2. Tissue Viability - Cornwall Council · - 4 – Mattresses Min weight kg/st Max weight kg/st Grade Prevention Healing Deteriorating Unable to reposition Pain/ Discomfort Rehabilit

- 1 –

2. Tissue Viability

Equipment in this section:

2.1 Foam Overlay mattress

2.2 Static air overlay mattress

2.3 Foam Replacement mattress

2.4 Visco elastic foam replacement mattress

2.5 Dynamic overlay mattress

2.6 Dynamic overlay with integral foam base

2.7 Alternating/Low pressure dynamic replacement

2.8 Dynamic Alternating Replacement

2.9 Propad overlay cushion

2.10 Static air Cushion

2.11 Visco-elastic overlay Cushion

2.12 Gel with foam base replacement Cushion

2.13 Dynamic air overlay Cushion

2.14 Gel Heel pad

2.15 Heel lift suspension boots

2.16 Troughs

- 2 –

General considerations:

Link with MHRA guidance and circulars- HSE website

Link with TV care pathway

Link with wheelchairs policies

Link to EPUAP grading system

Follow 24 hr approach to pressure area care

Utilise expertise of community nursing and tissue viability teams

Tissue Viability training available; book via Westheath (Tel 01208 251503)

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Tissue Viability Care Pathway

Grade 1 Grade 2 Grade 3

Able to move and turn?

Yes No

Dynamic

overlay

Dynamic

overlay

with

integral

foam base

Refer to Tissue viability

Commence PURCA

Dynamic

Alternating

Replacement

Only sit out once pressure

damage has commenced

healing. Limit seated time to 1

hour once or twice per 24

hours to assist healing.

Reducing seating time if failing

to heal.

Alternating/

Low Pressure

Dynamic

Replacement

*Repose/Visco/Foam Replacement Are bed heights/cot

sides a problem?

No Yes

Grade 4

Ensure 24 hour pressure relief

Ensure patient stands or moves

regularly to reduce risk of

developing pressure damage

Heel Pressure

Damage

Pressure

Ulceration

Yes

HLSB

Trough

NO

Gel Heel

Pad

No Pressure

Damage

Foam Overlay (for use

with patients own

mattress)

- 4 –

Mattresses

Min weight

kg/st

Max weight

kg/st

Grade Prevention Healing Deteriorating Unable to

reposition

Pain/

Discomfort

Rehabilit

ation

Static air overlay Repose none 139 /21 1-2

Foam overlay Propad none 108/17

Foam

replacement

Softform

original none 165/26 1

Softform

Premier none 250/39 1

Pentaflex none 90/15

Visco overlay Memaflex 20/3tbc 114/18 1

Visco

replacement

Memaflex 20/3tbc 250/39 1

Dynamic overlay Alphaxcel 20/3 140/22 2

Autoxcel 20/3 203/32 2

Dynamic overlay

with integral

foam base

Alpha

Trancell None 120/19 2

Alternating/low

pressure

Alpha None 160/25 3

- 5 –

dynamic

replacement

Response

Dynamic

alternating

replacement

Nimbus 3 none 250/39 4

Quattro

Acute none 250/39 Terminal care

Cushions *

Static air

overlay

Repose none 139/21 1-2

Static air

replacement

Vicair* none 250/39 3-4

Roho none none 3-4

Foam overlay Propad none 108/17 -

Flotech

Contour 191/30 1-2

Viscoelastic

overlay

Memaflex 127/20 1-2

Gel Flotech 140/22 1-2

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Image

Flotech Plus 191/30 1-2

Flotech

Solution 140/22 3-4

Dynamic

overlay

Aura 120/19 3-4

Heel Supports

Gel pad none none 1-2

Leg trough none none 1-4*

Heel lift

suspension

boot

none 113/17 1-4

Bariatric

suspension

boot

90/14 272/42 1-4

Gel Pad

Flexipad none none

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2.1 Equipment: Foam overlay mattress

Description: A modular foam overlay mattress with a multi stretch vapour permeable cover, designed to go on top of a person’s

own divan mattress indicated for prevention only

Dimensions: Single 187.5x 87.6x8.5 cm Double 187.5 x 137.2 x 8.5cm

Related policies/Guidance: Infection control, Audit, Waste Disposal, MHRA reporting

Example Brand names: Propad

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy in the prevention of pressure ulceration

The person is assessed as at risk of developing pressure damage

Carers, informal and formal, are instructed on use by a health practitioner.

