Intergrated Community Equipment Service

Code of Practice for the Provision

Of

Alternating Pressure Air Mattresses

and Cushions

In the Community

Title:Code of Practice for the Ordering of Alternating Pressure Air Mattresses and Cushions in the Community

Code Approved: I.C.E.S.: Contract Monitoring Group.

Date: 30th. June 2008

Issue:

Review Date: June 2009

Contents

  • Introduction
  • The Tissue Viability Service
  • Protocol and request procedure for alternating pressure air mattresses
  • Protocol and request procedure for pressure reducing cushions for high risk/very high risk patients
  • Re-assessment procedure
  • Cancellation procedure
  • Information leaflets:

“Information for patients/relatives and carers regarding this special mattress”

“Information for patients/relatives and carers regarding this special cushion”

Appendices

APPENDIX IProcedure to be followed in the event of an Alternating Pressure Air Mattress developing a fault, including Out of Hours assistance.

APPENDIX IIUse of alternating pressure air mattresses for patients who receive respite care, or patients who are transferred to an acute unit.

APPENDIX IIICleaning procedures for alternating pressure air mattresses and cushions.

APPENDIX IVA cleaning procedure for Roho cushions.

APPENDIX VServicing and maintenance. Recommendations for alternating pressure air mattresses ‘owned’ by D.N. bases and practices.

APPENDIX VISpecimen forms to be photocopied locally.

Introduction

The purpose of this document is to:-

  • Identify the types of pressure relieving mattresses and pressure reducing cushions available to D.N.s for the care of their patients.
  • Define and standardise the procedures to be followed to request alternating pressure air mattresses (A.P.A.M’s) and pressure reducing cushions for the prevention and treatment of pressure ulcers in the community.

In addition to this it contains a specimen set of the necessary documentation to be used to request alternating pressure air mattresses and pressure reducing cushions and a specimen copy of the “Pressure Ulcer Local Incident Report” form, as specified in NIHCE Guideline 29 (2005). (Please see Appendix VII)*

*PLEASE PHOTOCOPY THESE FORMS LOCALLY

AS NEED DICTATES

The Tissue Viability Service

(Hosted by Leicestershire County & Rutland P.C.T.)

Tissue Viability AdministratorTelephone:(0116) 2253695

Fax:(0116) 2256652

Based At:Cropston Ward

Towers Hospital

Gipsy Lane

Leicester

LE5 0TD

The Alternating Pressure Air Mattresses Fleet currently comprises of the following types of alternating pressure air mattresses:-

Full thickness mattress replacement – see note below

  • Pegasus Airwave
  • Pegasus Biwave plus/carer
  • Pegasus Cairwave
  • HH Autologic APAM/CLP
  • HH Nimbus III

Mattress overlays – see note below

  • Pegasus Overture/Viaclin
  • Talley Quattro
  • HH Alpha X-Cell
  • Parkhouse Eclipse
  • KCI 1st Step Low Air Loss

Important Information regarding fitting of mattresses

  • Alternating Pressure Air Overlays – must be fitted on top of another mattress. They cannot be placed directly onto the bed base, extended height safety rails may be required
  • Alternating Pressure Air Mattresses – must be placed directly onto the bed base.

These alternating pressure air mattresses are installed, maintained and serviced by British Red Cross Technicians based at Red Cross Community Equipment Service, Euston Street, Leicester.

Protocol for the allocation of

Pressure Relieving/reducing mattress

The criteria for allocation of pressure relieving/reducing mattresses is as follows:

Patients who are assessed as being at risk of developing pressure ulcers, but who have intact skin should be nursed on a pressure redistributing mattress/overlay, e.g.

Vaporlux mattress (DN/F099) – or similar

Modular Propad or similar (DN/F090)

Spenco Type Overlay (DN/F100)

Repose Mattress FO40 especially where the patient has a Grade 1 pressure Ulcer

All available from British Red Cross Community Equipment Service.

Alternating Pressure Air Mattresses/Overlays will only be allocated to patients with Grade 2 or higher pressure ulcers Ref: NIHCE Guideline 29 (2005), and patients who are currently being nursed on pressure relieving equipment in hospital if it is considered essential to maintain alternating pressure therapy in the community.

Patients who are in the TERMINAL phase of an illness may also be allocated an Alternating Pressure Air Overlay. If there are insufficient resources, Terminally-ill patients needs will take precedence over patients who’s condition is not immediately life threatening.

