NURSING PATIENT CARE POLICY & PROCEDURE
June 30, 2017
Nursing Manual (Red)
Policy #: 8.17AP
Title: Therapeutic Support Surfaces and
Frames (Specialty Beds) (Adult & Pediatric)
To provide guidance in the selection of a support surface to maintain patient skin
integrity, prevent skin breakdown and/or promote healing of damaged skin in patient
clinical situations where extended immobility and/or restricted positioning options are
1. Stryker bed frame
2. Bariatric surface with bariatric frame
3. Low air loss bariatric surface with bariatric frame
B. Support Surfaces
1. Alternating pressure redistributing surface with pump
2. Low air loss surface
3. Air fluidized surface
4. Polyurethane foam support surface for cribs (standard)
A. The nurse will perform a skin assessment and calculate a Braden Risk Assessment
or Braden Q Risk Assessment score to assist in appropriate support surface
selection refer to Nursing Patient Care policies 13.12A, Basic Care Standards
Inpatient Adult or 13.16P, Basic Care Inpatient Pediatrics (Birth-18 years of age).
B. Clinical indicators guiding support surface selection include: current skin
condition including existing breakdown, pressure ulcer risk assessment score,
patient diagnosis/procedure of flap, graft or burn, and patient weight and height.
C. The Wound, Ostomy, and Continence Clinical Nurse Specialists, Wound and Skin
Nurse Clinicians, and unit Resource in Skin Care (RISC) nurses are available to
assist with support surface selection.
D. Sleep surfaces will be kept clean using designated hospital disinfectant whenever
exposed to blood and/or body secretions, according to UW Health Clinical Policy
4.1.4, Cleaning of Blood and Body Fluid Spills.
A. Utilization of Alternating pressure redistribution surface with pump:
Page 2 of 4
1. Use of surface with pump is contraindicated for patients with unstable
cervical, thoracic and/or lumbar fracture or cervical traction – use surface
without pump for patients with these fractions or traction
2. Support surface is standard on hospital bed frames.
3. Has alternating air cell capacity
4. Has pressure redistribution in all positions
5. Has an alternating pressure feature promotes circulation
6. A firm mattress perimeter provides seating support for patients as they sit
on the edge or get out of bed
7. Use for patients who weigh up to 500 pounds
8. Appropriate nursing care prevents breakdown:
a. In patients not at risk
b. In patients with moderate to high risk (Braden or Braden Q score
of 18 or less)
c. In patients with a history of pressure ulcers
d. In patients with head of bed greater than 30 degrees,
e. In patients with stage 2 or greater pressure ulcers who can be
turned or patients who have at least two (2) body turning surfaces
B. Utilization of pressure redistribution bariatric surface with bariatric frame:
1. Used for prevention and treatment of skin loss due to pressure.
2. Used for bariatric patients with a body mass index (BMI) greater than 35
or patients whose body habitus impairs the ability to turn comfortably in
bed, with or without assistance.
3. Expandable bed width up to 48 inches.
4. Integrated bed scales built in the frame.
5. Appropriate for patients weighting up to 1,000 pounds.
C. Utilization of pressure redistribution low air loss surface, Pressure
redistribution low air loss bariatric surface - Bariatric and non Bariatric:
1. Contraindicated for unstable cervical, thoracic, and/or lumbar fracture or
2. To perform CPR: Pull red CPR lever on power unit to disconnect hoses
and deflate overlay. A backboard may be required under patient as well.
3. Sensors automatically adjust air flow to patient positioning and movement.
4. Appropriate nursing care prevents breakdown for inpatients with moderate
to high risk Braden or Braden Q score of 18 or less.
5. Used for treatment of multiple stage 2 or 3 pressure ulcers on trunk or
extremity, patients at high risk of added skin breakdown or history of
pressure ulcers, late post-op skin graft or flap, or patients with any stage
pressure ulcer who cannot be turned or who have fewer than two (2)
6. Turning and repositioning of the patient is still necessary.
7. Hand checks of the mattress, as needed, will identify "bottoming out" of
a. With head of bed elevated, place hand palm up between support
surface and bed frame at level of patient’s buttocks to assure that
no bony prominences are felt.
b. If bottoming out occurs consider; patient’s weight exceeds
manufacturer recommendation for surface, patient positioning, or
under/over inflation of support surface.
Page 3 of 4
c. Consult Wound and Skin Service if above troubleshooting is
8. Pressure redistribution in all positions.
9. Deflate the surface prior to the patient sitting at the edge of the bed and
when the patient is transferring from the bed to another seating surface.
10. Low air loss feature is inactivated during transport although pressure
redistribution is maintained.
11. Use with non-fitted flat sheets and air-flow chux only
12. All four side rails must be up at all times to prevent the patient from
sliding out of bed due to the slippery surface. This is not considered a
D. Utilization of pressure relief high air loss air fluidized surface:
1. Contraindicated for patients with unstable cervical, thoracic and/or lumbar
fracture or cervical traction.
2. Special CPR instructions for air fluidized surface: Turn bed
fluidization off. The bed will become hard and allow the patient to be
repositioned for CPR. A backboard may also be required under the patient.
3. A framed air surface that utilizes fluidized microsphere beads.
4. Used for treatment of multiple stage 3 and 4 pressure ulcers with no
unaffected turning surface or post-operatively after skin graft or flap.
5. Use non-fitted flat sheets and air flow chux only.
6. Use for patients who weigh up to 350 pounds.
E. Ongoing Monitoring
1. It is the ongoing responsibility of the patient's nurse, Care Team Leader,
the unit RISC nurse and the Wound, Ostomy, and Continence Team to
evaluate the effectiveness and continued need for a therapeutic pressure
reducing/relieving device. When the patient no longer meets the
guidelines, the patient should be placed on a more appropriate surface.
1. Utilization of a specialty bed or support surface is documented in the
Flowsheet – daily care – specialty bed.
2. Document utilization of a specialty bed or support surface on initiation
and daily or if the support surface changes.
V. UWHC CROSS REFERENCES
A. UW Health Clinical Policy 4.1.4, Cleaning of Blood and Body Fluid Spills
A. Nursing Patient Care Policy 13.12A, Basic Care Standards (Inpatient Adult)
B. Nursing Patient Care Policy 13.16P, Basic Care – Inpatient Pediatrics (Birth-18
years of age)
A. McNichol, L., Watts, C., Mackey, D., Beita, J., Gray, M. ((2015). Identifying the
right surface for the right patient at the right time: Generation and content
validation of an algorithm for support surface selection. Journal of Wound
Ostomy Continence Nursing, 42(1):19-37.
B. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel
and Pan Pacific Pressure Ulcer Injury Alliance. Prevention and Treatment of
Page 4 of 4
Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (Ed.). Cambridge
Media: Perth, Australia; 2014.
C. Nix, D., & Mackey, D. (2012). Support Surfaces. In R. A. Bryant, D. P. Nix
(Eds), Acute and Chronic Wounds: Current Management Concepts (154-167). St.
Louis, MO: Mosby.
D. Noonan, C., Quigley, S., & Curley, M. (2011). Using the Braden Q Scale to
predict pressure ulcer risk in pediatric patients. Journal of Pediatric Nursing, 26,
VII. REVIEWED BY
Clinical Nurse Specialists, Wound & Skin
Nursing Patient Care Policy and Procedure Committee, June 2017
Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive