Developing a Hospital Specific Support Surface Algorithm for use at the Bedside

Wendy Kinsey, RN, OCN, CWOCN1, Melissa S. Hiscock, BSN, RN, OCN, CWOCN2, Judith Del Monte, MS, CPHQ3, Jennifer Lindemann, RN, MSN, OCN3, Anna Foster, RN, BSN, OCN3, Kathleen O'Hearn, RN, MSN, CWOCN1, Deanna Capozzi-Meyers, RN, BSN3, April Meyer, RN, BSN, CCRN3, Jessica French, RN, FNP3 and Thomas Stewart, PhD4, (1)WOC Nursing, Roswell Park Cancer Institute, Buffalo, NY, (2)WOC Nursing, RoswellPark Cancer Institute, Buffalo, NY, (3)Nursing, Roswell Park Cancer Institute, Buffalo, NY, (4)Roswell Park Cancer Institute, Buffalo, NY
Purpose:   In our hospital, a WOC Nurse referral was required to obtain a support surface other than the standard one, which could result in a delay in patient care.  A retrospective analysis of our pressure injury (PI) data compared to bed rental invoices revealed support surface changes were often made after the development of a PI.  A support surface algorithm was developed to provide a user-friendly guide for the bedside nurse to assist with selecting and obtaining the correct support surface for her patient. The tool combines published evidence with the support surfaces available at our hospital and instructions for obtaining the surface. 

Administrative support was required to coordinate the efforts of several departments to utilize support surfaces and low air loss (LAL) pumps which were in storage and unavailable to staff until the algorithm was developed. Procedures were developed for transporting, storing and cleaning the surfaces.

Objectives:  Our aim was to empower the bedside nurse to select the appropriate support surface using a tool that concentrates on the Braden Scale subscale scores for moisture and mobility, in conjunction with a full nursing assessment. The guideline combines easy to follow pictograms with a priority ranked list for appropriate support surfaces. The flip side has photographs of the support surfaces and details how to obtain them, so that previously purchased equipment could be utilized.

Outcome:  The bedside nurse is now enabled to select the correct surface based on evidence.  Support surface usage (including rentals) was monitored and evaluated and a cost increase was identified, despite utilizing already purchased equipment.  This increase was attributed to the proactive procurement of support surfaces and providing best practice.  The increase also confirmed the necessity for more advanced surfaces, particularly in the critical care areas and trials for capital purchase were begun.