Abstract
People who are unable to move about often suffer from pressure sores. They reduce the quality of their lives, as well as the costs of their healthcare. As opposed to standard mattresses, alternating pressure beds have been shown to reduce the risk of developing pressure ulcers in this population, according to the research that is currently being conducted. According to recent randomized controlled studies and comprehensive reviews, alternating pressure mattresses have been shown to prevent and alleviate the discomfort associated with pressure ulcers. Additionally, alternating pressure beds are recommended for use with hospital mattresses. The modification will be put into action, and then it will be measured and evaluated. Alternating pressure mattresses should be used on all senior patients with difficulty moving to significantly reduce the risk of developing pressure ulcers. This is because these mattresses are both clinically and financially successful. Changes that are supported by evidence have the potential to improve patient outcomes, satisfaction, and treatment.
Alternating Pressure Mattresses for Pressure Ulcer Prevention in Elderly Patients
Introduction
Skin and tissue damage produced by continuous bone pressure is called pressure ulcers, pressure injuries, decubitus ulcers, or bedsores (Cleveland Clinic, 2023). Pressure ulcers are also known as pressure injuries. According to Shi et al. (2021), pressure ulcers are a significant problem for older adults who are less active and have diminished sensory awareness as a result of reasons such as malnutrition, long-term illnesses, and the use of electronic devices. Patients can suffer injuries, infections, immobilization, and even death as a result of pressure sores (Kim et al., 2022). People’s quality of life is negatively impacted, and the cost of healthcare is increased, when they are required to remain in the hospital for extended periods of time, return, and have more complex wound treatments (Li et al., 2022). Pressure ulcer prevention must be adequate to get the best possible results as the older population expands.
Based on the findings of Shi et al. (2021), clinical practice recommendations encourage the use of pressure-distributing surfaces for elderly persons at risk of developing pressure ulcers. Conventional hospital beds made of static foam do not release pressure very effectively. According to the Cleveland Clinic (2023), alternating pressure mats (APMs) can change the air pressure of the mattress on the fly, which helps to alleviate bony prominences and promote cardiovascular circulation. Most hospitals still employ static air beds despite evidence that APMs are more effective (Kim et al., 2022). This is due to the significant cost of APMs. When minimizing the risk of pressure ulcers in senior persons, this page compares and contrasts the most recent evidence about APMs and traditional mattresses. It suggests implementing an APM policy across the entire hospital for all older patients to achieve better outcomes.
Background
Those who are unable to move, have difficulty feeling, and have diabetes or vascular disease, which makes their tissues less able to tolerate pressure and air, are more likely to develop pressure ulcers (Cleveland Clinic, 20293). Pressure ulcers have become more common in older persons. (Shi et al., 2021) Identified risk factors include accidents, inadequate blood flow, a deficiency in food, and the use of electronic devices. In older hospital patients, nosocomial pressure ulcers can afflict as much as twelve per cent of the population, yet they are typically avoidable (Li et al., 2022). Pain, extended hospital stays, delayed recovery, a multitude of therapies, infection, and mortality are all outcomes that are associated with these sores, which result in increased costs (Kim et al., 2022). Methods that are efficient in terms of cost are required to protect older adults from developing pressure ulcers.
According to Meube et al. (2021), APMs constantly use fluctuating air pressures within flexible cells to change support surfaces continually. The release of pressure enhances oxygen flow into the tissue, reducing the risk of pressure ulcer ischemia (Kim et al., 2022). The Cleveland Clinic (2023) discovered that despite being more expensive, APMs are superior to standard beds in terms of their ability to avoid pressure ulcers. To examine the most recent evidence about the effectiveness of APMs over hospital mattresses in lowering the incidence of pressure ulcers in elderly patients, this research employs a PICO inquiry. In elderly adults with limited mobility, does the utilization of alternating pressure mattresses (Intervention) instead of foam mattresses (Comparison) reduce the severity of pressure ulcers and lower the incidence of pressure ulcers? New randomized controlled trials (RCTs) and systematic reviews are analyzed to identify the most reliable data and provide recommendations for changes in clinical practice.
