In Juliet’s quest to tell Romeo that it was he that she loved and not his name, she uttered the now famous line, “What’s in a name? That which we call a rose, by any other word would smell as sweet.” While this might be true in romantic tales, many experts and researchers working to define the term “support surface” might disagree on the significance of a name.
The National Pressure Ulcer Advisory Panel recently released its first draft of its Support Surface Initiative, a three-year project aimed at defining the term “support surface” and determining what products fall into a “support surface” category.
Names such as static, dynamic, pressure reduction and pressure relief are jus some of the words tossed around when people discuss support surfaces. As a result, terms and words have changed and been misused, and NPUAP set out on a mission to clear up the confusion.
“The committee was formed out of a NPUAP initiative and a realization for the need to standardize support surface terminology,” said Darren Hammond, director of training and education at The ROHO Group. “Once they determine terminology, they will be able to come up with testing criteria to be able to establish a baseline of products and determine if those products do what they say they are going to do,” Hammond said.
According to the National Pressure Ulcer Advisory Panel’s (NPUAP) Support Surface Initiative’s new support surface terms and definitions draft statement (2006), a support surface is defined as: “A specialized device for pressure redistribution designed for management of tissue loads, micro-climate, and/or other therapeutic functions (i.e., any mattresses, integrated bed system, mattress replacement, mattress overlay or seat cushion, or seat cushion overlay.”
According to the new definition, it is clear that wheelchair cushions are considered support surfaces.
“Yes, under the NPUAP definition ‘a specialized device for pressure redistribution’ wheelchair cushions are considered support surfaces,” said Cynthia Fleck, MBA, BSN, RN, APN/CNS, ET/WOCN, CWS, DNC, DAPWCA, FCCWS, secretary/treasurer of the American Academy of Wound Care (AAWM) and member of the Board of Directors of the Association for the Advancement of Wound Care (AAWC).
“It is absolutely necessary for our industry to have standardized terminology. Without it, no one can discuss products from a research and clinical standpoint,” Hammond said.
NPUAP is welcoming feedback from the support surface community on the draft of its support surface terms and definitions.
According to Hammond, a few of the terms are likely to be revised. “The plan is, once the standards are finalized, to turn the definitions into the International Organization of Standardization (ISO) so that these terms can be used nationally as well as internationally.”
Hammond said the work, rigor, and revision that was put into the first draft was quite an undertaking, “especially to please everyone — from clinicians and manufacturers.”
NPUAP’s Components of Support Surfaces
A means of encapsulating a support medium.
- Viscoelastic — A type of porous polymer material that conforms in proportion to the applied load, and to the rate of loading.
- Elastic — A type of porous polymer material that conforms in proportion to the applied load.
- Closed Cell — A non-permeable structure in which there is a barrier between cells, and gases or liquids from passing through the foam.
- Open Cell — A permeable structure in which there is no barrier between cells, and gases or liquids can pass through the foam.
A semisolid system consisting of a network of solid aggregates, colloidal dispersions or polymers which may exhibit elastic properties.
A cushion-like mass of soft material used for comfort, protection or positioning.
A fluid with a relatively high internal resistance to flow.
Any material that can be repeatedly stretched to at least twice its original length; upon release of the stretch will return to approximately its original length.
Features of Support Surfaces
A feature of a support surface that provides pressure redistribution via a fluid-like medium created by forcing air through beads as characterized by immersion and envelopment.
A feature of a support surface that provides pressure redistribution via cyclic changes in loading and unloading as characterized by frequency, duration, amplitude, and rate of change parameters over the active area of the surface.
A feature of a support surface that provides rotation about a longitudinal axis as characterized by degree of patient turn, duration and frequency.
Low Air Loss
A feature of a support surface that provides a flow of air to assist in managing the heat and humidity (microclimate) of the skin.
Categories of Support Surfaces
Reactive Support Surface
A powered or non-powered support surface that changes mechanical load distribution only in response to external forces.
Active Support Surface
A powered support surface, with the capability to change its mechanical load distribution properties, independent of external forces.
Integrated Bed System
A bed frame and support surface that are combined into a single unit whereby the surface is unable to function separately.
Any support surface not requiring or using external sources of energy for operation.
Any support surface requiring or using external sources of energy to operate.
A support surface designed to be placed directly on top of an existing mattress.
A support surface designed to be placed directly on the existing bed frame.
For more information on the terms and definitions of support surfaces visit www.npuap.org.
HHP Question: Is Reimbursement Keeping Up with Trends in Technology for Wound Care?
Answer: “Unfortunately, NO, not in every aspect,” said Darren Hammond, director of training and education for The ROHO Group. “There are a lot of things which are covered which truly do not have the evidence behind their use. Conversely, there are a lot of other technologies out there that do have strong evidence, but reimbursement is slow to follow. We need the evidence to drive what we do in wound care. We also need the technology to be used appropriately; not just because it is the new “fad” in wound care. Technology should not be approved unless there are randomized double blind studies behind the efficacy of their use. We spend so much time with the technology and less time thinking why the patient may not be healing. Until physicians and health care practitioners are better educated throughout the country in the correct physiology of wound healing and stop ordering archaic dressing and doing things based upon ritual, the art and science of wound healing will suffer. There needs to be less focus on all of the “motions, lotions, and potions” and more time dealing with
and addressing the individuals “system” for potential healing or lack thereof. In addition, until there is reimbursement for prevention, I will never be able to say that we are keeping up with the time and technology used for wound care.”