit, eg. Low weight adults, Infants and toddlers may need to be a certain weight to
immerse into the mattress replacement or overlay.
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Section 3: Static Options
3.1 Static Mattress Replacements or Overlays - Alternatives
Static (Reactive) Alternatives
Considerations
3.1.1
Foam Mattress Replacements
•
•
•
Constant Low Pressure Device
The Victorian Quality Council (PUPPS
Report, 2003, pp41) recommends these
mattress replacements should be a
minimum of 150mm (or 6”) thickness.
3.1.2
Foam Mattress Overlays
•
•
•
Constant Low Pressure Device.
Various foams can be used singly or
combined in layers to provide pressure
redistribution.
More commonly thinner than mattress
replacements, so may bottom out more
easily, particularly when the occupant is
sitting up in bed.
•
•
•
•
•
•
•
•
All polyurethane foam has a type and a grade defined by density and hardness measurements. (eg. HR 36130, means high resilience; density -36 kg/ cubic meter and hardness of 130Newtons at 40% compression).
Density: The higher the number given for density, the more foam per cubic meter (and the longer lasting it
will be).
Hardness: The lower the number for foam, the softer its feel.
Depending on the density and hardness, bed mobility and transfers may be affected.
Some foam can be custom made for size and load capacity. This may involve sandwiching different grades
with different properties of foam
Maintenance is required to monitor how the foam wears over time. It may require rotation to prolong the life
of the foam. Regular removal of the cover for foam inspection is recommended.
Different foam types can be used at different parts of the mattress, such as at the heels. Different foams
include:
1. Varying density and hardness.
2. Foams can have varying properties, including slow release (memory, visco elastic ) foam which
conforms more to body shape and has less push back or resilience
3. Latex.
Foams can have variable temperature ranges at which the hardness/softness changes and can impact bed
mobility, and interface pressures.
The features of the cover are very important for the mattress replacement. A tight, hammocking cover will
reduce the mattress replacement’s effectiveness. See page 14 for further information regarding covers.
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•
•
•
•
•
Generally less maintenance issues for carers to monitor and adjust.
Generally less expensive than dynamic (active) options.
Various shapes cut into the foam such as convoluted or castle top surface can help reduce the interface
pressure by spreading the weight distribution, and reducing shear.
These mattress replacements and overlays rely on the user continuing to be repositioned and turned.
Some mattress replacements have raised sides to prevent a user rolling out of bed. This can also reduce
their bed mobility and affect pressure ulcer risk.
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3.1.3
Air Mattress Replacements and
Overlays (Static)
•
•
Natural movement of air is used to
distribute the pressure underneath the
occupant.
3.1.4
Fibre Filled
•
•
Comfort Device
Channels of fibre filled material run
across the bed aiming to provide a soft
surface on an overlay. This prevents the
fibre from migrating to the end of the
mattress.
3.1.5
Gel Pads
•
•
An overlay of gel segments.
•
•
•
•
•
•
•
•
•
•
•
•
Useful to reduce shear and friction but does not reduce pressure significantly.
Softens the bed but can tend to bottom out.
May be used for comfort.
Can be warmer than other alternatives.
Can be useful for some people with fragile skin.
Can reduce bed mobility (thus affecting possibility of pressure ulcer development) and affect transfers due to
its softness.
•
•
•
•
•
•
Can feel cold initially.
do not allow significant immersion and pressure redistribution
Available in various thicknesses. Generally thin and may not affect height for transfers.
Heavier than other materials. Consider potential OH&S issues.
May reduce shear and friction.
Firmer Gel( low viscosity) products do not tend to offer good immersion, generally resulting in a lowpressure distribution (so there is generally less pressure redistribution than on other surfaces).
Flat surface to clean.
•
3.1.6
Sheepskin
The initial degree of inflation should allow immersion into the mattress overlay without bottoming out. This
should be checked in various lying positions such as recumbent or side lying.
These mattress overlays need to be monitored for correct inflation, particularly when the occupant changes
position. Eg. Sitting up in bed. Bottoming out may occur.
Stability may be an issue, as air will move when providing its pressure distribution.
Maintenance issues such as loss of air over time, or punctures can affect the product’s effectiveness.
May be useful to accommodate shear and friction.
These options may be incorporated into a foam mattress where increased pressure redistribution is required
for a specific body part. Examples include the heels, pelvic girdle region or other bony prominence.
