Implementing Appropriate Pressure Redistribution Seating Surface Through Use of an Algorithm

Purpose:  To create an algorithm based on specific patient criteria that will assist staff in selecting an appropriate pressure redistribution seating surface.

Objective: With the new Center for Medicare and Medicaid Service reimbursement guidelines as of October 2008, there has been increasing pressure to prevent pressure ulcers or avoid existing pressure ulcers from deteriorating.  One avenue for prevention is appropriate pressure redistribution seating surfaces.  A process improvement team in an urban, tertiary, academic medical center, was formed to create an algorithm that addresses the needs of the predominately chairfast patients that require pressure seating redistribution based on specific patient criteria.  This multidisciplinary team, comprised of wound care nurse specialists, physical therapists, and occupational therapists, convened to develop the criteria and determine the appropriateness to the institution’s population thereby meeting patients’ needs. The feasibility of this project was determined by screening 70 patients on one medical and one surgical unit.  The four criteria decided upon by this team were:  a) Braden Scale score of 18 or less, b) existing pressure or previous history of pressure ulcer, c) chairfast or requiring assistance with mobility, and/or (d) tube fed or total parental nutrition.  The current phase of the project will determine which criteria will accurately decide whether a high profile versus a low air-filled cushion should be placed.

Outcomes: With a more efficient system through the use of an algorithm, patients will be more easily assessed for the appropriate pressure redistribution seating surface.  The appropriate surface will help to prevent pressure ulcer formation or stave off pre-existing pressure ulcers from further deterioration.  Additionally, the team will create patient education materials to help this population outside the acute care setting.  Future research will determine the effectiveness of the algorithm to redistribute pressure per patient-based criteria through use of a pressure mapping system.