Specialist mattresses and cushions have long been available to help relieve and manage pressure. Healthcare professionals routinely implement them to help prevent skin damage and the resulting bed sores. But how can the bed itself play a part in reducing the risk factors associated with prolonged pressure over bony prominences?
Pressure ulcers, commonly referred to as bed sores present an ongoing challenge in long-term care and because of the aging population which continues to heighten the acuity of the SNF population, the risk may become increasingly severe.
The Agency for Healthcare Research and Quality advises that "each year, more than 2.5 million people in the United States develop pressure ulcers. These skin lesions bring pain, associated risk for serious infection, and increased health care utilization."1
While we know that constant pressure applied over a bony prominence for a length of time is the primary cause of triggering the cascade of skin damage, there are also other contributing factors that can affect risk and resistance to the forming of pressure sores. Nutrition, hydration and the presence of co-morbidities are all recognized risk factors for pressure complications, but mobility (or lack thereof) also has a considerable impact on pressure risk.
Tissue Viability Nurse Specialist (the British equivalent to a wound care nurse), Sarah Thompson advises2 that the average person moves "around about 55 times per night and putting that into perspective, that’s every seven to nine minutes." Even since you started reading this article, you will likely have repositioned yourself at least once even if only in a small way.
The average person may not even notice these small movements but someone with reduced mobility or impaired ability to feel sensation is likely to be more susceptible to developing a pressure sore because of the absence of these movements to relieve pressure on the cells and let blood flow freely around the body. There is a particular risk on parts of the body that are frequently in contact with a surface for a prolonged period.
We know that "if you reduce pressure on one body part, this will result in increased pressure elsewhere on the body. Hence, [why] the goal is to obtain the best pressure redistribution possible3 ." Despite this, some areas of the body are more likely to develop pressure wounds than others and again, the surfaces they are frequently in contact with can affect this.
Individuals who are seated in an upright position (including in wheelchairs) for prolonged periods of time may develop pressure injuries on their buttocks, shoulder blades, spine or the backs of their legs or arms4. These are typically the places where tissue cells may experience compression and/or loading against the support surface.
Those on bed rest are at particular risk of deep tissue injury as those who spend periods of time without repositioning in their beds may experience pressure ulcers on the back or sides of their head, shoulder blades, heels, ankles, hips, lower back or tailbone4.
This is because when cells are compressed between a surface, such as a bed or chair, and the body on which gravity and/or shear forces are also operating, then the pressure causes the cells to rupture. The result is dead tissue (necrosis) in the subcutaneous tissue layer of the skin, and this forms the wound bed close to the bone.
Consider this: Aging can be a long process, often peppered with incremental losses. Losing independence, memories, freedom of travel and the ability to carry out the occupations that were once such a big part of your identity can be extremely taxing emotionally. While a resident may use a stick, walker, wheelchair, a geri chair or none of the above, one thing every resident will have is a bed. A supportive surface that is only theirs, at least for the length of their stay.
It's our responsibility as healthcare providers to ensure the beds we have, meet the clinical needs of our residents as well as every other need. This means it needs to be height adjustable to help with assisted or self-transfers, it needs to be the right size for the resident's physiology and it needs to be able to perform any clinical function the patient may need. When it comes to bed frames, some will work harder for your residents than others so make sure you have ones that can be instrumental in relieving pressure and preventing skin damage.
Research suggests that the most comfortable position for humans to maintain is what is known as the 30-degree tilt2. This is when the backrest is elevated up to 30 degrees and the same with the leg rest. This aids pressure redistribution across larger surface areas of the body such as the back, thighs and calves. It must be noted though, that no matter how comfortable a position is to maintain, periodic repositioning is still necessary to encourage healthy circulation and prevent prolonged pressure leading to dead tissue and a wound.
The following image shows how shear presents a greater pressure risk the more the backrest is elevated and the resident begins to migrate down the bed. That's why healthcare professionals learned long ago to raise the leg rest to mitigate the shear pressure risk for residents' skin.
We often sit residents up in their beds to aid with breathing, comfort or circulation. While theoretically there is nothing wrong with this, Tissue Viability Specialist Sarah Thompson2 expresses some key elements regarding profiling positions and the impact upon pressure distribution.
For the longest time, caregivers have continued to utilize profiling beds in this way to reduce shear and pressure, but there is, in fact, a better solution than this.
Accora’s unique BodyMove technology has been shown to reduce interface pressure over the sacrum by 23% compared to a standard profiling bed5. It's a feat of innovative engineering that uses regression during profiling for both the back and leg rest to create space and comfort over the sacrum which is a high-risk area for a subcutaneous tissue injury to occur.
As the backrest comes up, it pivots away from the sacrum and creates more space for the sacral pressure to be redistributed. Our Empresa FloorBed handset has one button for simultaneous profiling, so you don’t even have to think about getting the knee break up first and bonus, there is also one button to get the mattress platform back to flat from wherever the bed is at.
Wound care certified long-term care professional Nicole Watson, explains her view of the benefits of the double auto-regression feature of the Empresa FloorBed.
The prevention and treatment of pressure ulcers can require continuous management on the part of the caregivers and the management team in SNF settings. Ensuring that caregivers have adequate access to the resources, equipment and training they need to carry out best practices is paramount to success and failure to do so can result in fines and citations for inadequate attention to the F686 guidance.
Despite this, we know that expectations must be continuously managed in long-term care settings. Providers sometimes must choose whether pressure ulcer risk and other risk factors such as fall risk are the prevalent issue on a case-by-case basis.
Fortunately, this is no longer a choice caregivers are required to make. The Empresa FloorBed is the only fall prevention nursing bed with BodyMove technology and caters to both needs without compromise for better clinical outcomes and well-being.
1 - https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/index.html
2 - https://accora.wistia.com/medias/gjyfryhqcu
3 - https://www.ncbi.nlm.nih.gov/books/NBK2650/
4 - https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893
5 - https://us.accora.care/whitepaper/bodymove-technology-whitepaper
{{widget-brochure}}