•
AWMA (2001, p23) states “sheepskin has a questionable role in pressure relief, but can guard against
friction and provide comfort” when in direct contact with the skin.
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•
3.2
Useful for moisture management
Static Mattress Replacements or Overlays – General Considerations
3.2.1
Maintenance
3.2.2
Type of Material
•
Generally less maintenance issues for carers to monitor and adjust.
•
Often a firmer surface that may assist bed mobility when compared to
dynamic options.
Generally provides pressure redistribution and does not totally remove
localised pressure.
•
3.2.3
Cost
3.2.4
Load Capacity
•
Generally less expensive than active options.
•
Consider the product’s load capacity – both maximum and minimum
weight.
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Section 4: Covers
(An important consideration for all pressure redistribution mattress replacements and overlays)
Feature
Reasons for these features
Stretch
•
•
•
•
•
•
•
•
Covers can have one way or two way
stretch, or no stretch
Breathable
•
Allowing air to circulate
Water / fluid resistant
Vapour Permeable
•
Allows water vapour to circulate through
the cover.
Anti microbial and anti fungal
•
Treated for infection control
Seams welded, zips or Velcro
•
Whether or not the cover may be
removed, and how it is sealed.
Fire retardant
•
•
•
•
•
•
•
•
•
•
Can reduce shear and friction and increase immersion with increased stretch in the cover.
Stretch and softness may negatively affect independent bed mobility.
Check the direction of the maximum amount of stretch. This is not always the same in each direction.
Allows air to circulate and help prevent moisture from developing on the skin.
If it does not breathe, temperature can be affected.
Can be wiped down for cleaning, as this may be required for incontinence issues.
Aims to prevent liquids from filtering through to the inside materials. This can affect infection control, and the
lifespan of the product.
Allows perspiration and other water vapour to circulate without condensing between the occupant and their
underlying surface.
High vapour permeability of the cover may lead to foam degeneration prematurely.
Allergies such as latex allergies need to be considered.
Cross infection is an important consideration in places where several users will use the product.
Infection control.
The filling may be affected by liquids or other contaminants if there is no water / fluid resistance.
Removal of the cover can allow for replacement, cleaning and checking for any degradation in foam.
The position of seams may risk damaging the skin. For example, during transfers.
To protect against possible fire.
Check local standards required.
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Section 5: Other Considerations for All Dynamic (Active) and Static (Reactive) Options
Size
•
Width, length and thickness
•
•
•
•
•
•
Manuals, labels and instructions
Attachment to a recommended bed
surface by sitting directly on the bed
surface
•
•
•
•
•
•
•
Various size mattresses are available including single, double and other sizes.
If bed rails are used on the bed, and the mattress replacement or overlay does not meet with the sides of
the bedrails, there may be a risk of body part entrapment. Bed rails are generally used to try and protect the
bed occupant from injury. Careful consideration needs to be taken when choosing a bed rail or stick. They
may increase the risk of injury to the occupant in several ways. Entrapment of limbs or body parts may occur
within the rails, or between the rails and the bed mattress replacement or overlay. Examples where this may
happen include those having a seizure, or rolling over in bed, or if unstable while transferring out of bed.
Foam surrounds can be made to increase the size of the mattress to fit the bed base that may reduce the
risk of the mattress replacement or overlay from moving on the bed, and resultant entrapment. This option
may provide firmer sides that may assist transfers, but may affect pressure related issues. When choosing a
support surface, careful consideration should be given to whether or not bed rails should be used.
Alternating air mattress overlays or other mediums can be inserted into one side of a foam double mattress
so a user can sleep with their partner.
Size can sometimes be customised for length and/or width.
If folding bed rails are used, damage may result to a mattress replacement or overlay that is too big for the
bed.
If the support surface is too wide for the bed, damage may result from possible contact with bed parts such
as mattress retainers.
Can be attached to the mattress replacement or overlay or come separately.
Clear written instructions and warranty should be retained for future reference.
Specific clinical warranty requirements need to be specified at point of purchase.( eg: will not bottom out
with 80 kg client with head raise at 45 degrees.
Labels on the product should have the manufacturer, model number and load capacity clearly stated.
Can be an advantage to have foot end clearly marked.
Some mattress replacements or overlays may move on the manufacturer’s recommended bed base during
transfers, bed mobility or when an adjustable bed is moved (eg. The backrest or knee break raises). This
could affect safety.
A slip resistant base material may reduce the product moving on its bed base.
