While there are scant statistics on the increasing number of patients with pressure ulcer concerns that require special mattresses, providers do know that the population of those patients is growing, and that they must find ways to serve them.
For instance, obesity rates for adults age 20 and older are at 34 percent, according to the Centers for Disease Control & Prevention. Moreover, we know that the U.S. population is aging, which means more elderly patients with thinner skin.
Pair an increasing population with the variety of mattress options and features related to treatment, and the learning curve gets a bit steeper. What do providers need to consider when matching mattresses to patient needs?
Understand technology developments. “There are some new technologies out there, and a lot of people do not understand the differences in those technologies,” says Dan Anderson, vice president and co-owner of Ft. Worth Texas-based provider Woundkair Concepts Inc. To begin with, Anderson says there are two standard mattress types that have been on the market for some time: standard low air loss mattresses and alternating pressure mattresses. “The big difference in the market has been three-cell technology,” he says.
Typically an alternating pressure mattress has “A” and “B” cells, which alternate in pressure. When A cells are inflated, the B cells are deflated and vice versa. A three-cell mattress has A, B and C cells.
“When the A and B cells are inflated and the C cell is deflated, you have two inflated cells on either side of a deflated cell, and you can bridge the patient,” Anderson explains. “This relieves more pressure than you can with just one cell across from another cell. That is the biggest step in alternating pressure in the last several years.”
This sort of mattress would be used for patients with multiple stage three or four pressure wounds. (See “Learn More” for more information on the pressure ulcer staging.)
Understand cost and coverage. “That’s one huge consideration you have to take in,” Anderson says. Support surfaces designed for patients with serious pressure wounds can cost in the $2,000 to $3,000 dollar range. Medicare and private payor insurance will cover these mattresses, but the provider needs to build in the time it will take to cover such a large cost.
Study patient factors. The patient’s situation also plays a role in determining mattress needs. Beside the diagnosis, factors such as oxygen and nutrition will impact healing. While the mattress might be doing its job, poor nutrition or oxygen will most likely mean poor healing.
Look at durability. Not all mattresses are made equally. “In the business we call these ‘tail light warrantees’—when you don’t see my tail light any more, the warranty is done,” Anderson jokes. “There are a lot of knock-off products out there.” Anderson advises providers to beware of mattresses that are made to fit Medicare guidelines, but are not built for long-term use.
Key aspects to durability are the blower and pump motors for mattresses and how they’re designed, Anderson says. Motors that run loud or hot might not hold up over the long haul, especially considering that they are most likely running 24-hours a day. Also, pump motors that use the air that is already in the cells will last longer than those that recalculate outside air into the mattress, because they don’t have to work as hard.
Consider patient financial factors. There’s another aspect to heat that is a key concern for patients residing in hotter areas of the country: a motor that runs hot will mean higher electricity bills since their air conditioning will be working that much harder.
Don’t forget lower-tier surfaces. There are patients who need mattresses to ensure they don’t get pressure sores, or who might have a single stage 2 or less. They might simply need a gel overlay or similar product. The issue is that while prevention is a huge consideration from a medical standpoint, most insurance companies and Medicare are not prevention providers. However, if the patient has another related condition, then the provider might be able to put them on a prevention product due to the co-diagnosis.
Consider compliance factors. Like any home medical equipment, ensuring the patient actually uses a mattress is central to compliance. For instance, an adjustable mattress can be “tuned” so that it feels more like the patient’s home mattress. Likewise, a mattress that can fit a patient’s bed frame and box spring, or use home linens will increase compliance. The key is to work up front with the patient to try to suit their needs as best as possible. “When you walk into a patient’s home, people don’t want you to see medical equipment in there,” Anderson notes. “The more you can make the product normal to the patient, the better the outcome.”
For various pressure wound resources, visit the National Pressure Ulcer
Advisory Panel site at www.npuap.org, and make sure you understand the
NPUAP’s complete pressure wound staging guidelines, which were updated
in 2007. The full guidelines are available at www.npuap.org/pr2.htm,
but here is cursory rundown:
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
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 or eschar in the wound bed.
Points to take away:
• Learn the technologies and how they apply to patient needs.
• Consider how patient factors will impact healing.
• Look for durability, especially in the blower and pump motors.
• Consider compliance factors.