Risk Assessment to ensure the person has been assessed with 24 hr pressure area care needs

Ladder Approach Contraindications Safety & function Prescriber/assessor Actions

All other alternatives have been considered;

increased awareness

increased movement

Referral to other services e.g. rehab OT

Risk assessment Carers assessment Increased care package

The person cannot transfer with the increase height of mattress

Weight limit 108kg/17st

Adequate supporting surface with patients own mattress

Avoid layering incontinence products

The person has pressure damage

Annual equipment audit of mattress and cover

Patient advised on turning, movement and mobility

Patient given pressure ulcer information leaflet

The person is admitted to the nursing caseload for regular review dependent upon clinical need

Risk assess

Product familiarisation completed

HSE/MHRA

Practitioners accountability

Risk assessment

Prescription goals identified.

Prescription form completed

Demo/delivery planned

Review date Manufacturers leaflet, including care of equipment

Infection control

- 8 –

Safety Checking of Community Loan Equipment

DESCRIPTION

STANDARD EQUIPMENT ITEMS

FI Bar Coded

Manufacturer’s Instructions Supplied to User/Carer

Single use Items

Legislation Comments/ technical

instruction N R LOLER PUWER

Foam overlay mattress

M C

Y Y

Key: FI - Final Inspection, N – New, R – Recycled, M – Manufacturer, C - Community Equipment Loan Store

- 9 –

2.2 Equipment: Static air overlay mattress

Description: a pressure redistributing air overlay mattress with a 2 way stretch vapour permeable cover, mattress supplied inside

the hand pump

Dimensions: 1780x770mm x (inflatable)

Related policies/Guidance: Infection control, Waste disposal, MHRA safety link

Example Brand names: Repose

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy to prevent pressure ulceration or to treat all grades of pressure ulcers as an emergency response measure


Carers are instructed on correct use by a health practitioner,

Requires daily review of manual inflation



increased awareness

increased movement

repositioning

Equipment Ladder Approach


Risk assessment

The person cannot manage the additional height of the mattress


An unstable spinal fracture

The persons body shape is not fully supported by the mattress, e.g. dimensions are greater than the mattress


Patient/Carers advised on turning, movement and mobility



Risk assess


HSE/MHRA


Risk assessment

Prescription goals

identified.

Prescription form

completed


Review date

- 10 –

Carers assessment Increased care package

Adequate supporting surface


Ability to check inflation daily

Available as a sub store item for rapid access

Refer to MHRA/HSE guidance

PRISM/Datix

Monthly pressure ulcer audit

Manufacturers leaflet inc Care of equipment

Infection control


DESCRIPTION


FI Bar Coded


Single use Items



mattress- repose

M

C

Y Y


- 11 –

2.3 Equipment: Foam replacement mattress

Description: A pressure redistributing foam mattress, with a 2 way stretch vapour permeable cover

Dimensions: Softform premiere 197 x 88 x 15.2cm

Related policies/Guidance

Example Brand names: softform original, softform premier, pentaflex, key 2 care, softform premier spinal

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy to prevent pressure ulceration and to treat up to Grade 2 dependent upon patients mobility


Carers are instructed on use by a health practitioner



increased awareness

increased movement

repositioning




Weight limit varies between manufacturers from 90kg/15st to 250kg/39st



Patient/carers advised on turning, movement and mobility




TV course – introduction to pressure area care

Risk assess

HSE/MHRA


Risk assessment

Prescriber goals identified and care plan formulated

Completed prescription form


Review date


PRISM/Datix incident



Infection control

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DESCRIPTION


FI Bar Coded


Single use Items



foam replacement mattress

M

C

Y Y


- 13 –

2.4 Equipment: Visco foam replacement

Description: A pressure redistributing Visco elastic foam mattress, with a 2 way stretch vapour permeable cover

Dimensions: Softform visco 198 x 88 x 16 cm

Related policies/Guidance:

Example Brand names: Memaflex, Softform Visco

Indicators:

