Do we really need Dynamic mattresses?

Over the last decade the level of education, understanding and clinical interventions available for the prevention and treatment of pressure ulcers has increased significantly.
There is now an abundance of options available to clinicians, but does this make the decision on which technology to adopt more difficult? 

Given a legacy of introduction of new technologies over the last decade or so, its little wonder that lead clinicians are taking a long hard look at what options are available and what is or isn’t working in their equipment arsenal.  

Managing any healthcare equipment formulary is a tricky business, the chosen range of equipment has significant impact on a range of healthcare drivers, such as: 

•    Staff acceptance
•    Training 
•    Patient compliance
•    Patient comfort
•    Budget 
•    Clinical efficacy

Traditionally, it has always been the perception that those at most risk, or those who have already developed a pressure ulcer can only be successfully treated on a fully dynamic air therapy mattress system.  Indeed, it should be acknowledged that for a small percentage of patients, this type of system may be the only suitable option and there will always be a place for fully dynamic air alternating systems in a pressure area care equipment formulary. However, with the rise in the use of high specification foam and ‘hybrid’ systems, the use of dynamics for every ‘At Risk’ patient is in decline.
For many patients the noise and continuous inflated air cells that alternate in pressure at the skin interface have been found to be uncomfortable, and at times compromise the patient’s sleep.  

Many hybrids, for instance the Invacare Softform® Premier Active 2, offers a high specification castellated foam as the patient interface. The foam offers a comfortable but stable surface, and if air therapy is required, the gentle movements of the air cells underneath the foam do not disturb the patient’s rest.  As patient preference has grown for the hybrid system with a foam interface, it has been possible to analyse its clinical benefits and also the extent of its use in Acute and Community settings.  

A recent project by some of the UK’s leading experts in Tissue Viability has prompted many clinicians to review their equipment offering and how it is being deployed on a day to day basis.

The findings, published in Wounds UK, Vol 13, No 7, 2016 (1), have highlighted a number of matters that when addressed can have real benefits to staff, patients and healthcare expenditure.

These findings, and investigation over time has illustrated that as well as offering improved patient ‘comfort’, patients who have had up to Grade IV pressure ulcers have shown evidence of healing, (2).  

With the financial outlay being significantly lower for a ‘hybrid’ system than a complete dynamic replacement mattress system, there is of course a cost saving to be made; this is particularly important given the pressure on NHS budgets.  

In a recently published study (1) it was discovered that the main reason why a dynamic mattress replacement system is still prescribed rather than a hybrid, is down to the prescribers lack of knowledge on what the hybrid system is able to offer in terms of clinical efficacy.  The study concluded that if staff were retrained and educated on the wide range of patient conditions and risk levels that the hybrid mattress is suitable for, then even more cost savings could be made in equipment expenditure, without compromising clinical benefit. 

With the majority of patient needs now being successfully met with ‘hybrid’ systems, the evidence clearly allows us to pose the question on why in some areas there is still a widespread use of dynamic mattresses – are they really the best option for the patient? 

(1)    Evaluating the effectiveness of pressure-redistributing equipment for the best clinical and financial outcomes Wounds UK | Vol 13 | No 7 | 2016 STEPHEN-HAYNES, JONES & ALLSOPP
(2)    A retrospective analysis of the use of the Softform® Premier Active 2 in an NHS Trust Wounds UK | Vol 11 | No 4 | 2015 STEPHEN-HAYNES, CALLAGHAN & ALLSOPP

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