Methods
The search terms “alternating pressure mattress,” “standard mattress,” “foam mattress,” “pressure ulcer/injury,” “elderly,” and “hospitalized patient,” amongst others, produced a significant amount of content. We examined the EBP databases of CINAHL, PubMed, the Cochrane Library, and the Joanna Briggs Institute for works published between 2019 and the present. We looked at English systematic reviews, randomized controlled trials, and data summaries that compared APMs to standard hospital beds to prevent pressure ulcers in elderly patients. The articles must be from the past ten years to provide the most up-to-date information. Exclusion criteria included patients who were not elderly, surfaces found in operating rooms, non-hospital scenarios that included long-term care, and indications of a lower level. Studies that provided consistent and generalizable information and practice suggestions were given more weight to advocate an evidence-based practice change.
Literature Review
One of the primary objectives of treatment is to prevent pressure sores from developing or becoming more severe. Alternating pressure mattresses, also known as APMs, are frequently used as an alternative to conventional mattresses to reduce the likelihood of pressure ulcers in higher-risk individuals. Kim et al. (2022) compiled the findings from several research that investigated how APMs can be utilized to prevent pressure ulcers. The findings indicated that, in comparison to conventional mattresses, APMs had the potential to avoid the development of new pressure ulcers. The review discussed how automated pressure monitors (APMs) automatically redistribute pressure by applying cycles of inflating and deflating, which help relieve pressure on skin that is more prone to injury. Even though several trials had issues, the review concluded that APMs appear beneficial in preventing pressure ulcers. This conclusion was based on the bulk of the evidence.
In a study by Li et al. (2022), APMs were compared to standard mattresses in the context of elderly hospital patients. Through the use of APMs, they reduced the number of new pressure ulcers in older people. When compared to ordinary static mattresses, elderly individuals who are at a high risk of developing pressure ulcers may be less likely to develop pressure ulcers when using APMs, as demonstrated by this study. The authors discussed the potential benefits of employing APMs in preventing pressure ulcers in elderly individuals.
The authors Meaume et al. (2021) investigated the events that transpired with a particular APM overlay product. As a result of their research, they discovered that the APM overlay could reduce the likelihood of pressure ulcers occurring in high-risk individuals compared to the use of standard mattress surfaces alone. To achieve the desired effect of altering the pressure, the patch uses air-filled sacs that undergo a process of expanding and contracting. According to this study, individuals who are more likely to develop pressure sores may benefit from using APM overlays.
While putting up a Cochrane review, Shi et al. (2021) utilized data from several clinical studies that focused on APMs. According to their research findings, APMs are superior to regular mattresses in terms of their ability to avoid pressure ulcers. Through the combination of data from several different randomized studies, this systematic review boosted the statistical power to discover differences between the different types of mattresses. It has been shown that the use of APMs is effective in preventing pressure ulcers from developing in people who are at a higher risk of developing them.
Another comprehensive evaluation was carried out by Shi et al. (2021), who utilized meta-analysis to aggregate the findings of several different investigations. Compared to standard hospital mattresses, the findings demonstrated that APMs are more effective in preventing the development of pressure ulcers. Various types of mattresses were discussed in this review, and this review also made some hazy comparisons between them. According to the current evidence, the findings indicate that APMs are superior to ordinary mattresses in avoiding pressure ulcers. Additional research is still needed to be conducted to compare various APM models and approaches.
Discussion
Air pressure mattresses (APMs) have been shown to significantly reduce the incidence of facility-acquired pressure ulcers in elderly hospital patients compared to foam mattresses alone. According to the Cleveland Clinic (2023), hospitalization makes these patients more fragile and immobile, which raises the risk of ulcers if they do not receive pressure relief. Pressure from weak, subcutaneously thin regions is not repositioned over bone prominences in conventional hospital beds, according to Kim et al. 2022. This results in tissue ischemia, cell death, and skin degeneration (Li et al., 2022). Constant pressure and shear forces are the factors that cause this issue.