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy to prevent pressure ulceration and to treat up to grade 2 pressure damage




increased awareness

increased movement

repositioning






Patient/Carers advised on turning, movement and mobility


The person is admitted to the nursing

caseload for regular review dependent upon clinical need


TV course – introduction to pressure area care

Risk assess

HSE/MHRA


Risk assessment




Review date


Maintenance & service contract

Add to PAT list

PRISM / Datix incident



Infection control

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DESCRIPTION


FI Bar Coded


Single use Items



visco plastic replacement mattress

M C

Y Y


- 15 –

2.5 Equipment: Dynamic overlay mattress

Description: a dynamic overlay for use with a foam replacement mattress or patients own divan mattress

Dimensions: 2040x860x114mm

Related policies/Guidance Cot sides policy

Example Brand names: Alphaxcel, Autoxcel, Quattro, Trinova

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy to maintain skin integrity and to treat up to a grade 2 pressure ulcer


Carers are instructed on use for procedures, interventions and the action to take in the adverse event of electricity failure by health practitioner.




Repositioning

Increased awareness

Increased movement Referral to other services e.g. rehab OT


Weight limit , manufacturers vary from 140kg/22st to 203kg/32st

Adequate supporting surface, needs persons own mattress of a foam replacement

If ulcer is positioned to the heel refer to heel support items


Unstable spinal injury


Ensure set up and correct fitting of retention straps by health care worker

Patient /Carers advised on turning, movement and mobility


The person is admitted to the nursing caseload for regular review


TV course an introductory day into pressure area care

Risk assess

HSE/MHRA


Risk assessment




Review date



Add to PAT list

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Single mattress dynamic overlay system

Ensure on adequate support surface

Do not use back rests, pillow elevators on top of dynamic mattresses

Do not use Fitted sheets

Do not use standard height cot sides

Requires manual change to motor to accommodate patients change of position, eg when sat up in bed

dependent upon clinical need

Correct usage of settings determined by patients weight and position

PRISM / Datix incident


Has the person notified their electrical supplier regarding essential medical equipment


Infection control

Access to power supply


DESCRIPTION


FI Bar Coded


Single use Items



Dynamic overlay

M

C

Y

Y


- 17 –

2.6 Equipment: Dynamic overlay with integral foam base

Description: integral foam base to the dynamic overlay offering a full depth mattress



Example Brand names: Alpha Transcell (nb not suitable for use with divan bed – Jan 2012) , Quattro plus

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy to maintain skin integrity and to treat a grade 2 pressure ulcer



The person requires a dynamic overlay with integral foam bed due to height of bed/ transfer issues




Repositioning

Increased movement




If ulcer is positioned to the heel refers to heel support items



Single mattress replacement system only



Patient /Carer advised on turning, movement and mobility


The person is admitted


TV course – an introduction to pressure area care

Risk assess

HSE/MHRA


Risk assessment



Review date



Add to PAT list

PRISM/ Datrix incident

Monthly pressure ulcer

- 18 –

Do not use back rests, pillow elevators on top of dynamic mattress

Do not use Fitted sheets

Requires manual change to motor to accommodate patients change of position, e.g. when sat up in bed

to the nursing caseload for regular review dependent upon clinical need

audit



Infection control


DESCRIPTION


FI Bar Coded


Single use Items



dynamic overlay with integral foam base

M C

Y Y

Y


- 19 –

2.7 Equipment: Alternating/low pressure dynamic replacement

Description: A full mattress replacement system for the treatment of Grade 3 pressure ulcers with automatic adjustment to the

weight, size and position of the patient



Example Brand names: Alpha Response nb not suitable for use with divan bed (Jan 2012)

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy to maintain skin integrity and to treat a grade 3 pressure ulcer






repositioning




If the ulcer is positioned to the heel refer to heel support items







Patient given pressure ulcer information


TV course

Risk assess

HSE/MHRA recommendation referred to


Risk assessment




Review date



Add to PAT list

- 20 –


Fitted sheets

leaflet


Refer to Tissue Viability

Commence Pressure Ulcer Root Cause Analysis

PRISM / Datrix incident


Has the person notified their electrical supplier


Infection control


DESCRIPTION


FI Bar Coded


Single use Items



alternating/ low pressure dynamic replacement

M C

Y Y

Y


- 21 –

2.8 Equipment: Dynamic Alternating Replacement

Description: A full mattress replacement system for the treatment of Grade 4 pressure ulcers with automatic adjustment to the

weight, size and position of the patient

Dimensions: 2085 x 890 x 215mm


Example Brand names: Nimbus 3, Cairwave, Deep Cell

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy to treat a grade 4 pressure ulcer






repositioning

Heel pressure ulcers require treatment with specific devices, refer to Heel lift Suspension boots, Troughs Referral to other services e.g. rehab OT



