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Alternating mattress replacements: an evaluation

Nikki Stubbs
RGN DNCert MSc
Clinical Team Leader Tissue Viability
Leeds Community Healthcare
NHS Leeds

In October 2006, Leeds Community Equipment Service (LCES) and the tissue viability service agreed to evaluate a new alternating mattress replacement system, the Gaymar Plexus Aire Express, by identifying patients' views of this mattress system. Nikki Stubbs summarises the results ...

Alternating pressure-relieving mattresses work by reducing pressure on the individual's body directly below the deflated cell(s) of the mattress. They deliver pressure relief as opposed to the pressure reduction provided by static mattresses (such as foam replacements).

It is generally accepted that alternating pressure-relieving systems can manage a greater level of risk, although there is little evidence to direct mattress choice specifically. Mattress provision to patients should, in the main, be based upon the individual's level of risk and their ability to alter their own position and weight. Patient comfort, and moving and handling requirements also need to be considered. The National Institute for Health and Clinical Excellence (NICE) guidelines support this principle and recommend specific types of mattress based on patient risk or grade of pressure ulcer.1

It is universally accepted best practice to provide pressure-relieving or reducing equipment, including a mattress, to all patients deemed at risk of, or with, existing pressure damage.
Therefore, it is necessary for clinicians to determine which mattress, based on available resources, is going to be "fit for purpose" for their client group. It would be impractical to suggest that a randomised, controlled trial should be conducted for every local product evaluation, although this approach is perhaps the best way to establish whether a difference exists between two treatments (mattresses).

However, it is probably fair to say that clinical trials do not always provide clinicians with definitive answers on which to base clinical decisions; for example, the PRESSURE trial in 2005 identified no difference between alternating mattress replacements and alternating overlays in the proportion of people who develop a pressure ulcer.2 Therefore, sometimes clinical decisions need to be made in the absence of specific clinical evidence. This article describes the process one primary care trust adopted to evaluate two different mattresses from both a patient and clinical perspective.

The Medicines and Healthcare products Regulatory Agency (MHRA) supports the practice of procuring beds and mattresses from the same supplier/manufacturer to ensure that the operation of the mattress does not adversely affect the operation or effectiveness of the bed's function.3 This practice is designed to facilitate patient safety and assist in the management of risk for NHS organisations with regard to equipment provision and use by patients.

In October 2006, Leeds Community Equipment Service (LCES) and the tissue viability service agreed to evaluate a new alternating mattress replacement system, the Gaymar Plexus Aire Express (Mattress A), by identifying patients' views of this mattress system. Scan Mobility have the contract to supply LCES with profiling beds and static mattresses, so it was deemed appropriate to evaluate their alternating mattress replacement system as a potential alternative to the existing supplier, given the MHRA guidance.

Aims and objectives
The main aim of the evaluation was to establish whether Mattress A was fit for purpose. An evaluation process was set up to compare this alternating mattress replacement system with the previously procured alternating mattress replacement system (Mattress B).

Nine patients were approached by the tissue viability service and asked if they would be willing to exchange their current mattress (Mattress B), with Mattress A for a period of 12 weeks. Before the evaluation the patients provided verbal consent and Scan Mobility completed an indemnity form for the equipment on loan.

The evaluation included a pre-trial assessment of the patient's satisfaction regarding Mattress B and a six-week and 12-week evaluation of the patient's views and satisfaction regarding Mattress A. One of the tissue viability service nurse specialists conducted these evaluations and the results of the evaluation are detailed below.

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Summary of the results
Overall patient satisfaction with Mattress A was extremely high, with 71.5% of patients stating that they preferred it. However, patient satisfaction with Mattress B (pre-trial) was also high at 78%. One significant difference between the two systems was with regard to the noise emitted from the pump, with 86% of patients stating that they found Mattress A less noisy. 

The majority of patients found Mattress A comfortable, which appeared, in part, to be related to the quilted cover over the mattress. Carers also found that the "slippery" material of the cover facilitated moving and handling.

Of the six mattresses loaned to LCES from Scan Mobility it was noted that the light on the on/off switch failed on two systems. On the pumps with a functioning light, patients found the bulb dim and struggled to tell whether the machine was switched on or not. This was compounded by the lack of pump noise.

The lack of audible alarm over a sustained period was also a concern in terms of patient safety and risk management. The short alarm time could result in any fault going undetected for long periods, particularly in a community setting. Scan Mobility have worked with LCES since to address these concerns.

The mattress was also evaluated by one of the technicians working in LCES whose role it is to install and repair the alternating mattresses supplied to LCES. The technician identified that the use of an inflator was required to reduce the inflation time when installing the trial mattresses in patient's homes. However, the mattresses were lighter to transport and were easy to repair.

Two patients were unable to complete the evaluation at six and/or 12 weeks. One patient found that the cover on Mattress A impaired his ability to transfer independently and the evaluation was discontinued. The other patient cancelled his involvement following the pre-trial evaluation due to ill health.

Conclusion
Mattress A, during the 12-week evaluation, appeared to be a comfortable and effective system for the management of patients with, or at risk of, pressure ulceration. Patients who, over long, medium or short term, had been nursed on Mattress B transferred, on the whole, with ease onto Mattress A. No deterioration was noted over the trial period to any patient's pressure areas in spite of the differences in the pressure relief cycles.

This mattress evaluation enabled the clinicians to identify, from the patient's perspective, the suitability of an alternative mattress replacement system for procurement in line with MHRA recommendations.

Acknowledgements to the staff at LCES and Scan Mobility

References
1. National Institute for Health and Clinical Excellence (NICE). The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care. London: NICE; 2003.
2. Iglesias C, Nixon J, Cranny G et al. Pressure relieving support surfaces (PRESSURE) trial: cost effectiveness analysis. BMJ 2006;332(7555):1416.
3. Medicines and Healthcare products Regulatory Agency (MHRA). Medical Device Alert: Replacement mattresses for hospital beds used in hospitals and the community. London: MHRA; 2004.