Pressure ulcers are one of the most common conditions found in skilled nursing facilities today. They are not only painful and have devastating effects on residents, long term care facilities must deal with the escalating costs of treating the condition and the risk of possible litigation by patients and their families should the ulcer be considered avoidable.
“Pressure ulcers are very painful, and in fact, some patients can even die from them because they can become infected and the patient may have to undergo amputation,” says Joyce Black, PhD, RN, CWCN, FAAN, co-chair of the National Pressure Ulcer Advisory Panel’s Education Committee. [1]
Black emphasizes the best treatment for a pressure ulcer is prevention. To aid in this prevention, there are a variety of different support surfaces to help long term care professionals stop pressure ulcers before they begin, and to speed up treatment if they do develop.
Choosing the correct surface is crucial, and while seasoned caregivers are more likely to know what is best to treat residents, it can be difficult for new long term care providers to determine what each resident may need, especially with so many options to choose from.
Taking a few minutes when a resident is admitted to assess his or her mobility and past history of pressure ulcer development can greatly aid in future treatment.
“There are all kinds of fancy assessments nurses will use to determine relative risk, but really it all boils down to: Can the resident move?” Black says. “It’s not hard to prevent pressure ulcers if you come up with a plan to make it work.”
Group 1 Support Surfaces
Residents who are admitted to a long term care facility who have a low risk of developing a pressure ulcer are typically placed on a mattress or mattress overlay categorized by the Centers for Medicare & Medicaid Services as a Group 1 support surface.
The surfaces are made of high-density foam, air or gel and are made to conform to the residents’ body so that pressure is distributed over a larger surface as opposed to specific areas.
Group 2 Support Surfaces
When a resident develops a pressure ulcer, they should be moved to one of the CMS-categorized Group 2 support surfaces.
These surfaces are powered or non-powered alternating pressure mattresses and powered air flotation beds. They are commonly referred to as low-air loss mattresses. The surfaces can be placed directly over a hospital bed frame and provide pressure relief to help the wound heal faster and keep the skin dry.
Group 3 Support Surfaces
A group 3 support surface is intended for residents with multiple advanced stage pressure ulcers or muscle flaps that have not had favorable outcomes with Group 2 mattresses. A Group 3 support surface is an “integrated bed system,” also known as air-fluidized beds. The resident is submerged in silicone-coated beads, stimulating the movement of fluid by having air circulated through them. As a result, these beds can aid in the prevention of further damage by maintaining near normal blood flow.
Bed to Chair Support
It is common when discussing support surface in long term care to focus solely on the proper mattress and mattress overlay for each resident. However, pressure ulcers can develop during a brief period while sitting in a chair. The best method is for long term care facilities to purchase a variety of foam seat cushions and lumbar support for wheelchair use.
Black stressed that it’s also critical to change the position of residents who are immobilized when in bed or up in a chair. Her recommendation is to turn these residents every two hours or more often, depending on the patient.
“The two factors you have to account for in pressure ulcer prevention are the intensity, or the magnitude, of the pressure and the duration of the pressure,” Black states. “The beds can deal with the magnitude component, but no support surface will change the duration. The only way you can change duration is to move the patient.”
[1] Novotney, Amy. “In search of support.” McKnight’s Long Term Care News. Web. 1 August 2012.
