Pressure redistribution surfaces (airbeds) are a vital part of any skin program. In over 25 years of serving the medical community I have yet to see a skilled nursing facility, hospice program, hospital, or in-patient rehabilitation facility that did not integrate airbeds into their plan of care. They can be a double-edged sword though. When set inappropriately these devices can increase pressure and often lead to a higher risk of falls.
When an air mattress is set too firmly it loses its ability to provide the pressure redistribution therapy it’s designed for. The cells become rock hard, often firmer than a standard mattress. Any pressure reduction qualities go by the wayside. Most of these surfaces have a low shear/low friction cover on them to reduce external factors that could cause more issues. When the bed is too firm and the top sheet is low friction, the surface becomes a slip and slide that often leads to increased falls. In my time providing (thousands of) these units I can say with confidence that most fall situations involving air surfaces were the result of improper patient settings. This is avoidable with appropriate patient settings. In fact, when set properly, an airbed can serve as an anti-fall device.
When an airbed is set properly, the patient is going to naturally sink into the surface. Visually, about 1/3 of their body mass should be cradled into the mattress. This will provide the maximum pressure relief offered and create pillowed bolsters around the perimeter of the patient and under his or her knees. Unless a patient is actively trying to leave the surface it’s unlikely that a fall can occur. So, how do you tell if the mattress is set properly for the patients’ body type?
Let’s start with saying that relying on the weight settings of a mattress is not the most reliable. There are very few beds with the software sophistication to read the correct distribution of weight across the surface. Most of these units use weight as a starting point for pressure. They do not account for the difference in height or location of weight that can occur from one patient to the next. Some patients might have a “normal” distribution of weight with an average body type, where another may carry the majority of his weight centrally causing the patient to “bottom out.” The best way to set the mattress to the patient is to do a hand check. Once you have the mattress set to the pressure you think will be appropriate you can place your hand between the cells directly beneath the patient’s coccyx. With your hand perpendicular to the patient and your pinky contacting the base of the mattress, the patient should sink about 4” into the surface. Most (not all) air cells are about 8” tall, so the weight of the patient should just make light contact with your pointer finger.
Once you have established the appropriate setting using a hand-check, it’s best to mark the setting on the control unit. You can use a small piece of dressing tape and a sharpie. You should see the patient comfortably “cradled” in the mattress with about 30% of his body sinking into the bed (rolled shoulders are a sign the mattress is too soft). Best practice tip: Train your staff including CNAs, therapists, nurses, dieticians, and any other care provider to do a visual inspection.
Powered air surfaces are incredible therapeutic tools for the prevention and treatment of pressure injury. They are also a worry spot for teams worried about fall risk. When your team understands the proper use and setting you can nearly eliminate the risk of fall while maximizing the therapeutic value. ProCare is dedicated to helping our care partners administer the most effective and safe care possible. We offer on-demand inservices to our partners and their teams. Give us a call to schedule your inservice.
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