The 2014 HME Handbook: Support Surfaces

How to Help Achieve Optimal Outcomes for Support Surface Patients

Providing Support SurfacesPreventing wounds, caring for wounds and ensuring they heal lies at the heart of providing therapeutic support surfaces. Providers of support surfaces key players in ensuring that the patient enjoys an optimal issue, because of their product knowledge.

Unless a patient has the right support surface, they can develop pressure ulcers that could require extensive medical treatment.

So providers must ensure that patients have the exact support surface they need. And that’s not necessarily a simple process. Various factors, such as the patients, weight, age and mobility can factor into the mattress choice, just as much as how far advance a patient’s wound might be. Also the homecare environment, diet, available funding and other factors can play a role in what mattress will get provisioned and how it will fit into the patient’s care.

So, while providers are, in the very basic of terms, providing a mattress, the business of offering support surfaces goes much further than that. After assessing patient needs and providing a mattress, the support surface provider is involved in that patient’s care until the end, and that requires regular communication with the patient and caregivers, as well as educating them on key aspects of care related to the support surface.

Bearing all that in mind, let’s take a look at some of the things support surface providers need to consider when trying to achieve optimal outcomes for their patients:

Wound Staging

Key in understanding what mattress solutions are right for a patient is to understand pressure wound staging. For a basic gist, here is a summary of the National Pressure Ulcer Advisory Panel’s wound stages:

Suspected Deep Tissue Injury — This will have a purple or maroon localized 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 by an eschar in the wound bed.

Mattress Types

There are many effective mattresses, but be aware that no one mattress can effectively address all patients. Matching the right mattress to the patient versus a patient to a mattress is key to effectively addressing any wound care issue. 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. 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. 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. True low air loss with alternating pressure is a good solution for treating pressure wounds.

Monitoring Patients

One thing that can really make a difference is simply keeping in touch. Monitoring a patient with a phone call every 15, 30, 60 and 90 days to check patient condition and progress is a good policy from a care and business perspective. Moreover monitoring can be required. For a Group 2 or Group 3 surface used by Medicare beneficiaries, 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.


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. In fact, it can 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 foods that can help patients heal.


If a patient is incontinent, it is incredibly important for caregivers to be reliable and properly educated on how to clean and care for the patient. 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 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 providing this care.

Points to Remember:

  • In order to understand what mattresses are ideal for different patients, providers must have a solid grasp of pressure wound staging.
  • They must also be product experts and fully understand the capabilities of different therapeutic supports surfaces and how they apply to different wounds.
  • Regularly monitoring patients is beneficial for outcomes and can even be required for certain mattresses under Medicare guidelines.
  • Proper diet and managing incontinence are fundamental in ensuring optimal wound care and healing.

Learn More:

  • The wound staging information provided in this article is a basic overview, but the National Pressure Ulcer Advisory Panel provides highly detailed guidelines on staging pressure sores and illustrations of pressure sores online at

This article originally appeared in the June 2014 issue of HME Business.

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