The above criterion has been discussed with, and has the approval of, the Community Equipment Professional Advisory Group. The situation will be kept under review.

Please see algorithm.

ICES/The Code of Practice for Provision of Alternating Pressure Air Mattresses and Cushions

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K Charity, TVN - April 2008

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Protocol for the Use of Pressure Relieving Mattresses

This is intended as a guide only – and is to be used in conjunction with clinical judgement

ICES/The Code of Practice for Provision of Alternating Pressure Air Mattresses and Cushions

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PROTOCOL FOR THE ALLOCATION OF ALTERNATING PRESSURE AIR MATTRESSES

  • District Nurses will apply by fax to the Tissue Viability Nurse using Form TV/1 and TV/1A
  • A copy of TV/1 and TV/1A should be placed in the patients case notes.

ONLY IN EXCEPTIONAL CIRCUMSTANCES WILL REQUESTS BE ACCEPTED BY TELEPHONE AND WITHOUT SUPPORTING DOCUMENTATION (which must be furnished ASAP)

  • Equipment is subject to availability
  • District Nurse Caseload Managers will take overall responsibility for the equipment and ensure that:-

i)Patients and relatives are educated in the use and care of the equipment and understand that the equipment belongs to Leicester, Leicestershire & Rutland NHS Trust and must not accompany them into hospital if they need to be admitted.

ii)The District Nurse’s team are educated accordingly.

iii)All outside agencies involved in the care of the patient are educated accordingly.

iv)Damage is reported immediately.

v)Record is kept locally of all patients using an alternating pressure air mattress.

  • All patients’ need for equipment will be re-assessed by the District Nurse on an ongoing basis.
  • District Nurses will ensure that equipment is downstepped as the patient’s condition improves.
  • District Nurses will ensure that a request for a higher level of equipment is made if a deterioration of the patient’s condition is thought to warrant it.
  • District Nurses will be informed by the Tissue Viability Nurse when equipment is not available and of the patient’s position on the waiting list. This communication must be recorded in the District Nurse documentation.
  • When the A.P.A.M is no longer required by the patient, the District Nurse must immediately notify the Tissue Viability Nurse, who will arrange for cancellation of the loan of the mattress with Red Cross Community Equipment Service.

A.P.A.M’s and overlays are provided to support District Nursing Care. Before closing a case, District Nurses must ensure all alternating pressure equipment has been returned.
Request Procedure

To request an alternating pressure air mattress:

  1. Complete TV/1* and TV/1A ‘Pressure Ulcer Incident Form’ and ‘request for alternating pressure air mattress’ and respectively, giving as much information as possible (this is necessary to enable the Tissue Viability Nurse to allocate mattresses on a ‘needs-led’ basis)
  1. FAXTV/1 and TV/1A along with a completed copy of the patient’s Waterlow Risk Assessment to the Tissue Viability Nurse at the number shown. Please ensure that a fax cover sheet is used to preserve confidentiality.
  1. On receipt of the request, an appropriate alternating pressure air mattress will be allocated, if available, and the D.N. will be notified (by fax) of the type of alternating pressure air mattress and its identifying number, and any conditions appertaining to its use. This information will also be copied to the Red Cross Community Equipment Service.
  1. In the event of there being no suitable alternating pressure air mattress available, the request will be added to the waiting list. The D.N. will be informed of this, and of the patient’s position on the waiting list (by fax) using TV/4, which is designed to acknowledge the request and form part of the D.N’s documentation.

* TV/1 is the Pressure Ulcer Local Clinical Incident Report specified in NIHCE Guideline 29 (2005). Whenever possible it must be completed and accompany TV/1A (faxed to 0116 2256652).

It is recognised that there will be situations where this is not possible, but TV/1 must be completed a.s.a.p and in any case within 3 weeks. Locality Service Managers will be notified of any that are outstanding.

It is the data accumulated from TV/1A that allows the PCT to fullfil its Clinical Governance obligations, and informs the PCTs “Annual Health Check”.

Note:If you consider that any issues relating to this pressure ulcer warrant further investigation, please refer to the Policy for Managing, Reporting and Investigating Incidents and Serious Untoward Incidents and submit an Incident Report Form (App 1 of that policy).