Max weight 250kg / 39 stone

If ulcer is positioned to the heal refer to heel support items


Fitted sheets





Product familiarisation completed,

competent in set up of equipment

TV course, Pressure Area Care Day

Risk assess

HSE/MHRA recommendation referred to





Review date to be monthly care plan evaluation, and recorded on monthly pressure ulcer audit


- 22 –


Multi - layered incontinence products



Add to PAT list

Refer to Tissue Viability


PRISM incident



Manufacturers guidance, inc care of equipment

Access to power supply

Infection control

- 23 –


DESCRIPTION


FI Bar Coded


Single use Items



dynamic alternating replacement

M C

Y Y

Y


- 24 –

2.9 Equipment: Propad Foam Overlay cushion

Description: Modular foam overlay cushion with a multi-stretch vapour permeable cover

Dimensions: 45 x 45 x 10.2cm


Example Brand names: Propad

Indicators



Carers, informal and formal, are instructed on use by health practitioner.





increased awareness

increased movement Risk assessment Carers assessment Increased care package






Assess persons ability to transfer and mobilise in and out of the chair

Patient /Carer advised on repositioning, movement and mobility




TV course introduction to pressure area care

Risk assess

HSE/MHRA


Risk assessment



Review date



Infection control

- 25 –


DESCRIPTION


FI Bar Coded


Single use Items



foam overlay cushion

M

C

Y Y


- 26 –

2.10 Equipment: Static air overlay cushion

Description: A pressure redistributing air overlay cushion with a 2 way stretch vapour permeable cover, supplied within manual

hand pump

Dimensions: 450x450mm x (inflatable)


Example Brand names: Repose

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy to prevent pressure ulceration or to treat all grades of pressure ulcers as an emergency response measure


Carers, informal and formal, are instructed on use by health practitioner. Risk Assessment to ensure the person has been assessed with 24 hr pressure area care needs



Increased awareness

increased movement



The person cannot manage the additional height, to the bed mattress height






Assess person’s ability to transfer and mobilise in and out of the chair


Patient given pressure


TV course (?levels)

Risk assess

HSE/MHRA


Risk assessment



Review date



Infection control

- 27 –

ulcer information leaflet


Sub store item for rapid supply


DESCRIPTION


FI Bar Coded


Single use Items



cushion repose

M C

Y Y


- 28 –

2.11 Equipment: Visco elastic foam overlay cushion

Description: A pressure redistributing Visco elastic foam overlay cushion with a 2 way stretch cover

Dimensions: 43 x 43 x 7.5cm


Example Brand names: Memaflex

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy in the prevention of pressure ulceration and for treatment for up to and including grade 2 damage with a structured seating care plan regime

Carers, informal and formal, are instructed on its use by health practitioner.




increased awareness

increased movement












TV course

Risk assess

HSE/MHRA


Risk assessment




Review date


PRISM/Datrix incident



Infection control

- 29 –


DESCRIPTION


FI Bar Coded


Single use Items



M

C

Y Y


- 30 –

2.12 Equipment: Gel cushion

Description: A cushion with a contoured foam base with a dual layer of gel sacs over the entire cushion surface. Dimensions: 17 x 17 x 3cm


Example Brand names: Flotech Solution

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy in the prevention of pressure ulceration and the treatment of grade 3 and 4 pressure ulcers with a seating regime

Carers, informal and formal, are instructed on use.





increased awareness





Ensure cushion is utilised in the correct position as it is shaped




Patient given pressure ulcer information


TV course an introduction to pressure area

Risk assess

HSE/MHRA


Risk assessment

Prescriber goals identified



Review date


Prism/Datrix incident

Monthly Pressure Ulcer Audit


- 31 –

leaflet



Infection control


DESCRIPTION


FI Bar Coded


Single use Items



M

C

Y Y


- 32 –

2.13 Equipment: Dynamic cushion

Description: a pressure relieving dynamic cushion



Example Brand names: Aura

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy in the prevention of pressure ulceration and the treatment of grade3 or 4 pressure ulcers with a seating regime