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•
•
Attachment to a recommended bed
surface using straps
Servicing and Repairs
•
•
•
•
•
•
•
•
•
How the mattress replacement or overlay fits on the bed base may reduce movement. If it is too narrow, it
may move around. ( also causing safety issue and potential for body parts entrapment )
Clear labelling, instructions and the knowledge of the person who will set up the support surface should be
considered. For instance, some support surfaces have specialised areas for care of the heels, or to keep the
head still, and if these are incorrectly placed, the occupant’s optimal pressure redistribution could be
affected.
Straps may secure the mattress replacement or overlay on the recommended bed base.
A slip resistant base material may reduce movement.
How the mattress replacement or overlay fits on the bed base may reduce movement. If it is too narrow, it
may move around ( also causing safety issue and potential for body parts entrapment )
Straps may be elastic or webbing using buckles.
Some mattress replacements and overlays allow parts to be replaced such as individual cells or the pump.
Some may require replacement.
Location of supplier.
Twenty-four hour service.
Some suppliers will provide a pressure reducing mattress replacement or overlay when their product is
taken for repair or servicing.
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Section 6: References
AWMA - Australian Wound Management Association (2001). Clinical Practice Guidelines for the Prediction and Prevention of
Pressure Ulcers. 1st Edition. West Leederville, WA. www.awma.com.au
Dean, S., & Young, C.. (2004). Pressure Ulcers – Are you struggling to manage the WHOLE as well as the HOLE??? Connective
Issues – Wound management association of Victoria Inc. quarterly publication. 7(4).
Dean, S., & Young., C. (2004). Reduce the risk with the right foundations- mattress guidelines. National Healthcare Journal. 45-46.
Independent Living Centre Catalogue Structure. www.ilcaustralia.org.au
NPUAP – National Pressure Ulcer Advisory Panel.- 2007. Terms and Definitions Related to Support Surfaces. Retrieved from
http://www.npuap.org/NPUAP_S3I_TD.pdf
Victorian Quality Council. (2003). VQC State-Wide PUPPS Report – 2003., The Clinical Councils Unit, Quality and Safety Branch,
Rural and Regional Health and Aged Care Services Division of the Victorian State Government, Department of Human Services,
Australia. http://www.health.vic.gov.au/qualitycouncil/
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Appendix 3
Pressure Redistributing Support Surfaces
Product Checklist: Active/Reactive mattresses (Overlays and Replacements)
Specifications/Brand Name
Overlay or Replacement
Strength of evidence: supporting clinical claims:
RCT/cohort studies/case control studies/
comparative studies with no control/case studies.
Outcome measures?
User weight limit
Mode of operation: reactive (static)/active
(dynamic), alternating/micro air loss/zoning/genuine
low air loss.
Foam Specifications/Quality - density/
hardness/layers /HR/LR.
Depth - mattress overlay/replacement mattress
(when inflated) overlay min 10cm
Cell cycle time e.g. 10 mins cell down time?
Cell Movement, eg. 1 in 2/1 in 3/1 in 4.
Type of cells – no. of cells/individual cell size/
attachment to mattress base. i.e. potential for client
to “bottom out”.
Mattress construction – 1st/2nd layer - active/
reactive e.g.: Layers – foam/gel/air
Pressure differential delivered from the pump to
the cells eg. 30mmHg–80mmHg
Attachment to bed surface - check bed base
recommended. Review action with head raise and
knee break.
Cover – two-way stretch/vapour permeability
transmission rate (MVTR)/waterproof/antimicrobial/
fire retardant/welded/zip seams.
Pump: pressure control - auto adjust/manual dial
- changes for body weight/upright position Pump
type – air output (litres/min) Noise level
(decibels)
Safety features - CPR release/transport mode –
time/static mode auto reset?
Alarms - battery back up
Hosing Connections - attachment of hoses/
covers over hoses (potential of hose to kink) impact
on speed of cell inflation/ deflation
Warranty: all components covers/mattress/pump
Set up instructions- specific/head-foot marked
on the product/infection control/cleaning methods
Maintenance/service requirements: repairs/
replacement costs- pump/cells/life of the product/
company response time/replacement
© Young and Dean (2012) Ref: Australian Wound Management Association. Pan Pacific Clinical Practice Guidelines for the prevention and management of
pressure injury. AWMA: 2012. Cambridge Publishing, WA
57

Prescriber Manual Beds and Mattresses - SWEP

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