Who's Is Sleeping In Our Beds? An Interdisciplinary Approach to Determining Bed Use for Pressure Ulcer Prevention

The purpose of this project was to significantly decrease the inappropriate use of redistribution devices, devise an evidence-based practice method to select the appropriate device based on the patient’s emergent condition, and monitor the effectiveness of such methods. Primary outcomes included a decrease in expenditures on pressure redistribution devices and a reduction in pressure ulcer development or progression.   A group of clinical and product specialists reviewed current practices for selecting the appropriate product.  The group reviewed the practices of clinical areas presently using high volumes of redistribution devices. The group then reviewed current tools used by bedside clinicians for selecting the appropriate device based on contributing factors such (e.g. activity, moisture, nutrition, and disease-related issues) including the Pressure Ulcer Prevention Policy, Education Materials, and the Support Surface Decision Guide. Product selection by bedside clinicians was inconsistent utilizing these tools. During the review by the WOCNs, the appropriate selection rate was fifty-one percent. The tools were modified to improve their ease of use for the bedside clinician to easily identify the appropriate product based on the patient’s compensating factors.  This included understanding the approval process for each device and assigning corresponding Braden Scale indicators as associated factors.  The Support Surface Decision Guide was updated to include these additional methods for clinical approval.  Education of bedside clinicians was implemented using the new support tools. As a result, pressure ulcer incidence continues to decline and existing ulcers continue to heal while inappropriate, expensive surface use declines.