sue monaro, concord repatriation general hospital - pressure injury prevention equipment:...
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Pressure Injury Prevention
Equipment Pressure Injury Conference Melbourne 2014
Sue Monaro
Clinical Nurse Consultant – Vascular Surgery
Concord Repatriation General Hospital
ACKNOWLEDGEMENT
Tracy Nowicki
The Prince Charles Hospital
Brisbane
Overview of equipment
1. Ward
• Beds
• Mattresses
• Seating options
• Heel devices
• Specialised devices
2. Emergency Department
3. Operating Theatre
4. Procedural Suites
5. Ambulatory Care
6. Patient’s residence
• Pillows
• Lifters
• Hover mats
• Slide Sheets
• Bed rails
• Grab rails
• Monkey bars
• Bed extensions
• Bariatric equipment
Standards
• International Standards • ICE606601-2-38
• Australian Standards • AS/NZS3200.2.38:2007
• State contracts
Risk reduction
• Pressure injuries
• Skin Tears
• Falls
• Entrapment
• Contractures
• Bed design
• Bed adjustment
• Appropriate
mattress
• Gap between
mattress and bed
• Compatibility of
equipment
Features1
Patient benefits:
• Participation in
repositioning
• Security in
transfers
• ↑Comfort
• ↓Patient safety
hazards
• Sit up to eat
Clinician benefits:
• ↓manual handling
• ↑patient
satisfaction/comfort
• ↓Nursing time
• ↓Clinical incidents
Data1
Equipment:
• In use
• In stock
• Audit
• Replacement
Clinical Indicators:
• Prevalence
• Incidence
Equipment indicators:
• Inventory
• Stocktake
• Audit
• Financial reports
• Patient satisfaction
Equipment1
• Scientific approach when implementing a bed as an integrated system within the health care setting
• Staff education
• Design – relationship: • Bed
• Mattress
• Rails
• Walkers
• Chairs + Wheelchairs
• Hoists
• Furniture
Beds
Mandatory and desirable bed
features
Safety Features Function Features Comfort Features
Mandatory Desirable Mandatory Desirable Mandatory Desirable
Bed
lowerable to
35cm
Solid side-
rails with
handles
Electrical Chair
position
Extendable Profiling
back
Split side-
rails with
handles
Cable
management
system
Auto CPR Angle
indicators
Knee brace
Centrally
locking
breaks
Patient lock-
out system
Trendelenbu
rg function
Radio
translucent
Easy patient
access to
bed control
Steering lock Egress
alarm
150mm
castors
Compatible
with patient
mover
Night light Light-weight Linen keeper
Easy to
clean
Profiling features1,2
• Knee bend as head of bed elevates
• ↓Friction and shear
• ↓need to lift the patient up the bed
• ↓risk of patient sliding down
= auto contouring frame action
= 5 simultaneous movements activated
by one button
Base Mattress2 Must:
• All new materials
• Classification should be H (conventional resilience, heavy duty),
HR (high resilience) and/or LR (low resilience)
• Density and hardness should be expressed together e.g. 35/130
• Density minimum 35kg/m3 for single layer and all layers of
multilayered mattress
• Hardness single layer 130 Newtons and multilayer may increase
for base layer and decrease for other layers
• Side walls of 50mm and of H or HR foam if multilayered
• Depth of 150mm for beds and 100mm for trolleys
• Support a load of 150kg
Preferred:
• Double or triple layered
• A profile or hinging system which adapts the mattress to a variety
of bed positions
• Castellations that assist with spread of pressure
Base Mattress: Cover2
• Two-way stretch
• Vapour permeability transmission rate
(MVTR)
• Waterproof
• Antimicrobial
• Fire retardant
• Welded
• Zip seams
Evidence2
Recommendation 11
Use a high specification reactive (constant low pressure) support foam mattress on beds and trolleys for patients at risk of pressure injuries.
Recommendation 12
No one specific high specification reactive (constant low pressure) support foam mattress is better than any other.
