Support surfaces for pressure ulcer prevention

McInnes, Elizabeth; Jammali-Blasi, Asmara; Bell-Syer, Sally EM; Dumville, Jo C; Cullum, Nicky

doi:10.1002/14651858.cd001735.pub4

Cited by 106 publications

(55 citation statements)

References 110 publications

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“…All were found to be genuinely uncertain with the exception of one patient submission. A systematic review found reliable evidence for the use of medical grade sheepskins for the prevention of pressure ulcers 180 and so this was removed from the list. Partial evidence was found to answer two uncertainties submitted by patients and clinicians: the effectiveness of support surfaces for prevention and the use of nutritional interventions for prevention.…”

Section: Collationmentioning

confidence: 99%

“…13 that compression is an effective intervention for healing venous leg ulcers 184 and that higher-specification foam mattresses reduce the incidence of pressure ulceration compared with standard hospital foam mattresses. 180 This said, it should be acknowledged that the standard systematic review methods can be restrictive as they are based mainly on pairwise comparisons and group-level data. Other, more advanced, systematic review and meta-analysis methods are now available that may be more informative in areas of persisting uncertainty.…”

Section: Introductionmentioning

confidence: 99%

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Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Collationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

Self Cite

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“…The use of dynamic support surfaces purports to cause a reduction in pressure ulcer formation in high risk patients (Inma et al, 1993). However, the effectiveness of existing dynamic support surfaces in reducing incidence of pressure ulcers remains controversial (Reddy et al, 2006;McInnes et al, 2011;Qaseem et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…However, all existing dynamic support surfaces are based on regular patterns of supports with no optimization of support array, size, shape, etc. While there are several dynamic interfaces in use currently, there is no definitive evidence of enhanced pressure ulcer prevention with their use (Reddy et al, 2006;McInnes et al, 2011;Qaseem et al, 2015). Furthermore, the support array sizes, shapes and patterns for dynamic support surfaces has not been optimized.…”

Section: Introductionmentioning

confidence: 99%

Pressure Ulcer Prevention: Optimizing a Temporally Redistributing Support Interface

Peterson¹,

Healey²,

Visser³

et al. 2016

American Journal of Engineering and Applied Sciences

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Abstract:One of the most common complications from long-term wheelchair use or bed rest is pressure ulcers. Pressure ulcers have significant morbidity and are associated with high mortality. Prolonged sitting can cause high pressures in the skin and subcutaneous tissue which can lead to local ischemia and breakdown of skin. Rapid relief of pressure prevents ulcer formation. One prevention strategy is to change the temporal distribution of pressure at the interface between user and surface so that no one area is subjected to high pressures for long periods of time. While there are several dynamic interfaces in use currently, there is no definitive evidence of enhanced pressure ulcer prevention with their use. The purpose of this research was to parametrically evaluate interface array sizes, shapes and patterns for dynamic support surfaces to optimize pressure redistribution to prevent pressure ulcers. Finite element analyses, anatomical phantom deep tissue pressure measurements and interface pressure mapping were used to test various support geometries and sizes and different array spacing and patterns. Results indicate that modulating pressure in an array of supports that are equally spaced is not effective. Only interrupted pattern arrays resulted in sufficient pressure reduction. These data suggest that dynamic surface supports can be optimized based on the geometry and size of the individual supports and the pattern of the array to further reduce the likelihood of pressure ulcer formation.

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“…while awaiting surgery or immediately afterwards) may benefit from the use of an alternating pressure mattress, but this should never replace the need for repositioning (see keep moving below). The relative merits of these higher specification support surfaces in preventing pressure injuries are unclear [11]. Once the patient can sit out of bed, it is essential that risk of pressure injuries is still acknowledged and a pressure redistributing cushion is used until the patient is fully mobile.…”

Section: Evidence-based Preventive Interventionsmentioning

confidence: 99%

Pressure Injury Prevention and Wound Management

Hommel

Santy‐Tomlinson

2018

Perspectives in Nursing Management and Care for Older Adults

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The management of wounds and the prevention of pressure injuries (also known as pressure ulcers) are fundamental aspects of the management of the patient following fragility fracture, especially following hip fracture and associated surgery. Ageing skin and multiple comorbidities are significant factors in skin injury and wound healing problems. The aim of this chapter is to provide the reader with an overview of evidence-based approaches to the prevention of pressure injuries and to wound management following hip fracture surgery. Learning OutcomesAt the end of the chapter, and following further study, the nurse will be able to:• Explain the causes and pathophysiology of pressure injuries • Recognise risk factors for pressure injury in patients following hip fracture • Provide evidence-based care to patients at risk of pressure injury • Discuss the factors that inhibit and enhance wound healing • Provide evidence-based care to patients with surgical wounds following fragility fracture surgery.

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Support surfaces for pressure ulcer prevention

Cited by 106 publications

References 110 publications

Wounds research for patient benefit: a 5-year programme of research

Wounds research for patient benefit: a 5-year programme of research

Pressure Ulcer Prevention: Optimizing a Temporally Redistributing Support Interface

Pressure Injury Prevention and Wound Management

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