Achieving clinically efficacious pressure redistribution without the use of low air loss

Purpose: Clinicians are often confused about the selection of support surface and the need for low air loss to provide pressure redistribution. The misconception about managing the microclimate and insensate vapor loss has resulted in the overuse of low air loss therapy. Patients who score a 1 on the Braden subscale for mobility and a 2-4 for moisture do not need the perceived added benefit from low air loss therapy.

Method:  A retrospective chart review of 125 patients was conducted using skin and wound assessment data. Patient’s requiring a therapeutic support surface for pressure redistributing, immersion, and shear management was accomplished using a pressure redistributing mattress with therapeutic foam and air bolsters delivering alternating pressure. Long Term Acute Care Hospitals eliminated rental use of low air loss with alternating pressure therapy and purchased therapeutic foam and air bolster mattresses for adjunct therapy for pressure ulcer prevention and treatment. Patient selection consisted of patients who score a 1 on the Braden subscale for mobility and a 2-4 for moisture do not need nor benefit from low air loss therapy. Using a standardized algorithm based on the Braden scale, patients were placed on the newly purchased mattresses eliminating the use of daily rental replacement mattresses. Patients who had pressure ulcers were followed for wound improvement, and  remaining patients were monitored for any new hospital acquired pressure ulcers.

Results: Implementation of alternating pressure therapy and elimination of combined low air loss and alternating pressure therapy resulted in optimal pressure ulcer outcomes as measured by wound healing scores, prevention and wound maintenance. Additionally, the hospital benefitted financially through the cost savings from on site support therapy availability.

Conclusion:  Effective pressure redistribution was accomplished cost effectively with therapeutic foam and air bolster mattresses with alternating pressure eliminating the added feature of low air loss therapy.