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Support Surfaces
Supports surface products, such as gel or foam overlay mattresses and specialty beds, are designed to help reduce pressure placed on the skin.
Development of an Evidence-based Specialty Support Surface Decision Tool
Advancing technology, an aging population, increasing attention to appropriate resource use, and growing concerns about patient safety and professional liability combine to complicate support surface choice. Cognizant of these factors, staff in a 600-bed tertiary care hospital in a large urban center in western Canada decided to evaluate an existing specialty support surface decision tool and update the instrument based on current published literature (no older than 3 years), expert opinion, and results of pilot testing. Elements included in the existing tool were the patient?s Braden Score, mobility/activity indicators, and identification of existing skin breakdown. The tool allowed considerable latitude in decision-making based on other clinical factors and established professional practices and had not been formally evaluated. The revised tool addressed relevant assessment criteria such as risk category, patient weight, presence of existing skin breakdown/number of ulcers, flap surgery, pulmonary complications, palliative care, positioning, and Braden score, as well as oversight of support service choice. Although the incidence of nosocomial pressure ulcers did not change significantly during the trial period, costs incurred for support surface use decreased 26% overall, underscoring the need for improved guidelines for support surface selection. KEYWORDS: clinical decision-making, pressure ulcers, beds and mattresses, evidence-based practice, specialty support surfaces
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Preventing Hospital-acquired Pressure Ulcers: A Point Prevalence Study
The deleterious effects of mechanical forces on the development of pressure ulcers have been recognized for many years. A cross-sectional study was conducted to ascertain the effect of implementing a new support surface on the development of pressure ulcers in one acute care facility. Two pressure ulcer prevalence studies were conducted using the Pressure Ulcer Prevalence Audit Data Collection Tool. To ascertain whether ulcers were facility-acquired, a retrospective chart review was completed for all patients with pressure ulcers. Following completion of the first audit, only the support surface used for at-risk patients was changed. The second audit was conducted 3 months after the new support surface was implemented. Pressure ulcer prevalence was 8.3% in June 1999 and 7.8% in October 2000; whereas, the prevalence of nosocomial pressure ulcers was 5.5% in 1999 and 3.1% in October 2000. Despite the inherent limitations of this study design, the results suggest that use of the new support surfaces for at-risk patients has lowered the prevalence of nosocomial pressure ulcers in this facility.
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Comparison of Air-Fluidized Therapy with Other Support Surfaces Used to Treat Pressure Ulcers in Nursing Home Residents?Part 3.
Healing rate. Resident level. Effects of initial pressure ulcer size.
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Comparison of Air-Fluidized Therapy with Other Support Surfaces Used to Treat Pressure Ulcers in Nursing Home Residents?Part 1.
To provide empirical evidence comparing pressure ulcer healing rates between different support surfaces, data were analyzed from eligible residents with pressure ulcers (N = 664) enrolled in the National Pressure Ulcer Long-Term Care Study, a retrospective pressure ulcer prevention and treatment study. Support surfaces were categorized as: Group 1 (static overlays and replacement mattresses), Group 2 (low-air-loss beds, alternating pressure, and powered/non-powered overlays/mattresses), and Group 3 (air-fluidized beds). Calculation of healing rates, using the largest ulcer from each resident, found mean healing rates greatest for air-fluidized therapy (Group 3) (mean = 5.2 cm2/week) versus Group 1 (mean =1.5 cm2/week) and Group 2 (mean = 1.8 cm2/week) surfaces (P = 0.007). Healing rates also were assessed using 7- to 10-day ?episodes?; each ulcer generated separate episode(s) that included all ulcers when residents had multiple ulcers. Mean healing rates were significantly greater for Stage III/IV ulcers on Group 3 surfaces (mean = 3.1 cm2/week) versus Group 1 (mean = 0.6 cm2/week) and Group 2 (mean = 0.7 cm2/week) surfaces (Group 2 versus Group 3: P = 0.0211). This finding persisted for ulcers with comparable initial baseline areas (20 cm2 to 75 cm2) on Group 2 and Group 3 surfaces; healing improved on Group 3 surfaces (+2.3 cm2/week) versus Group 2 surfaces (-2.1 cm2/week, P = 0.0399). Residents on Group 3 (6 out of 82; 7.3%) and Group 1 (47 out of 461; 10.2%) surfaces had fewer hospitalizations and emergency room visits than those on Group 2 surfaces (23 out of 121; 19.0%, P = 0.01) despite significantly greater illness in residents on Group 2 and 3 versus Group 1 surfaces (P <0.0001). Despite limitations inherent in retrospective studies, ulcers on Group 3 surfaces versus Groups 1 and Group 2 surfaces had statistically significant faster healing rates (particularly for Stage III/IV ulcers) with significantly fewer hospitalizations and emergency room visits (Group 3 versus Group 2), despite significantly m
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Guest Editorial: The NPUAP Support Surface Standards Initiative
The outcome of this endeavor will have numerous positive effects. For example, the Terms and Definitions work group is charged with developing standardized nomenclature, terms, and definitions. The stakes are high.
