Hospital Mattresses - Best Buy?

Hospital Mattresses – Best Buy?
2 Year evaluation in one North West NHS Trust
Author: Deborah Gleeson MSc, BA (Hons), RN
Co-author: Sarah Moran – Trial Facilitator
Introduction
Method
Results
Un-relieved pressure, friction and shearing forces on the skin, particularly
over bony prominences leads to the development of pressure ulcers. This
is despite advances and significant investments in solutions and
technologies to overcome the risks of developing pressure ulcers.
A Trust-wide mattress audit was conducted in St Helens & Knowsley Teaching
Hospitals NHS Trust in 2010, which demonstrated a total of 560 mattresses
needed replacing. Due to the urgency of the replacement programme and time
frames, a full trial of mattresses could not sufficiently be undertaken. In
realization of this and the knowledge that to date there is no “best buy” on the
market, a decision was made to approach market leaders in the provision of high
specification foam mattresses. A trial of various mattresses was conducted over a
two year period, to establish the longevity and performance of the mattresses.
The four companies agreed to the trial and 140 of each company’s products were
purchased.
Results demonstrated that of the 560 mattresses trialled, cover failure rates
ranged from 13% to 25% between the four products. Only 5% of failures were
due to problems with the foams. During the trial period the trust had over
180,000 admissions and demonstrated a 14% reduction in hospital acquired
pressure ulcers in 2010 and a further 29% reduction in 2011.
“Pressure ulcers remain problematic across healthcare settings, with
prevalence and incidence changing little over the past two decades”
(Thomas 2010)
It is realised that an essential feature in the prevention and management
of pressure ulcers, is the selection of appropriate pressure redistributing
support surfaces.
This has been substantiated by numerous guidelines (NICE 2011, EPUAP
and NPUAP 2009), that a higher specification foam mattress is more
effective than ordinary foam mattresses in reducing pressure ulcer
incidences of patients. As a direct consequence of scientific evidence the
current UK lead consensus is that “all individuals assessed as being at risk
of developing or have developed Category I and II pressure ulcers should
be placed, as a minimum, on a high specification foam mattress” (NICE
2009, EPUAP and NPUAP 2009).
A number of variables where measured throughout the trial and utilised as
performance measures. These were failure rates for both covers and
foams, comfort, durability, cost, company support and incidence of
hospital acquired pressure ulcers.
Discussion
One of the main contributing factors for mattresses failing was poor storage
and transportation systems in the Trust. In most NHS Trusts, storage and
transportation of hospital mattresses is often inadequate, however we have a
facility to store mattresses whilst they are not in use. This storage facility is not
specifically designed to safely house these products and they are often ‘piled
on top of each other, on bed frames or the floor’. Mattresses are put against a
wall in the wards when not required until portering services can transport
them to the mattress store.
Conclusion
What the guidelines fail to provide is advice or guidance on which high
specification foam mattress performs / evaluates best. This is not
surprising as the number of commercially available pressure
relieving / reducing devices available are both numerous and
confusing (BHTA 2012).
All mattresses performed well over the two year trial. The main cost
implication was the cover failure rates, which was largely due to poor storage and transportation of the mattresses in the Trust, as opposed to any of
the mattress cover components.
To date there is no evidence of the superiority of one higher specification
foam mattress over an alternative high specification foam mattress
(EPUAP and NPUAP 2009). Decision makers in healthcare continue to
invest significant fiscal resources in pressure reducing foam mattresses
based on unsupported and unsubstantiated claims.
After the trial it was decided that the Permaflex Plus Advance mattress
manufactured by Park House Healthcare would be the mattress of choice for
our Trust. The deciding factors lay in the fact that this mattress had proven
not only efficient and effective throughout the two year trial, but
significantly more cost effective.
In recognition of the problems faced when considering the purchase of
high specification foam mattresses, the author conducted an 18 month
performance and functionality audit of four commercially available
mattresses. The audit was conducted across two sites, namely St Helens
and Whiston hospitals.
In January 2012, the Trust further invested in special mattress covers to be
used during storage and transportation of the foam mattresses, to facilitate
the longevity of the covers. The Trust is also looking into providing mattress
shelving in storage areas.