Apollo DynamicMattress Clinical Evaluation Large scale patient study on the appropriate use of Apollo dynamic mattress system and the impact of a ‘step down’ discharge decision tree on clinical practice.

Authors: Linda Kemp-Sheridan, Tissue Viability CNS. MSc, PGCert Ed, NMP, BSc (Hons), RGN Sarah Westcott, RGN RSCN Product Support Specialist Drive DeVilbiss Healthcare Ltd

IntroductionThe Hillingdon Hospitals NHS Foundation Trust provides services from both Hillingdon Hospital and Mount Vernon Hospital. The Trust has a turnover of around £222million employs over 3,300 staff. They deliver healthcare to the residents of the London Borough of Hillingdon, and increasingly to those living in the surrounding areas of Ealing, Harrow, Buckinghamshire and Hertfordshire, giving them a total catchment population of over 350,000 people.

In line with the Trust Quality and Safety Improvement Strategy 2016-2021 to reduce the number of hospital acquired pressure ulcers through improved education and appropriate utilisation of specialist equipment, a programme of education was developed and the dynamic system Apollo by Drive DeVilbiss Healthcare was chosen in 2016 as the pressure relieving mattress of choice across the Trust sites.

Greater demands are being placed on healthcare organisations to implement cost effective strategies for pressure ulcer prevention and it is important to understand which types of patients can benefit from different types of support surfaces1. Pressure ulcer prevention is therefore a high priority for patients admitted to hospital who are particularly vulnerable. Not only have the majority of patients sustained a fracture following a fall but many are elderly, have multiple comorbidities and many have a diagnosis of dementia. All of these factors increase the risk of pressure ulcer development2.

The aim of pressure ulcer prevention strategies is to reduce either the magnitude or duration of pressure between the patient and his or her support surface or both3.

Stepping down from dynamic mattresses onto static foam mattresses was not routine practice because of the patients’ sustained level of risk. A step down decision tree was implemented to encourage and provide clarity on support surface decision prior to discharge. The Tissue Viability Nurse Linda Kemp-Sheridan developed and introduced the ‘step down decision tree’ protocol to be implemented 48 hours prior to discharge with the aim of enhancing the patients longer term experience of support surface selection in the community setting4.

The Apollo mattress system from Drive DeVilbiss Healthcare is a powered dynamic mattress that has additional manual comfort control settings to allow adjustment of internal cell pressures resulting in optimum pressure redistribution.

The mattress has a 2:1 cycle of 10 minutes which provides pressure relief to the tissue by provide cyclic loading to the skin, so that each area of skin experiences pressure only intermittently.

The Apollo alternating dynamic system features zoning with narrower cells in the heel section and this study aimed to identify pressure ulcer to heel outcomes in order to measure the effectiveness of this mattress feature in an acute setting.

MethodThe study was carried out to capture 100 patient’s data over a 16 week period with inpatients on elderly wards who were prescribed a dynamic mattress for more than 3 days. Clinical Areas included: Hillingdon Hospital Rehab including Neuro rehab, Orthopaedics and Care of The Elderly wards.

Nursing staff were asked to continue their standard pressure ulcer preventative practice as per Trust policy which included skin assessments and repositioning according to level of risk.

The clinical nurse advisor reviewed the patient records both during and at the end of the evaluation period against the agreed outcomes, these were measured as follows: reason for admission, length of stay, number of days on the mattress, pressure ulcer risk score, mobility, frequency of skin assessment and skin integrity on discharge, heel tissue integrity.

Results100 patient records were reviewed and evaluated• The average age of the patients was

83 with a range of between 33 and 97.• High number of patients admitted following

a fall resulting in # hip fracture.• The average length of stay was 17 days

with a range of between 3 and 56 days.• The majority of patients were at high risk of

developing pressure ulcers with a range of between13 and 25 on the Waterlow risk assessment scale.

• Most had intact skin on admission which remained intact.• 15 patients had superficial tissue damage

which in the majority of cases resolved.

No patient developed a pressure ulcer during the study period whilst being nursed on the Apollo mattress, this met the criteria for heel damage assessmentThere was clear evidence that the education, promotion of and results from TVN ‘decision tree’ in implementing the 48 hour ‘step down’ and good practice in Safe Discharge Planning was adopted successfully by the clinical areas included in the study.

References: 1. Support surfaces for pressure ulcer prevention - McInnes et al 3

September 2015 Editorial Group: Cochrane Wounds Group2. An overview of co-morbidities and the development of pressure

ulcers among older adults Efraim Jaul et al BMC Geriatr. 2018; 18: 305.3. Iglesias C, Nixon J, Cranny G, Nelson EA, Hawkins K, Phillips A,

et al. Pressure relieving support surfaces (PRESSURE) trial: cost-effectiveness analysis. BMJ 2006;332(7555):1416.

4. Support surface selection for long term patients in the community. S Westcott L Welding JCN 2017, Vol 31, No 4

Most had intact skin

on admission which remained

intact

No patient developed a pressure

ulcer during the study period whilst

being nursed on the Apollo mattress.

Contact us for more informationTel: 0845 0600 333 / 01274 475 000 | Fax: 0845 0600 334 Email: info@drivedevilbiss.co.uk | Web: www.drivedevilbiss.co.uk

Discussion Developing clear protocols to assist ward staff to identify support surface requirements and options following discharge home engages staff that ‘Step down’ activities are a valuable and important part of discharge planning to consider the impact on mattress choices in the longer term community settings4.

Conclusion This study confirmed that the Drive DeVilbiss Apollo mattress provided a clinically effective support surface which met the evaluation outcomes and contributes to the minimisation and prevention of pressure ulcers in the clinical environment. It is important to consider the impact of a combination of interventions namely regular skin assessments, re assessment of pressure ulcer risk, reposition regimes and support surface selection, all of which contributed to the prevention of pressure ulcers.

The Apollo alternating dynamic system use of zoning with narrower cells in the heel section may contribute to Pressure Ulcer heel outcomes and effectiveness.

Results showed clinical effectiveness of Apollo mattress and evidence of low hospital acquired Pressure Ulcer rates across both sites for an 18 month period. The potential for skin cell and tissue breakdown is reduced when using this safe and cost effective support surface.

Leaflet Code: LL451