Recommendation 13
Active (alternating pressure) support mattresses could be used as an alternative in patients at high risk of pressure injuries.
Mattress Replacement3
• User weight limit
• Mode of operation:
Specifications/Quality
• Depth Cell cycle time
• Type of cells
• Mattress construction
• Pressure differential
• Attachment to bed
surface
• Cover Pump:
pressure control
Pump
• Safety features
• Alarms
• Hosing Connections
• Warranty
• Set up maintenance/
service requirements
Audit & Replacement
• Initial
• Replacement strategy • Prioritise
• Risk management
• Financial considerations
RPAH Mattress Audit 2011
Mattress location (Ward/Unit)
Bed Number
Auditor Name
Criteria for mattress covers Yes No N/A
1. Is the mattress cover torn or damaged?
2. Is the mattress cover made of PVC material?
3. If the mattress is covered is the zip or fastening device broken?
4. Does the mattress cover have any soiling that cleaning cannot remove?
f the answers to any of the above questions are yes, the mattress cover has failed and must be replaced.
Fail Pass
Criteria for mattresses Yes No N/A
1. Undo the removable cover. Is the mattress soiled or stained? (not applicable to sealed mattress covers)
2. Does the mattress have an offensive odour?
3. Did the mattress fail the ‘Hand Compression Assessment’ (see below)?
If the answers to any of the above question are yes, the mattress has failed and must be replaced.
Fail Pass
Hand Compression Assessment 1. Where appropriate, adjust the height of the bed so that it is at the same level as the tester’s
head of hip. 2. Link hands to form fist and place them on the mattress. 3. Keep elbows straight and lean forward, applying the full body weight to the mattress 4. Repeat the hand compression at intervals along the entire length of the mattress. 5. The mattress should be condemned if the base of the bed can be felt at any point.
Note: If the mattress is torn or damaged an alternative mattress cover needs to be applied until the time of a new mattress is made available.
Seating Equipment2
• Specific to clinical needs
• ↑complexity = seating assessment by
specialist
Heel Equipment
1. Pressure must be completely offloaded from heels by lifting heels off the bed
2. Maintain offloading by using:
• A visco-elastic foam wedge
• A knee brace or knee break in an electric profiling bed to maintain knee flexion
↓
Specialised Equipment2
Business Plan1
• Product/Clinical Resource
• Workplace Health & Safety
• Patient Quality & Safety
• Infection control
• Engineering
• Biomedical Engineering
• Multidisciplinary Team
Sequential focus and education4
• Beds
• Mattresses
• Seating
• Heel protection • Bed cradle
• Heel offloading devices
• Preventative dressings
• Specialised equipment
• Device-related
• Repositioning
• ↓use of waterproof sheets
• Quality continence products
• Skin products
• Nutrition • Screening
• Referral
• Protected meal time
Summary
• Beds should be integrated • Safety features
• Performance
• Comfort
• Facilitate clinical care
• Equipment should be co-ordinated + centralised • Inventory
• Storage
• Infection control
• Replacement programme
• Monitoring should include: • Patient sensitive indicators
• Equipment audits
• Equipment needs to be available at point of entry and adjusted throughout the patient admission
• Awareness and education should focus on each intervention and should meet the needs of the target population
References
1. Nowicki, T., Fulbrook, P. & Burns, C. 2010 Bed safety off the rails.
Australian Nursing Journal 18, 1, 31-34.
2. Pan Pacific Pressure Clinical Practice Guideline for prevention and
management of pressure injury:
2012.http://www.awma.com.au/publications/2012_AWMA_Pan_Pacifi
c_Abridged_Guideline.pdf
3. Dean, S. & Young., C. 2004. Reduce the risk with the right
foundations- mattress guidelines. National Healthcare Journal, 45-46.
4. Miles, S.J., Fulbrook, P., Nowicki, T. & Franks, C. 2012 Decreasing
pressure injury prevalence in an Australian general hospital: a 10-
year review. Wound Practice & Research 21, 4, 148-156.
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