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New Recommendations Guide Choice of Hospital Bed Surface to Prevent, Treat Pressure Ulcers

Algorithm provides visual decision tree

A new algorithm published in the Journal of Wound, Ostomy, and Continence Nursing takes the guesswork out of choosing a bed surface to help treat and prevent pressure ulcers.

“Clinicians know and guidelines emphasize the importance of surface selection to protect patients from pressure ulcers,” said lead author Laurie McNichol, a nurse at Wesley Long Hospital in Greensboro, North Carolina. “Yet a comprehensive review of the available research was lacking. Clinicians needed a validated approach to maximizing the potential benefits of choosing a surface to treat and protect our patients.”

The algorithm distills more than 20 years of published research into a visual decision tree that clinicians can use to guide bed-surface selection in the hospital. The algorithm and supporting statements were developed by a consensus team of 20 clinical experts led by the Wound, Ostomy, and Continence Nurses Society.

Pressure ulcers are a serious and common complication, particularly for patients facing long-term hospitalization. In the U.S., 2.5 million patients develop pressure ulcers each year, at a cost of $9 to $11 billion.

Major guidelines presented in 2014 emphasized steps to help stop these preventable injuries, including the use of specialized support surfaces on patient beds. Support surfaces include a variety of overlays, mattresses, and specialized bed systems designed to help heal and protect skin. However, these guidelines lacked evidenced-based recommendations for clinicians on how to choose surfaces based on patient needs.

“We all saw a clear need for this tool,” McNichol said. “This algorithm will contribute to patient outcomes in hospitals around the country.”

Users enter the algorithm at the point of the initial skin assessment, followed by a pressure-ulcer risk assessment. Based on the risk for the development of pressure ulcers (Braden score cut-off of 18) or the presence of pressure ulcers, users follow pathways that guide clinical decision-making for the use of the appropriate support surface for the prevention or treatment of pressure ulcers. Support-surface selections based primarily on Braden moisture and mobility subscale scores are provided, as well as guidance regarding the performance of skin and pressure-ulcer risk reassessments; determining the need for a change in or removal from a support surface; and support-surface considerations and contraindications.

Additional publications are planned for later this spring to further guide the practical implementation of the algorithm.

The work was supported by an educational grant from Hill-Rom.

Sources: Hill-Rom; April 8, 2015; and JWOCN; January/February 2015.

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Decision supported by data from more than 4,000 patients