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Hybrid-Power Mattress Clinical Evaluation

Posted on March 13th 2018

This is the web version of the clinical trial that was first published in PDF format on this page.  


Releasing Time to Care

Single site large-scale evaluation of the clinical benefits and positive organisational impact of utilising the Hybrid-Power pressure redistributing mattresses in an acute setting.

Introduction

The Hybrid-Power mattress combines the pressure redistribution properties of high specification foam, with alternating pressure relief. Clinicians can quickly and easily provide immediate therapy by initiating a ‘step up/step down’ process without the need to provide an additional specialist mattress, therefore removing the need to swap out and clean mattresses, positively benefiting both staff and patients.

The aim of pressure ulcer prevention strategies is to reduce either the magnitude, or duration, of pressure between a patient and his (or her) support surface (i.e. the interface pressure), or both.

This may be achieved by regular manual repositioning alone (e.g. two-hourly turning), or combining this with the utilisation of pressure- relieving support surfaces such as cushions, mattress overlays, replacement mattresses or whole bed replacements, which are widely used in both institutional and non-institutional settings.

Support surfaces are used with the aim of redistributing pressure, reducing shearing forces and controlling the local microclimate1.

Greater demands are being placed on health organisations to implement cost-effective strategies for pressure ulcer prevention and it is important to understand which types of patients can benefit from specific types of support surfaces2. By pre-equipping with a dual therapy mattress, staff, patients and the organisation benefit by removing the requirement to replace static foam mattresses with dynamic therapy mattresses, according to individual patient support surface requirements.

To comprehensively evaluate and evidence the clinical efficacy of the Hybrid Power mattress the following outcome measures were identified;

  • The incidence of new pressure ulcers
  • Patient experience
  • Acceptability of the devices for clinical staff

The chosen setting for the full ward trial was ward 5B – a 30 bedded renal and high dependency unit within Crosshouse Hospital, NHS Ayrshire and Arran Health Board. The ward provides care for a wide range of patients with complex and differing health needs and levels of risk in relation to pressure ulcer prevention and management needs. It is vital to ensure that the support surface equipment available can meet the needs of patients from admission. The Hybrid- Power is a dual therapy mattress that provides advanced pressure relief to meet the needs of higher risk patients and allows clinical staff to immediately prescribe a dynamic support surface without the requirement to move the patient from the bed. The mattress allows staff to immediately ‘step down’ from a dynamic function to a static surface for the purposes of rehabilitation and discharge planning.

Method

Evaluation Implementation:

  • Current ward mattresses were exchanged for thirty Hybrid-Power mattresses
  • The Drive DeVilbiss Clinical Manager and the TVN Team updated the Equipment Selection Guidance Pathway to ensure staff follow current local and national guidance when prescribing a therapy mode (static or dynamic)
  • On-site clinical support and training was provided throughout the evaluation period by Drive DeVilbiss Healthcare

Evaluation Exclusion Criteria: Two patients were excluded from the study during the twelve week evaluation period. Following transfer to the ward from another clinical area, it was not medically safe to move each individual onto the Hybrid-Power mattress. Evaluation Inclusion Criteria: All patients were prescribed the Hybrid-Power mattress for a minimum of five days. Evaluation sufficiency requirements:

  • 100 patients completed clinical data forms 
  • 50 staff completed feedback forms 
  • One patient specific case study 
  • Ward Safety Cross data acquired for
  • the three months evaluation period 
  • Ward Safety Cross data gained for same

Results

Pressure Ulcer Incidence

During the three month evaluation period nine patients were admitted with existing pressure damage. The most severe ulcer was a Category III to right shin3, this successfully healed through ward staff interventions. No hospital-acquired pressure related skin damage occurred. Safety Cross6 data identified that this was a reduction in the incidence of one hospital-acquired pressure ulcer from the three months’ data prior to the evaluation and an incidence of seven hospital-acquired pressure ulcers from the same period in 2016. The ward had received training and support on pressure ulcer prevention and management, from the TVN team. These results should not be taken as a result of the mattresses use only. It was highlighted that staff reported issues with getting dynamic mattresses under patients following delivery due to a lack of available bed spaces to safely inflate prior to provision. Having a dual therapy surface providing immediate pressure relief may be a factor in incidence reduction.

Patient Experience

Forty-two patients were able to comment. Patient comments include those who had experienced the pre-existing mattresses and were provided with the Hybrid-Power during the implementation.

16.67% Found the mattress to be very comfortable

  • One patient noted that the pump was less noisy than the previous mattress
  • One patient with bilateral below knee amputation and back pain reported a reduction in pain and a significant increase in her ability to mobilise independently in the bed

76.19 % Found the mattress to be comfortable

  • One patient noted that the mattress had plenty of room
  • One patient noted that it was less noisy than the last mattress
  • One patient with spinal stenosis noted that the mattress was more comfortable than previous mattresses

7.14 % Found the mattress to be quite comfortable

0% Found the mattress to be uncomfortable. Patient length of stay for data collection was a minimum of five days.

