Development of an evidence-based specialty support surface decision tool

Advancing technology, an aging population, increasing attention to appropriate resource use, and growing concerns about patient safety and professional liability combine to complicate support surface choice. Cognizant of these factors, staff in a 600-bed tertiary care hospital in a large urban center in western Canada decided to evaluate an existing specialty support surface decision tool and update the instrument based on current published literature (no older than 3 years), expert opinion, and results of pilot testing. Elements included in the existing tool were the patient's Braden Score, mobility/activity indicators, and identification of existing skin breakdown. The tool allowed considerable latitude in decision-making based on other clinical factors and established professional practices and had not been formally evaluated. The revised tool addressed relevant assessment criteria such as risk category, patient weight, presence of existing skin breakdown/number of ulcers, flap surgery, pulmonary complications, palliative care, positioning, and Braden score, as well as oversight of support service choice. Although the incidence of nosocomial pressure ulcers did not change significantly during the trial period, costs incurred for support surface use decreased 26% overall, underscoring the need for improved guidelines for support surface selection.