Air Bed vs Foam bed

PICOT: In critical Care Unit (P), is the Air-Bed (I) compared with the standard foam hospital bed (C) reduces or influences the development of pressure ulcers (O) over a six-month period? (T)

Purpose of the study

Facility acquired pressure ulcers is a preventable problem that costs 9-11 million dollars and affects 2.5 million people every year. The problem seems to be a constant topic of concern over the years. Furthermore, $17,000 lawsuits were related to pressure ulcers and 60,000 patients died as a result of PU in 2014. (Agency of Healthcare Research and quality, 2014). Most patients develop pressure ulcers due to being positioned at a 30-degree angle to prevent pneumonia, protein deficiency, immobility, increased skin moisture. Additionally, multiple comorbidities also influence incidence of pressure ulcers such as cardiac disease, renal disease, or musculoskeletal problems. The standard repositioning every two-hours protocol alone does not decrease the incidence of PUD. Consequently, new technology has developed the use of air mattresses, but then again, the question is: does an air mattress decrease PU vs. a standard mattress? Does having a patient in the “air” avoid trigger points and is the money spent on a Hill-Rom mattress the answer? Let’s explore the options…

Air Bed vs. Foam Mattress

According to Jackson, Mckenney, Merrick, Lemaster & VanGilder (2011), by using an Air Fluidized Therapy bed a critically ill patient significantly decreases the incidence of pressure ulcers. The beds provide low intermittent pressure between the patient and the surface, which causes the patient to float in the air and therefore minimizes friction. In the study, the approximated rent cost of the air beds was $18,000 for 28 patients. The outcome revealed that only one patient out of the 28 in the study, developed a pressure ulcer which decreased the incidence of PU by 40% during the trial (p.51). According to the Hill-Rom’s website, the bed also provides moisture control by keeping the skin cool and dry making the “skin not susceptible to damage” (HillRom.com).

It’s not all about the beds, but also about the assessment routine, the staff, and hospital policies regarding pressure ulcers. There is much more work to do when it comes to pressure ulcer prevention. Some of the issues include lack of assessment, lack of sufficient staff, and no reposition schedule performed. In the study, turning logs were not done consistently due to the lack of staff and workload. A patient can be on a Hill-Rom bed, but if a turning schedule is not performed a pressure ulcer is most likely to occur. Also, the use of foam dressing to the affected area can aid with healing of a deep tissue injury or beginning stages of PU. Ultimately, nurses need more support to perform duties and the hospital’s administration need to provide more support to the staff. Air bed can aid and decrease friction, but if the patient stays in the same position the ulcers will develop. (Sving, Idvall, Högberg, & Gunningberg, 2014).

EBP Model Discussion

The original Stetler/Marram model for RU was published in 1976, but it has undergone three revisions. The model, guides us by providing a series of steps to successfully conduct an Evidence-Based research. I have selected this model since it applies a practitioner oriented model, where the practitioner has more say on the results of the study. Moreover, internal evidence is obtained from clinical practices and external evidence is provided from actual research. Steps of Stetler model: preparation, validation, comparative evaluation/decision making, translation/application, and evaluation.

Stetler Model

Preparation: First the researchers will identify the need and prioritize the change. At this point, organization will be extremely important. Research will be gathered to prove stakeholder’s recent literature on the uses of different mattress in the hospital.

Validation:  After all literature has been obtained, a systematic review will be conducted to obtain validity before presenting the EBP to others.  

Comparative evaluation/decision making: Expose the need for an air mattress change. Introduce an assessment/intervention approach vs changing to an air bed. At this stage, education will be given to all staff regarding PU assessment and intervention. Also, make clear that intervention needs to be completed even if a patient is on a Hill-Rom bed.

 Translation/application: During the application models, the stakeholder will put the practice in place for six months. At this point a structural detail of the change will be provided to the stakeholders.

Evaluation: The last step is to appraise if the EBP has been carried out and to grasp if the goal has been met.

Clinician Involvement

Involved stakeholders consist of: Director of Nursing, nurses, Nurse Practitioners, Physicians, and nurse’s assistances. Physical therapist will also play an important role during the trial. The Seltler Model will be implemented to guide the team members during the process. First, education to all involved parties will be provided by conducting in-services for a month before the EBP is implemented. Contact information will be provided for staff members to address questions and concerns. This will include the Hill-Rom’s troubleshooting access line.

Education or in-service to staff will include the following:

1. Proper assessment of patient for risk factors of PU.
2. Reinforcement of PU stages.
3. Turned schedule.
4. Use of foam dressing and barrier creams
5. Need of air bed.

 

 

 

Expected Outcomes

At the end of the six-month trial, the EBP will conclude its trial timeline. Normally, we would want to see a zero incidence of pressure ulcers, but a decrease of at least 20% will indicate improvement.

 Expected outcomes:

1-      Decreased cost to patient.

2-      Nurse satisfaction: decrease in dressing changes decreases work load.

3-      Decreased cost of bed.

4-      Increased family and patient satisfaction.

Timeline

	Month 1	Month 2	Month 3	Month 4-6
Prepare evidence	X
Validation	X
Planning the approach	X
Presenting the EBP
Implementing the change		X	X
Evaluating the change and outcome				X

 

 

 

 

Budget

The nurse educator will take lead in this process by providing education of turning schedule and assessing the need of the airbed. Also, supplies such as foam dressings and barrier creams are already included. A nurse educator is already included in the budget of the hospital. Printout information in a form of a pamphlet will be given to all nurses and staff in the all units which will cost 0.10c per page. A total of 500 copies will be printed for a cost of $50 total budget. Additionally, a Hill-Rom representative will be rounding with the educator to educate the staff regarding bed purpose, uses, and troubleshooting at no cost.

Equipment/Supplies/Resources

Equipment, supplies, and resources are already in use in the facility. These are: beds, stretchers, mattresses, foam dressings, and barrier creams. Pamphlet will be provided at the time of the in-services. Furthermore, there will be presented an expected staff-to-patient ratio to the CEO indicating better outcomes for patient, overall satisfaction, and low costs.

Conclusion

            Standard foam hospital beds are hard surfaces for the older hospital population. Pressure ulcers is a preventable problem as long as the nurses have the right equipment and hospital support. Air beds do help with prevention, but it is essential to also assess the patient and continue repositioning to further help with decreasing pressure ulcers. Hill-Rom aids to decrease the incidence of such problems, but it does not magically prevent ulcers. There is an involvement of medical personnel to completely avoid the issue.

 

References

 Agency for Healthcare Research and Quality, Rockville, MD. (2014). Preventing Pressure Ulcers in Hospitals Are we ready for this change? Retrieved from: http://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool1.html

Jackson, M., McKenney, T., Drumm, J., Merrick, B., LeMaster, T., & VanGilder, C. (2011). Pressure Ulcer Prevention in High-Risk Postoperative Cardiovascular Patients. Critical Care Nurse, 31(4), 44-53. doi:10.4037/ccn2011830.

Sving, E., Idvall, E., Högberg, H., & Gunningberg, L. (2014). Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study. International Journal Of Nursing Studies, 51(5), 717-725. doi:10.1016/j.ijnurstu.2013.09.007