How to Match Mattresses to Bariatric Patient Needs
The population of bariatric patients is increasing, and with them the need for mattress solutions that fit those patients’ needs. Obesity rates for adults aged 20 and older are at 34 percent, according to the Centers for Disease Control & Prevention, and these patients need help from HME providers, especially when it comes to wound care and prevention.
Bariatric patients run a high risk of developing pressure sores due to their weight. If an overweight patient is sleeping on the wrong mattress, factors such as shear, heat and moisture can rapidly result in a pressure sore. Moreover, these pressure sore can become infected if left untreated, and that can become a life-threatening condition. (For more information on pressure sore staging, see the Learn More box accompanying “How to prevent pressure ulcers in mobility patients,” on page 42.)
Likewise, there are a variety of mattress types and technologies to help prevent and address pressure sores, and providers must understand which ones are right for each patient.
Pair an increasing patient population with the variety of mattress options related to treatment and prevention of pressure ulcers, and the learning curve gets a bit steep. What do providers need to consider when matching mattresses to patient needs?
Understand the solutions. There are two standard mattress types that have been on the market for some time: low air loss mattresses and alternating pressure mattresses. Low air loss mattresses provide airflow to help keep skin dry, as well as to relieve pressure. Both features help prevent pressure ulcers. Alternating pressure mattresses help treat pressure sores by providing two sets of air cells that expand and contract on an alternating basis so as to continually shift pressure.
A somewhat newer type of mattress involves three cells, which help relieve even more pressure than an alternating pressure mattress with two sets of cells. In a three-cell mattress, when two sets of cells are inflated, the third is deflated. This arrangement allows the mattress to “bridge” the patient across more cells than in a mattress with two sets of cells, and thusly relieves more pressure than a standard alternating pressure mattress.
Generally, the more severe a pressure wound, the more complex the mattress that will be required. A patient with a single stage two sore or less might simply need a gel overlay, while a patient with multiple stage three or four wounds might need a three-cell mattress.
Understand patient needs. Bariatric needs are perhaps the most complex. To begin with, bariatric patients often require treatment of other co-morbidities. A bed that articulates to help treat those other conditions, such as raising the legs in the case of edema or changing the position to aid a respiratory condition, might be required. This can affect the mattress choice.
Reliability is a key factor. You don’t want a mattress to fail on a patient that is at risk for pressure ulcers, so reliability is an important element in selecting the right mattress. Foam mattresses can break down and blower motors can overheat and fail. Make sure to look at blower motors and pumps that can hold up to a around-the-clock use. For instance, motors that use air that is already in the cells, rather than those that circulate outside air into the mattress, won’t have to work as hard.
Assess the patient’s circumstances. A good place to start in providing beds is to go to the patient’s home and conduct a walk-through. This is especially important in working with bariatric patients who might have special requirements when it comes to negotiating their homes. Ensure the sleeping area is large enough and free from clutter in order to accommodate the larger bed and support surface that the patient will need.
Sites visits offer an opportunity to educate patients about the type of support surface they should be using, as well as answer any questions. A site assessment gives the provider the opportunity to assess other medical conditions that can shape the decision for what kind of bed or support surface a patient might need. For instance, issues such as oxygen and nutrition could impact the healing of a pressure wound, and thus the effectiveness of a mattress.
Inventory expense. Funding and expense are pivotal considerations when it comes to providing support surfaces. A mattress that is designed to treat a serious pressure wound can cost as much as $3,000. Moreover, it’s safe to say that a mattress designed for bariatric patients can cost twice as much as a standard support surface. So, while Medicare or private payor insurance might cover the mattress, that’s a significant expense to have sitting on the books while the funding gets sorted out.
Points to take away:
- The population of bariatric patients is on the rise and so too is the incidence of pressure sores.
- There are various types of mattresses and support surfaces designed to prevent and treat pressure sores. Different mattresses address different wound care needs.
- Bariatric patients can have co-mobidities that can affect the mattress choice.
- Reliability is a key consideration when providing support surfaces.
- So is the expense of the equipment, as bariatric mattresses can cost much more than average-sized versions.
Drill down into the HME Business site for a number of special areas on mattresses and bariatric patients:
This article originally appeared in the July 2009 issue of HME Business.