According to Shi et al. (2021), the dynamic pressure redistribution devices of APMs are able to improve the distribution of pressure across mattresses. This allows blood and lymph to flow, protecting tissues (Meaume et al., 2021). Cycling APM air cell expansion and contraction does this. As a result of this increased pressure relief, APMs are superior to conventional mattresses in terms of their ability to avoid pressure ulcers and provide patients with clinical benefits. (Li et al., 2022) Even though it is more expensive initially, ulcer prevention is beneficial since it saves lives and minimizes substantial hospitalization, surgical, and therapeutic expenses. In place of wound nurses sending patients to obtain speciality equipment, the broad availability of APM makes it simple to assign patients according to their age and risk factors (Shi et al., 2021). When it comes to senior citizens, regular APM helps to enhance outcomes and speed up care.
Proposed change implementation
The purpose of the hospital is to provide care that is moral, compassionate and centred on the patient. This quality improvement supports that mission. It is possible for older adults to fully participate in their therapies and rehabilitation if they can prevent unpleasant pressure ulcers. This helps them to return home sooner with enhanced strength, mobility, and freedom. The use of APM consistently allows Healthy People 2030 to minimize the number of pressure ulcers of all stages, including those acquired in hospitals, among people aged 65. By doing away with the traditional usage of mattresses, evidence-based APM approaches will improve the quality of care, the experience, and the cost-effectiveness of the treatment.
Over the course of six to twelve months, an interprofessional task group will make this significant practice shift and coordinate its implementation. Members must include nurse managers from all units that treat older patients, wound nurses, and geriatric resource nurses who can provide training to other practitioners. Facilities engineers will be responsible for assessing whether or not the facility can manage extra electricity and how to clean it to prevent infections. Biomedical engineering is responsible for ensuring that the specifications of mattresses are suitable for patients, testing products, directing replacements, and adhering to manufacturers’ maintenance contracts.
Hospital administration can conduct cost analysis and guarantee that system-level approvals are met, while nursing administration is responsible for adjusting policies. Following the establishment of the infrastructure, APM installation will be carried out on a Gantt rollout timetable, unit by unit. Additionally, APMs will be assigned instantly based on the patient’s age through the implementation of individualized software upgrades. Everyone on the shift will receive training from wound specialists and lecturers on how to properly treat APMs to prevent causing damage to sensitive places inside the body that redistribute pressure.
Proposed methods to measure outcomes of the change
Hospital-acquired pressure ulcers in patients 65 and older will be the primary outcome measure. The ulcers in stages 2-4 are an essential secondary measure because of their relationship with various illnesses. Before and after the introduction, data at the unit level will be collected monthly and added every three months. The statistical significance of the data will be determined using the Student’s t-test. The inquiry will consider all factors that influence the frequency of ulcers, including simultaneous feeding, wound treatment, patient turn scheduling, and incontinence care.
Mattress alarm weariness, linen damage while bedmaking, delays in purchasing new mattresses, and facility repairs owing to cord or electrical circuit damage to wall outlets are all potential outcomes of balancing measures. Additional process metrics will monitor the number of elderly patients positioned on APMs instead of conventional beds, and audits will monitor staff compliance with the new skin evaluation and documentation standards. If the study reveals that hospital-acquired pressure ulcer rates are lower across all age groups, unit settings, and risk profiles, then alternative pressure management (APM) guidelines ought to be spread across the entire system to improve outcomes for vulnerable populations at institutions associated with the hospital. On the other hand, if the utilization of staff, electrical loads, product reliability, or any other variables impedes efficacy, the implementation of updated training, improvements to the environment, and collaboration from manufacturers will take place.
Recommendations for Practice Change
Pressure ulcers of a severe nature are more likely to affect older adults. A longer length of stay, difficulties leaving, increased nursing effort, and poorer outcomes are all outcomes that are caused by pressure ulcers in nursing homes. Injury prevention is a nursing healing objective ethical duty that must be fulfilled. APMs can prevent pressure ulcers throughout an entire hospital by redistributing pressure away from tissues at risk and by improving perfusion and tolerance. Patients at risk would no longer experience delays or speciality bed orders if everyone had access to APM.
