Choosing a Support Surface
Overlay or Mattress Replacement?
Support surface overlays are positioned on top of the existing support surface to provide additional pressure redistribution. They have the advantage of being quick and easy to fit and not requiring the existing mattress to be removed and stored elsewhere. In a home care setting and overlay placed on one side of the bed may also allow partners to continue sharing the same bed. However overlays may raise the total height of the bed making getting in and out of the bed more difficult, or cause safety issues if bed rails are in use.
Selection of an appropriate support surface should take in account risk factors for pressure ulceration as well as patient factors, ease of use and impact on nursing procedures. It is also important to take the views of patients and carers into account when selecting a support surface. However decisions on which support surface to choose are often limited by availability and funding issues.
Factors to consider when choosing a support surface
Weight and size of the patient
The weight limit of the support system should not be exceeded. Obese patients may need a bariatric support surface.
Patients who are very light or small may not sink into a reactive surface sufficiently to produce adequate pressure redistribution.
Some air filled surfaces can be adjusted for patient weight
Ease of Use
Is training required in the use of the surface?
The length of time before the support surface is ready to use (is there inflation time?)
The support surface must fit the space for it’s intended use. Can it be transported to the space easily? Some integrated bed systems are unsuitable for home settings because of their bulk and weight and the need for a generator in case of loss of electrical power.
How easy is the surface to clean and decontaminate?
Does the support surface need specialist maintenance? – Some support surfaces need to be taken off site for specialist cleaning between patients.
Impact on Nursing Procedures
Some integrated bed systems include a “turn assist” feature that helps with repositioning, examinations and linen changes.
Overlays may raise a bed surface height to a level where bed rails no longer prevent falling, or cause difficulties for patients getting in/out of bed: If an overlay is required consider using a reduced depth base mattress.
If the support surface lacks a firm edge, a patient previously able to transfer/stand from the bed may no longer be able to.
Some patients who are able to reposition themselves on a standard mattress might find that they are not able to do so on some support surfaces.
A patient with a high level of skin moisture or who has a highly exuding would may be best nursed on a low air loss or air-fluidising surface.
Support surfaces can influence the microclimate of a patient’s skin (eg foam mattresses tend to increase skin temperature and gel-filled products initially have a cooling effect but this wears off over time? So this must be taken into account when choosing a patient’s support surface.
Patient Comfort and Choice
Some support surfaces make a noise during operation that may disrupt sleep.
Some patients find the sensations produced by lying on some support surfaces disturbing or painful.