The Use of Continuous Bedside Pressure Mapping (CBPM) in the Management of Intensive Care Patients with Excessive Head of Bed Elevation Due to Medical Necessity

Problem Statement

National pressure ulcer prevention guidelines state to avoid head-of-bed elevation that places pressure on the sacrum/coccyx.¹   However, there is also clinical evidence that a sustained supine position increases the probability of aspiration pneumonia and therefore patients should remain with the head-of-bed at 45 degrees.²These two evidenced-based guidelines conflict in bedside practice, leaving healthcare providers puzzled over how to manage patients who are at-risk for aspiration pneumonia as well as pressure ulcers.

Methods

Patient position and support surfaces used both influence the amount of pressure exerted on patient’s skin.³  ICU patients with aspiration precautions had CBPM units placed on their beds.  The CBPM image was utilized by bedside caregivers to position patients to achieve reduced skin pressure over pressure points. If high pressure persisted under the sacral/coccyx area, then a higher level support surface was ordered for that patient.  The CPBM was utilized with the higher support surface to adjust the settings for maximum pressure redistribution, to position the patient with lower pressures, and to continually monitor the functionality of the support surface and the high pressure beneath the sacrum.

Results

Bedside caregivers were able to micro-shift patients, choose appropriate support surfaces and adjust airbed settings to gain more favorable pressure redistributions using CBPM.  Cost-effective support surface decisions were made as only patients who displayed higher pressures were upgraded to higher cost support surfaces.  Inter-professional collaboration resulted in physician’s who were more willing to reduce the head-of-bed elevation orders on lower risk aspiration patients to avoid hospital-acquired pressure ulcers.

Conclusion

Head-of-bed elevation is indicated and contra-indicated for different clinical diagnoses. The key is to be able to assess and manage conditions at the bedside to achieve best possible outcomes for the patient.  CBPM assists in making key pressure assessments and intervention decisions to aid in pressure ulcer prevention.