A more accurate evaluation of
the wound will be made after three
months. In the meantime, rather than
wait for the primary care trust to fund
an Optima mattress, she has elected to
purchase one from her own resources— meaning she will not have to revert
to using any other type of mattress once
the evaluation period is over.
Case report three
The patient was 56-years-old and had been paraplegic for about 46 years following an accident. For most of the time he stayed at home with an electric bed and an APAM, which was supplied by his local Community Loan Centre.
For many years he has had recurring
pressure ulcers (grades 1–4) (EPUAP, 1998) and had become an expert
patient with regards ulcer formation, different mattress types and the value of
electric-profiling beds.
From time to time he had been
admitted to a specialist spinal injuries
unit for reassessment or surgical
intervention, either to his soft tissues or
bones. In June 2008 he was admitted for
reconstructive surgery on two pressure
ulcers after unsuccessful reconstructive
surgery at another hospital.
While he was undergoing pre-
operative evaluation, he was offered
the use of an Optima mattress and
although he found it comfortable over
his remaining sensate areas, he asked to
be placed on an APAM after 48 hours
as he had become concerned that the
Optima mattress had ‘bottomed out’. However, during transfer to the APAM, the staff noted that no new skin damage
or markings had occurred.
After a discussion about the
functional differences between the
Optima mattress and an APAM, the
patient accepted that the principles
of continuous low pressure could be
beneficial and agreed to go back on
the Optima mattress to complete
a three-week period of total post-
operative bed rest.
Reconstructive surgery was performed and over the next three |
|
‘ weeks the patient remained on the Optima mattress, receiving regular repositioning, skin inspection and nursing care. Photographs of pressure areas were taken each week to assess the healing process.
Throughout this time no new skin breaks occurred and all the patient’s bony prominences remained intact and free from blanching and non-
blanching erythema. The consultant surgeon, ward staff and tissue viability nurse all expressed confidence in the Optima mattress and had no concerns about him continuing to be supported by it.
The patient appreciated the added comfort the Optima mattress provides – he was especially impressed by the non-appearance of ‘pink marking’ over his bony points. His principle concern is that when he is transferred home he will have to return to his Community Home Loans APAM and wants the primary care trust to purchase an Optima mattress for him.
Conclusion
In the absence of a randomised clinical evaluation, the purpose of this article is to report on at least three patient outcomes from three different care environments which borrowed a Carital Optima mattress from Nexus for their own evaluation purposes.
Over the years many different types of static and dynamic mattresses have been produced and careful selection is required by clinicians in order to avoid inappropriate use and possible harm to patients.
When evaluating the efficacy of new mattresses, interface measurements using pressure mapping is a common approach (Fletcher, 2006) and the technology used for the Optima mattress is recognised as being scientifically valid (Agam and Gefen, 2007).
Equipment selection should also be based on a holistic assessment of individual patient need (NICE, 2005), in order to identify the suitability of the. |
|
equipment for the patient and the care setting as well as providing patient choice.
Dynamic mattresses have been available for many years, with APAMs being the dominant type used in the UK. However, APAMs have certain drawbacks, such as pump noise, motion sickness, exacerbation of pain in existing wounds, sleep disturbance and patient migration down the bed.
Throughout the time the authors were studying the three patients featured in this article, the lack of pump noise was noted by staff and those patients able to comment..
>> click to continue >> |