One very high-risk patient with a Waterlow score of 26 and BMI of 16.7 with poor mobility, complex health and care needs was nursed on the Hybrid-Power mattress for 75 days. This patient was admitted to the ward with an existing Category III pressure ulcer to his right shin. This healed during his time on the ward.

Another very high-risk patient with a Waterlow score 22 and a BMI of 20 was nursed on the mattress for 64 days with a 3-4 hourly repositioning schedule. No deterioration in skin condition was reported.

There was an average patient stay of 15 days during the evaluation period.

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Acceptability Of The Device For Clinical Staff
100% of staff gave positive feedback on the Hybrid-Power in a clinical setting, with the majority of staff rating the mattress as excellent. Data was collated and evaluated against the following:

  • Install and set up
  • Ease of use 
  • Ease of cleaning 
  • CRP function 
  • Alarm functions 
  • Patient transfer 
  • Confidence in clinical application

Staff Comments

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On evaluation completion, the Ward Manager felt strongly that the utilisation of the Hybrid-Power mattress provided an effective solution and removed another barrier to patients receiving timely dynamic therapy. In a busy clinical setting empty bed spaces are often not available to inflate a dynamic mattress, which means patients are waiting for the support surface. Staff time is also taken up by decontaminating occupied bed spaces to safely set up a dynamic mattress. On evaluation completion, the Tissue Viability Nurse involved noted that the removal of the need to ‘swap out’ mattresses in accordance with patients’ needs, could contribute to a reduction in shear damage and promoted patients’ comfort and safety.

The following outcome measures were also identified;

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Conclusion
This single site large-scale evaluation of the clinical effectiveness, time savings and cost-effectiveness of the Drive DeVilbiss Hybrid-Power replacement mattress in an acute setting, shows conclusively the mattress provided a clinically effective support surface, that fully met patient’s comfort, provided an immediate therapy solution and staff found easy to use. It is a cost-effective solution that reduced time pressures on clinical staff teams and removed the requirement for additional specialist dynamic mattresses. Despite patients having complex needs, skin integrity was maintained during the evaluation with the appropriate utilisation of both dynamic and static functions. Two patients were excluded from the evaluation following a transfer from other wards and remained on specialist dynamic or Low Air Loss mattresses – it is noted that a small number of very complex patients would require specialist mattresses to maintain skin integrity in an acute setting.

The ward has now purchased the Hybrid-Power and will continue to use this product following evaluation. 

The ward is also fully utilising both therapy modes and ‘stepping down’ appropriately which is a positive clinical outcome. The Hybrid-Power promotes re-assessment of equipment and therapy modes on an individual basis. This will have a community impact as patients can be assessed prior to discharge for tissue tolerance on a static foam surface.

In whichever organisation the patient is being nursed, health professionals need to be able to prevent the development of pressure ulcers in vulnerable patients effectively, by employing safe equipment with effective patient outcomes that are cost effective4.

A static led approach can be promoted by having a ward pre-equipped with this dual therapy mattress, providing greater flexibility in prescribing a therapy mode. This promotes ‘step down’ opportunities and raises staff awareness of appropriate equipment assessment.

Releasing Time to Care (RTC) is a programme developed by the NHS Institute for Innovation and Improvement. RTC frees nurses up to spend more time on direct patient care in an improved nursing environment through practical modules applied to improve and streamline hospital ward processes. Powered Hybrid mattresses provide an effective solution both for preventing and managing pressure damage effectively and releasing time to care by removing the requirement to swap and clean mattresses by ward staff5.

References: 

  1. Support surfaces for pressure ulcer prevention - McInnes et al 3 September 2015 Editorial Group: Cochrane Wounds Group 
  2. Iglesias C, Nixon J, Cranny G, Nelson EA, Hawkins K, Phillips A, et al. Pressure relieving support surfaces (PRESSURE) trial: cost-effectiveness analysis. BMJ 2006;332(7555):1416. 
  3. Source: Healthcare Improvement Scotland. Scottish Adaptation of the European Pressure Ulcer Advisory Panel Pressure Ulcer Classification Tool (PDF, 3091K) 
  4. Rafter L. Evaluation of patient outcomes: pressure ulcer prevention mattresses. Br J Nurs. 2011 Jun 10-23;20(11):S32, S34-8 
  5. Healthcare Improvement Scotland and NHS Education for Scotland 2013 www.healthcareimprovementscotland.org www.nes.scot.nhs.uk 
  6. http://www.healthcareimprovementscotland.org/our_work/patient_safety/tissue_viability_ resources/nhsscotland_safety_cross.aspx

 

Image of patient in bed with a nurse 

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Hybrid-Power Mattress Clinical Evaluation