2008 TV/1A

TISSUE VIABILITY SERVICE – Hosted by Leicestershire County and Rutland NHS PCT

REQUEST FOR ALTERNATING PRESSURE AIR MATTRESSES / REPOSE MATTRESS*
(*Delete as applicabe)
PATIENTS NAME:
ADDRESS postcode must be given:
Tel No:
DATE OF BIRTH:GP:
DIAGNOSIS:

WATERLOW SCORE: / (Please attach waterlow risk assessment TV/3)
INCONTINENT: Yes No ASSESSED:Yes No
Please state management, eg. Pads
NB: Mattresses have been very badly damaged by continuous soiling with urine and faeces
PRESSURE ULCERS PRESENT /
SITE
/
GRADE
Does the Patient have a hospital bed Yes No
Is a hospital bed being ordered Yes / No
What Mattress/Cushion does the patient currently have?
General condition of the patient (include nutritional status) plus social circumstances eg. Is there a carer who can reposition patient (30o tilt)? Can patient move independently in bed?
WEIGHT OF PATIENT:
DISTRICT NURSE: RED CROSS PIN NUMBER:

BASE:
CONTACT NUMBER:FAX NUMBER:
Is the patient in hospital? / Yes No
Is this equipment NECESSARY to facilitate discharge? / Yes No
ETHNIC CODE (mandatory)
Please Fax to Ken Charity, Tissue Viability Nurse (0116) 2256652
PLEASE USE FAX COVER SHEET TO ENSURE CONFIDENTIALITY

2008 TV/1

TISSUE VIABILITY SERVICE – Hosted by Leicestershire County and Rutland NHS PCT

PRESSURE ULCER LOCAL INCIDENT REPORTING FORM

(As specified – RCN/NIHCE Clinical Guideline 29 September 05)
PATIENT NAME : D.O.B :
Did the patient have the pressure ulcer on admission to your caseload? / Yes / No
In which care setting did the pressure ulcer Originate? (If known)
Patients Home Residential Care Nursing Home
Hospital : Acute CommunityOther
How long has the Ulcer been present?
On admission to your case load, was the patient considered to be at risk of pressure ulcer?
If so, was a Waterlow risk assessment completed by a Registered Nurse? / Yes / No
Yes / No
Prior to development of the ulcer, was the patient or their carers made aware of the risk of pressure ulcers?
If Yes, by whom? / Yes / No
Don’t know
Has the patient ever been given any advice/information on how to prevent pressure ulcers?
If Yes, by whom? / Yes / No
Don’t know
Was the patient / carers concordant (Compliant) / Yes / No
Does the patient have a care plan, agreed with patient/carers, to reduce the risk of, or to treat existing, pressure ulcers? / Yes / No
Does the patient have documentary evidence that any necessary repositioning is carried out? / Yes / No
Unnecessary
Was pressure reducing equipment requested?
If yes, type : Alternating Pressure Mattress
Foam Overlay Repose Overlay Cushion
Pressure Reducing Foam Mattress FO99
Was pressure re-distributing or pressure relieving equipment readily available? / Yes / No
How often is / will be the care plan formally re-evaluated?

Note:If you consider that any issues relating to this pressure ulcer warrant further investigation, please refer to the Policy for Managing, Reporting and Investigating Incidents and Serious Untoward Incidents and submit an Incident Report Form (App 1 of that policy).

2008 TV/3

TISSUE VIABILITY SERVICE – Hosted by Leicestershire County and Rutland NHS PCT

Waterlow Pressure Sore
Risk Assessment
NAME : ………………………………………………………………………………………..
Ring scores in table, add total. Several scores per category can be used.
SCORE: 10+ AT RISK 15+ HIGH RISK 20+ VERY HIGH RISK
Build Weight
For Height / Skin Type
Visual Risk Areas / SPECIAL RISKS
Neurological Deficit
Average0
Above average1
Obese2
Below average3 / Healthy0
Tissue paper1
Dry1
Oedematous1
Clammy (temp)1
Discoloured2
Broken/Spot3 / Eg Diabetes MS, CVA
Motor/Sensory
Paraplegia4-6
Continence / Mobility / Major Surgery/trauma
Complete/caterterised 0
Occasionally incont 1
Cath/Incont of faeces 2
Double Incont 3 / Fully0
Resless/Fidgety1
Apathetic2
Restrictive3
Inert/traction4
Chairbound5 / Orthopaedic-
Below waist, spinal5
On table2 hours5
Sex/Age / Appetite / Tissue Malnutrition
Male1
Female2
14 – 491
50 – 642
65 – 743
75 – 804
81+5 / Average0
Poor1
NG Tube/Fluids only2
NBM/Aborexic3 / Eg Terminal Cachexia 8
Cardiac failure 5
Peripheral vascular
Disease 5
Anaemia 2
Smoking 1
COMMENTS/ADDITIONAL INFORMATION / Medication
Cytotoxics, high dose steroids, anti-inflammatory 4
Date: ……../………/……… / SCORE: / SIGNATURE:
PRINT NAME:

TV/4

TISSUE VIABILITY SERVICE
ACKNOWLEDGEMENT OF REQUEST
FOR EQUIPMENT
TO:
BASE:
DATE:
Thank you for your request for a high risk alternating pressure mattress/cushion. Unfortunately there is no suitable surface available at the moment.
YOUR PATIENT:

IS CURRENTLY NUMBER:

ON A WAITING LIST FOR:
Nimbus lll□ Cairwave□ Airwave□
Biwave Plus□
Alternating pressure air overlay□
Terminal Care Waiting List□
NB. Whilst waiting for a mattress to be allocated for your patient, please ensure the patient has a care plan for manual repositioning, if possible, and that the patient, and/or other carers have been made aware of any other actions that can be taken to relieve pressure.
CUSHION:
You will be contacted as soon as a mattress/cushion is available.
Please use this letter as part of your documentation.
With regards,
Ken Charity
Tissue Viability Nurse

CRITERIA FOR USE OF PRESSURE REDUCING CUSHIONS

(INCLUDING FOAM CUSHIONS AVAILABLE FROM THE RED CROSS CATALOUGUE (Superceding that in Red Cross Community Equipment Service Catalogue of August 2005)

INTRODUCTION

The number of requests for pressure reducing cushions has risen sharply in the recent past, and as a result, it has been considered necessary to introduce measures to ensure that available resources are being used efficiently and effectively to provide care for vulnerable patients.

Patient who reside in “Care Homes” (Residential Homes without Nursing Care)

It is an expectation that all such homes will be fit for purpose and as such will have armchairs/domestic seating which have inherent good pressure reducing abilities, and therefore, pressure reducing cushions should only be requested for used in this care setting for patients who have been assessed to have existing pressure ulcers (Grade 2 and above) on their sacrum/buttocks, or who are at exceptional risk of developing such.

Patients who reside in their own homes

In the case of patients who are cared for in their own home, cushions should only be considered where the domestic seating has been assessed and found to have little or no pressure reducing ability and where the patient has, or is at high risk of pressure damage from being seated.

Assessment

Cushions must not be requested unless an assessment which takes into account the patients sitting posture and the effect the cushion will have on this has been carried out, (and documented).

Management

The management of a patient in a sitting position is important. Even with appropriate pressure relief, it may be necessary to restrict sitting time to less than 2 hours until the condition of an individual with an elevated risk changes.¹

The use of Cushions should not lead to prolonged sitting time.

Positioning of individuals who spend substantial periods of time in a chair should take into account distribution of weight, postural alignment and support of feet. ¹

Advice from trained assessors with acquired specific knowledge and expertise should be sought about correct seating positions, if in doubt. ¹

Be particularly aware that :

  • Slouched postures produce higher interface pressures than sitting upright²
  • Interface pressures are further increased when users, in addition to the slouched posture, lean on an armrest.

NB. Patients must be assessed for an appropriate cushion when seated in the chair that they will use at home.

No seat cushion has been shown to perform better that another¹, but the following guidance may be of use:-

  • 3” foam cushion – FO39 suitable for patients with tissue damage up to and including Grade 1 pressure ulcer².
  • Repose cushions – FO41 suitable for patients with Grade 2 pressure ulcers.
  • 1½” foam cushions – FO31 give only minimal pressure redistribution, and should be used only where ‘transfer’ difficulties prevent the use of a 3” cushion.
  • Patients with Grade 3 or 4 pressure ulcers should be referred to Tissue Viability Nurses for very high specification pressure redistribution cushion allocation.
  • One cushion only per patient will be provided

Pressure Reducing Cushions for use in Wheelchairs

Patients who require pressure reducing cushions for use in wheelchairs should be assessed by Disablement Services Centre of Leicester General Hospital.

Refs:1. “Pressure Ulcer Prevention” Clinical Guideline 7 NICE 2003.

2. Wheelchair cushions – Static and Dynamic PS4.MDA 1997.

ICES/The Code of Practice for Provision of Alternating Pressure Air Mattresses and Cushions

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Protocol for Use of Pressure Reducing Cushions (Community)