Carers, informal and formal, are instructed on use by health practitioner. Risk Assessment to ensure the person has been assessed with 24 hr pressure area care needs



increased awareness

increased movement



The person cannot manage increase of height to chair

Risk of falls from cables which come from the font of the cushion










TV course introduction to pressure area care

Risk assess

HSE/MHRA

Practitioners Accountability

Risk assessment




Review date



Add to PAT list

Prism/Datrix incident

Monthly Pressure Ulcer Audit



Infection control

Power supply

- 33 –


DESCRIPTION


FI Bar Coded


Single use Items



M

C

Y Y

Y


- 34 –

2.14 Equipment: Gel heel pads

Description: Sacs of gel to reduce pressure on the vulnerable heel area. The controlled volume of gel in the sacs allows pressure displacement and even weight distribution

Dimensions: single 32x48x5cm, Double62x48x5cm

Related policies/Guidance:

Example Brand names: Heel Pad

Indicators


The person is assessed as at risk of developing pressure damage Carers, informal and formal, are instructed on use by a health practitioner




increased awareness


Not to be used in weight bearing transfers

Pressure damage


No minimum or maximum user weight





TV course

Risk assess

HSE/MHRA

Professional Accountability

Risk assessment




Review date



Infection control

- 35 –


DESCRIPTION


FI Bar Coded


Single use Items



M

C

Y Y


- 36 –

2.15 Equipment: Heel lift suspension boot

Description: Single patient use foam boot, designed to suspend the heel free from pressure with Velcro retention straps

Dimensions: Heelift Standard Calf Circumference is 8 inches - 14 inches (20.32 cm - 35.56 cm) Height Range is 60 inches - 77 inches (152.40 cm - 195.58 cm) Weight Range is 120 lbs. - 250 lbs. (54.43 kilo - 113.40 kilo) Heelift Bariatric Calf Circumference is 12 inches - 23 inches (30.48 cm - 58.42 cm) Height Range is 65 inches - 80 inches (165.10 cm - 203.20 cm) Weight Range is 220 lbs. - 600 lbs. (99.79 kilo - 272.16 kilo)


Example Brand names: VM Marketing Heel Lift Suspension Boot

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy in the prevention of pressure ulceration and for the treatment of pressure ulceration for all grades





Increased awareness

Increased movement

All heel pressure is transferred to the Achilles Tendon and calf which is susceptible to pressure

Annual equipment audit

Patient /Carer advised on repositioning,


TV course, introduction to pressure area care

Risk assessment


- 37 –

and repositioning



injury. Close observation is necessary.

Should redness (erythema) occur, a wedge should be removed from the fixed pad, or the spare pad applied proximal to the tendon

Boots should be regularly removed for skin inspection

movement and mobility



Single patient use item only

Sub store item for rapid supply

Risk assess

HSE/MHRA

Professionals accountability


Review date


Prism/ Datrix

Commence Pressure Ulcer Root Cause Analysis in grade 3 and 4 ulcers


Infection control


DESCRIPTION


FI Bar Coded


Single use Items



M

N/A

Y Y


- 38 –

2.16 Equipment: Leg Trough

Description: Shaped foam leg support with a vapour permeable 2 way stretch cover

Dimensions: mlt/ s 51cm, mlt/ m 61cm, mlt l, 66cm


Example Brand names: Invacare leg trough

Indicators

The person has been fully assessed by a practitioner whom has clinically indicated the use of this therapy in the prevention of pressure ulceration and for the treatment of pressure ulceration for all grades






Increased awareness

Increased movement and repositioning


All heel pressure is transferred to the Achilles tendon and calf which is susceptible to pressure injury. Close observation is necessary.

Should be regularly removed for skin inspection

Annual equipment audit




Sub store item for a rapid supply


TV course

Risk assess

HSE/MHRA

Professional Accountability

Risk assessment

Prescriber goals identified



Review date


Prism/ Datrix

Commence Pressure Ulcer Root Cause analysis in grade 3 and 4

- 39 –


DESCRIPTION


FI Bar Coded


Single use Items



M

C

Y Y


Documents

2. Tissue Viability - Cornwall Council · - 4 – Mattresses Min weight kg/st Max weight kg/st Grade Prevention Healing Deteriorating Unable to reposition Pain/ Discomfort Rehabilit