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Payment Perspective: Pressure-reducing Support Surfaces
Payment Perspective is part of a series of occasional articles intended to provide information on reimbursement relevant to topics addressed in the issue.
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Comparison of Air-Fluidized Therapy with Other Support Surfaces Used to Treat Pressure Ulcers in Nursing Home Residents?Part 2.
Resident level analyses. Number of ulcers/resident. Residents placed on Group 3 surfaces (mean = 3.5 ulcers) had significantly more pressure ulcers than those on Group 2 surfaces (mean = 2.5 ulcers), while residents on Group 2 surfaces had more pressure ulcers than those on Group 1 surfaces (mean = 1.8 ulcers) (P Mean initial...
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NPUAP Best Practices for Pressure Ulcer Care: Abstracts of Presentations
Heel Pressure Ulcers Presenter: Catherine Ratliff, PhD, APRN-BC, CWOCN Plastic Surgery Research University of Virginia Health System Charlottesville, Va The heel is the second most common location for pressure ulcers on the body. Pressure Ulcer Prevention and Treatment: Implications for ...
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A Comprehensive Program to Prevent Pressure Ulcers in Long-Term Care: Exploring Costs and Outcomes
With scrutiny from survey agencies (Centers for Medicare and Medicaid Services and state agencies) and potential litigation increasing, long-term care facilities must implement aggressive pressure ulcer prevention programs. However, cost-effective pressure ulcer prevention continues to be a challenge for most long-term care facilities, in part because limited research is available to guide their efforts. Two long-term care facilities (Facility A with 150 beds and Facility B with 110 beds) participated in a quasi-experimental study using retrospective and prospective study data to evaluate the effect of implementing a protocol of care to address the incidence of pressure ulcers. Retrospective study results showed a combined, cumulative, 5-month pressure ulcer incidence of 43% in Facilities A and B. Implementation of the comprehensive prevention program resulted in an 87% decrease in pressure ulcer incidence in Facility A (from 13.2% to 1.7% per month, P = 0.02) and a 76% decrease in Facility B (from 15% to 3.5% per month, P = 0.02). The average monthly cost of prevention for a high-risk resident was $519.73 (plus a one time cost of $277 for mattress and chair overlays). More than half ($277.15) of the monthly costs relates to labor; the most expensive item cost is for support surfaces. This study demonstrated that this comprehensive program resulted in a significant decrease in the incidence of pressure ulcers in two long-term care facilities. Because labor and support surface costs remain high, long-term care facilities are encouraged to use prevention intervention strategies based on risk stratification.
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CAWC Abstracts
This study intended 1) to identify how occlusive versus semi-occlusive wound dressings are defined in the literature, and 2) to determine the clinical evidence to support the use of occlusive dressings versus semi-occlusive dressings in chronic wound care. Since 1998, a tertiary care hospital in Toronto has implemented a pressure ulcer prevention and treatment program, utilizing the Braden Scale, National Pressure Ulcer Advisory Panel pressure ulcer staging system, the AHCPR guidelines, and ...
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