APMs ought to be obligatory for patients who are of advanced age and high risk. Electronic medical records should automatically issue APMs to patients who are over the age of 65. Because of this, preventative care is improved without the need for manual risk assessments, which can be unsuccessful when staff are busy. Through regular skin checks and Braden scale scores, medical professionals can identify patients who are frail and require specific beds for help and tracking. All shifts must undergo comprehensive APM competence training to execute and maintain practice change successfully. New employees must undergo annual refresher training on operating an air pressure monitor (APM) safely to prevent the internal air tubes that transfer pressure from being damaged. Teaching gentle movement and using sliding sheets and lifts is essential to prevent chambers of air from being pushed. During the process of passing patients over and checking their records, the staff should report any instances of tube disconnections or air leakage.
Collaboration and communication make use easier to grasp. When relocating a patient from one bed to another, all new paperwork, care plans, and electronic medical records (EMRs) must include an APM. Following a patient from the time of admission till the time of discharge allows for a better understanding of the pressure relief steps. In the event that charged APM surfaces are not turned off, EMR warnings may be triggered. Standards can be monitored and communicated by leaders. An implementation committee ought to be in charge of handling the specifics of the setup. The number of APMs that each output can manage during load testing is determined. This helps establish a schedule for the replacement and enhancement of infrastructure. When consumers are trying to decide whether to buy or rent, they can benefit from cost studies that take into account upfront fees, maintenance contracts, and the lifespan of the equipment.
Some of the best APMs feature long-lasting components that may keep their pressure even after years of use. Regarding 65-year-olds, pressure ulcers before and after the implementation of APM are indicative of costs and effects. Significant ulcers in stages 2-4 are substantial. Testing statistical data on a unit-by-unit basis can be used to identify monthly and annual trends. Tests will be conducted to determine the appropriate utilization of APM assignment rates and staff commitment. Keep an eye out for alarm weariness. Regarding wounds and costs, low-pressure wounds indicate that disadvantaged people receive better care.
Conclusion
Contemporary alternating-pressure mattresses, designed to change pressure continuously, are superior to conventional beds in terms of preventing the development of severe and bothersome pressure ulcers in elderly hospital patients. According to the findings of this study, all elderly patients should be provided with APMs rather than mattresses throughout the entire institution. A patient-centered, evidence-based care that satisfies ethical and quality criteria to prevent harm is an illustration of what the APM guidelines are. By providing regular pressure relief with APMs, thousands of older adults will experience improvements in their skin, healing, freedom, and overall health results. Investments can improve the lives of many older people in APMs.
References
Cleveland Clinic. (2023, February 24). Bedsores (Pressure Ulcers): Symptoms, Staging & Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17823-bedsores-pressure-injuries
Kim, S., Kim, H., An, J., Lee, Y., & Shin, Y. (2022). Effects of alternating pressure air mattresses on pressure injury prevention: A systematic review of randomized controlled trials. Worldviews on Evidence-Based Nursing, 19(2), 94–99. https://doi.org/10.1111/wvn.12570
Li, Y., Zeng, X., Wang, J., & Wang, C. (2022). What is the better choice for nurses? Alternating air pressure mattresses versus static air mattresses to prevent pressure ulcers in elderly hospitalized patients. Medicine, 101(13), e29084. https://doi.org/10.1097/md.0000000000029084
Meaume, S., Rousseaux, C., & Marty, M. (2021). Incidence of pressure ulcer in patients using an alternating pressure mattress overlay: the ACTIVE study. Journal of Wound Care, 30(2), 143–149. https://doi.org/10.12968/jowc.2021.30.2.143
Shi, C., Dumville, J. C., Cullum, N., Rhodes, S., Jammali-Blasi, A., & McInnes, E. (2021). Alternating pressure (active) air surfaces for preventing pressure ulcers. Cochrane Database of Systematic Reviews, 5(5). https://doi.org/10.1002/14651858.cd013620.pub2
Shi, C., Dumville, J. C., Cullum, N., Rhodes, S., McInnes, E., Goh, E. L., & Norman, G. (2021). Beds, overlays and mattresses for preventing and treating pressure ulcers: an overview of Cochrane Reviews and network meta‐analysis. The Cochrane Database of Systematic Reviews, 2021(8), CD013761. https://doi.org/10.1002/14651858.CD013761.pub2
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