Support Surfaces – Product Selection

Despite their importance in patient care and their ubiquity in many chronic care settings, support services have neither performance standards nor functional criteria that can be tested against clinical outcomes.¹ For this reason, selection of the appropriate support surface can be left to individual healthcare professionals and institutions on the basis of their own judgment and experience.^1–3

Product Selection Questions for Support Surfaces

To help in the selection of the most appropriate support surface, the healthcare professional should try to consider all of the following questions:^1,2

1. What are patients’ specific load management needs? The first step should be a review of patients’ overall health and a consideration of the amount of time spent lying or sitting each day. The needs of patients who spend all day in a wheelchair, for example, will be different from those with limited mobility. Also, bariatric patients have particular support needs to ensure that pressure is offloaded in a way that is safe both for the patient and the healthcare professional.
2. How does the product function and how well does it perform? A new product should be thoroughly researched from sources such as marketing materials, clinical papers, and data from independent laboratory tests and studies where available.  Unfortunately, clinical comparisons between devices tend not to be definitive and often offer little help in terms of decision making. It is important to maintain records within individual institutions on the effectiveness of different support surfaces for future reference.  A list of queries for evaluating the effectiveness of a particular support surface is provided in the table below.
3. Rent or purchase? Renting can be an ideal solution for many institutions as it allows access to the latest technology without the responsibility for maintenance or cleaning. However, funding options such as the prospective payment system can make the outright purchase of equipment more viable.²

Next week is the final article in this short series on support surfaces, and will involve the usual mini-quiz.

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References

1. Brienza Dam, Geyer MJ, Sprigle S, Zulkowski K. Pressure redistribution: seating, positioning, and support surfaces. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles. 2^nd Edition. Lippincott Williams & Wilkins, Ambler PA. 2008.
2. Nix DP. Support surfaces. In: Bryant RA and Nix DP. Acute and chronic wounds. Current management concepts. 3^rd ed. St Louis, Missouri; Mosby Elsevier; 2007.
3. Bates-Jensen B. Pressure ulcers: pathophysiology and prevention. In: Sussman C and Bates-Jensen B. Wound Care: A Collaborative Practice Manual for Health Professionals. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.

Table: Queries for evaluating support surfaces effectiveness²

Patient factors   Has there been a decrease in factors that place a patient at risk for pressure ulcers? Has mobility become impaired because of the support surface? Is the patient comfortable? Can the patient sleep? Does the patient bottom out after the bed is properly adjusted? Is the wound improving?

Facility factors   Do accessible, standardized, or contracted support surfaces include enough variety of methods to meet the changing needs of all patients? Do the support surfaces meet the needs of the facility in the most cost-effective way after all costs are calculated? Is the staff competent with set up, maintenance, and cleaning? Do patients express overall satisfaction with the products? Do staff express overall satisfaction with the products? Is there an increase in entrapment, back injuries, or falls? Does the product live up to claims? Does the company live up to promises for support and value added services? Do the products conform to essential regulations?

Reproduced from Nix DP. Support surfaces. In: Bryant RA and Nix DP. Acute and chronic wounds. Current management concepts. 3^rd ed. St Louis, Missouri; Mosby Elsevier; 2007.