Reduction of low air loss support surface rental days while maintaining and/or improving hospital acquired pressure ulcers (HAPU) prevalence rates through increased use of static air overlay

This practice innovation began as a 2-fold concern, to decrease rental costs while maintaining and/or improving HAPU's. Our Emergency Department (ED) volume is among the busiest in the state resulting in extended time on ED carts. The hospital has a large, co-morbid, in-patient geriatric population at risk for HAPU development which frequently results in an upgraded support surface. In partnership with the Nursing Director, Materials Director, ED Educator and Skin Team nurses, a 3 phase process was developed to decrease LAL rental costs while maintaining exemplary, evidence based care and outcomes.

Phase one involved pressure mapping of inpatient beds and ED carts to measure pressure exerted on common pressure points.  Pressure mapping was done with the head of bed (HOB) at 0, 30, and 45 degrees, with and without a static air overlay. With HOB flat, there was little difference in pressure points with or without the overlay. When the HOB was increased without the overly, the pressure increased. When the HOB was increased with the overlay, the pressure increase was less.

In phase 2, an algorithm was designed to identify risk factors specific to ED including admission status, holding time, Braden of 12 or less, existing pressure ulcers and immobility.

In phase 3, algorithm and static overlay education was provided to ED and inpatient RN staff. Prevalence audits were continued monthly.

Results: From October 1, 2012 through April 30, 2013, total LAL rental days were 526 with 6 HAPU were recorded. With static air overlay implementation, total LAL rental days were 144 from May 1, 2013 through September 31, 2013 and an improvement of 0 HAPU’s for the same period.

Conclusion:  It is possible to reduce days of LAL support surface rentals while maintaining and/or improving HAPU’s with use of static air overlay.