Support Surface

Keeping Careful Watch

Wound care is a serious issue, and it is the reason why support surfaces are such a critical element of many HME providers’ offerings. Unless a patient has the right support surface, they can develop pressure ulcers that could require extensive medical treatment. The exact support surface is critical in ensuring that the patient’s wounds heal completely.

Key in understanding what mattress solutions are right for which patient is understanding pressure wound staging. Here is a very basic review of wound care staging:

  • Suspected Deep Tissue Injury — A purple or maroon area of discolored intact skin or blood-filled blister.
  • Stage 1 —Intact skin with non-blanchable redness of a localized area usually over a bony prominence.
  • Stage 2 —Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, but without slough.
  • Stage 3 — Full thickness tissue loss with visible subcutaneous fat. Slough might be present and the wound might include undermining and tunneling.
  • Stage 4 —Full thickness tissue loss with exposed bone, tendon or muscle; slough or eschar might be present; and will often include undermining and tunneling. • Unstageable —Full thickness tissue loss in which the base of the ulcer is covered, or eschar in the wound bed.

Generally, the more severe a pressure wound, the more complex the mattress that will be required. A patient with a single stage 2 sore or less might simply need a gel overlay, while a patient with multiple stage 3 or 4 wounds might need a low-air loss, alternating pressure mattress.

But wound care through support surfaces is not a “fire and forget” sort of process. It requires careful monitoring and follow-up to ensure that the patient is either not developing ulcers or that the patient’s wounds are healing.

First off, providers must undertake a solid assessment of the patient and the care he or she is receiving and from whom. The provider must know how much time a day the patient is spending sitting or lying down, how much ability to move themselves, what the patient’s diet is like, and whether or not incontinence is a factor. That initial assessment can tell the provider a lot about how the patient might fare and what care challenges might be present.

“It goes back to going in the home, assessing the situation they’ve got,” explains Brad Heath, operations and compliance manager for Family Medical Supply. “What kind of caregivers do they have? What’s the environment like? What is their support system? You can go into the home, look at the care the patient is getting, and kind of know what’s going to happen.”

Pivotal Player

Supporting a patient means partnering with them and their family members and caregivers. While a provider can check in, the key is to give the patients and the people caring for them the tools and information that can help them ensure the patient is not showing signs of a pressure sore.

First and foremost, beyond anything we can put in the house, there’s the caregiver,” Heath says. “Whether it’s the patient or someone else, it doesn’t matter what we put them on if they are monitoring the situation themselves.

So providers need to be in a position where they can assess first-hand, but also be able to communicate with physicians, patients and caregivers, and ensure everyone is on the same page is critical, he says. This will help the provider more quickly determine if changes need to be made. This also presents the provider with not only an option to ensure the patient is getting the right care, but the provider can demonstrate its expertise and commitment to care, and if the support surface needs to be increased, then the provider can gain additional reimbursement, as well.

A Must-Do

Monitoring a patient with a phone call every 15, 30, 60 and 90 days to monitor patient condition and progress is not only good policy from a care and business perspective, but in the case of a Group 2 or Group 3 surfaces, then the provider must be following up every 30 days from a compliance standpoint in order to ensure proper documentation, notes and home health notes, Heath says.

Incontinence and Diet

If a patient is incontinent, it is incredibly important for caregivers to be reliable and properly educated on how to care for the patient and ensure he or she is clean. Besides incontinence garments being regularly changed, the provider must provide ample instruction on how to clean care for patients that might not have any sensation in areas that need to be cleaned. This can be particularly difficult for family members who might feel that they are invading the patient’s privacy, so care must be taken to convey the importance of this sort of care, Heath notes.

Likewise, diet is essential in proper healing. A low-sugar, high-vegetable, high-protein and overall healthy diet will contribute greatly to a positive outcome for the patient, Heath says. In many cases a home health provider will offer diet support or a dietician. It might also work to the providers’ benefit to enlist the services of a dietician. At the very least, providers should be offering instruction on baseline healthy dietary habits to the patient and caregivers about the types of diet that can help patients heal.

Points to take away:

  • The provider must start by assessing the patient’s current situation. That will tell the provider much about what must be done, and how care will likely progress.
  • Patients and caregivers must be enlisted at the beginning of the process so that they can be educated on how to assess and monitor wounds, and communication must be regularly undertaken to monitor the process.
  • When the patient is on a group 2 or group 3 support surface then monitoring becomes a compliance requirement.
  • Providers must ensure caregivers and patients are properly educated on incontinence care and how it relates to wound care. Diet education is also pivotal, since diet contributes greatly to the healing of wound.

Learn more:

Visit the National Pressure Ulcer Advisory Panel website to read complete guidelines on staging pressure sores at

This article originally appeared in the June 2012 issue of HME Business.


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