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Configura® Pressure CushionsInformation Sheet

© Accora Configura® assessment helpline: 01223 206110 | configura@accora.uk.com 2

Introduction

This document is intended to provide guidance for HealthcareProfessionals prescribing Configura® cushions. It is important tonote that prescribing cushions is a professional decision andwhilst we (Accora) are able to describe our cushions, we are notqualified to prescribe.

We are often asked what Waterlow/Braden etc score our cushionsare appropriate for. A direct answer to this question is notstraightforward as many of the factors contributing to a Waterlowscore are beyond the scope of a cushion (i.e. continence,medication, build etc.). We are however able to give broadguidance on what level of risk our cushions are appropriate for.

A risk assessment tool such as Waterlow/Braden etc. is intended tobe an ‘aide memoir’ to help arrive at a risk level (low/medium/high/very high) for an individual. Such a scale should not be usedarbitrarily to assess a user’s pressure care equipmentrequirements and is no substitute for clinical judgement.

The overriding principle regarding pressure care is that it comesdown to risk assessment of each individual. In addition, regularand consistent monitoring is important. The following videomight be helpful:

http://www.configura.uk.com/videos/configura_pressure_considerations.html

One of the most useful websites we have found ishttp://nhs.stopthepressure.co.uk/ which has some really usefulinformation around pressure ulcer prevention and treatment.This website was created by NHS Midlands and East.

The evidence base around pressure care in the seating positionis still relatively weak. In the absence of a strong evidence base,in most areas, the following guidance is used:

n Users at risk of pressure damage and who have up tocategory 2 pressure damage should use a static, (pressurereducing) device such as foam, gel etc.

n Users with category 3-4 damage should use a dynamiccushion and the user should be seated for limited periods(max 2 hours) if at all

Note: the above guidance is generic and would besuperseded by specific local level guidance.

There are two key variable factors when considering pressuredamage:

1) Level of risk of developing pressure damage: i.e.low/medium/high/very high. This is a professional judgementand an ‘aid memoir’ such as Waterlow or Braden can beused to help arrive at this

2) Level of pressure damage: if a user has developedpressure damage, it will fall into one of four ‘categories’. See following link for more details:http://nhs.stopthepressure.co.uk/docs/PU-Grading-Chart.pdf

However the NICE guidelineshttp://www.nice.org.uk/nicemedia/live/10928/29180/29180.pdf(page 8) includes the following statement:

“No seat cushion has been shown to perform better thananother, so this guideline makes no recommendation aboutwhich type to use for pressure redistribution purposes.”

So prescription of pressure cushions is a rather challenging areaand we hope this document helps to provide some direction! Inthis context, the fact that the Configura® cushions are easilyinterchangeable helps to make cushion prescription easier andless costly.

Clinical studies/pressure mapping:Accora has a clinical study in progress and we have pressuremapping to demonstrate the difference between theConfigura® cushions.

It is however important to note that pressure mapping shouldonly be used as a comparison between cushions with thepressure mapping device at exactly the same setting –otherwise they can be quite misleading.

Also – pressure mapping of dynamic cushions is of limitedrelevance because by definition, the mapping varies as thecushion inflates and deflates.

Useful links:The following website links will be helpful in helping tounderstand pressure sores and risk assessment etc.:

http://nhs.stopthepressure.co.uk/ - very useful website from NHSMidlands and East

http://nhs.stopthepressure.co.uk/Path/path.htm - shows the pathto prevent and treat pressure damage step by step

http://www.nice.org.uk/nicemedia/live/10928/29180/29180.pdf -NICE guideline on pressure ulcer prevention

http://nhs.stopthepressure.co.uk/docs/PU-Grading-Chart.pdf -shows how to grade pressure ulcers

http://www.judy-waterlow.co.uk/downloads/Waterlow%20Score%20Card-front.pdf – Waterlow score download

http://www.bradenscale.com/images/bradenscale.pdf - Bradenscale download

http://www.npuap.org/wp-content/uploads/2012/03/NPUAP_S3I_TD.pdf – NPUAP definitions

http://www.configura.uk.com/wp-content/uploads/Configura-CushionAir-Cushion-Guide-Fitting1.pdf – Configura® Cushionairset up guide

http://www.configura.uk.com/videos/configura_pressure_considerations.html - Configura® pressure care considerations video

© Accora Configura® assessment helpline: 01223 206110 | configura@accora.uk.com 3

Configura® cushions:All cushions are upholstered in a 4-way stretch, vapour permeable fabric and are covered with the chair ‘overlay’ whichcomprises 4-way stretch vapour permeable material and a 12mm layer of Visco foam. In the case of the Cushionaircushion, the overlay part can be fitted underneath the cushion so the user is sitting directly onto the cells of the cushion(although the cushion tends to fit better if the overlay is fitted over the top).

Visco (standard):

Visco is a static, pressurereducing cushion which wesuggest for users who are at high

risk of developing pressuredamage but whose skin is intact*.

This comprises a 3” layer of standard foam then a top layer of1” Visco foam. Visco is a heat sensitive memory foam andtakes a certain amount of time to warm up so the userimmerses into it. Some users who have reduced core bodyheat (i.e. some neurological conditions), may find the cushiona little firm. In these cases, the Castellated cushion may be agood alternative.

The principle is that as the foam warms up, it conforms to theuser’s shape thereby providing a larger surface area ofcontact and therefore lower pressure – especially around thevulnerable ITs. This is called ‘immersion’.

Castellated:

As can be seen from thepressure mapping resultsbelow, Castellated is similar in

performance to the Visco cushionbut does not include Visco. In other

words, this is a static, pressure reducing cushion which wesuggest for users who are at high risk of developing pressuredamage but whose skin is intact*.

Castellated consists of standard foam with a castellated top surface which provides improved immersion. This cushion is useful for users who have reduced core body heat and for users who may find the Visco cushion too firm.

© Accora Configura® assessment helpline: 01223 206110 | configura@accora.uk.com 4

Cushionair:

The Cushionair cushion is a dynamic pressure relieving cushionwhich is normally recommended for users who have developedpressure damage*.

The principle is that the cells of the cushion inflate and deflatealternately. This provides pressure redistribution via cyclicchanges in loading and unloading (http://www.npuap.org/wp-content/uploads/2012/03/NPUAP_S3I_TD.pdf).

There is a dial on the cushion pump which allows the cushion tobe adjusted: soft through to firm. This setting is adjusted primarilyin terms of comfort and is not purely based on the user’s weight. For further details on pressure cushion set-up, please see thefollowing link:http://www.configura.uk.com/wp-content/uploads/Configura-CushionAir-Cushion-Guide-Fitting1.pdf

The overlay part can be fitted underneath the overlay so theuser is sitting directly onto the cells of the cushion (although thecushion tends to fit better if the overlay is fitted over the top). Asstandard when supplied from Accora, the overlay will be fittedon top of the cushion cells. This slightly decreased the effect ofthe dynamic therapy but provides superior comfort and stability.

Self-supply:

It is possible to fit cushions from other manufacturers into aConfigura® chair, depending on its size. We suggest you call uson 01223 206100 to discuss this so we can ensure the mostsuccessful outcome.

Further information on the recommended sizes can be foundon the below link:http://www.configura.uk.com/wp-content/uploads/Configura-Self-Supply-Cushion-Guide-Fitting1.pdf

*This is based aroundanecdotal evidence andAccora’s experience; wedo not yet have clinicalstudies to evidence thisalthough these are inprogress.

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