Frequently Asked Questions Emerald Mattress

Q: What is a Pressure Ulcer?

A: A pressure ulcer is a localised area of dead tissue. It is primarily caused by unrelieved pressure, for example when a patient lies in one position for too long, although there are many other factors which influence their development, such as incontinence and poor nutrition. The areas of the body most at risk of pressure ulcer development are the bony prominences, such as the ischial tuberosities and sacrum.

Q: Who is Most at Risk of Pressure Ulcer Development?

A: The elderly, people with neurological conditions, and orthopaedic patients are most at risk, as they frequently have reduced mobility, and are therefore less able to change their position. Hospitals use Risk Assessment scores in order to determine which patients are most at risk of pressure ulcer development. The most commonly used score is the Waterlow Score (1985).

Q: When Should a Patient have a Waterlow Risk Assessment?

A: All patients should have their pressure ulcer assessed on admission, for example in A & E, and should be reassessed whenever their condition changes, for example if their condition deteriorates.

Q: How Can Pressure Ulcers Be Prevented?

A: The most effective method of preventing ulcers is the provision of suitable pressure-reducing equipment, such as a mattress and seat cushion. These support the maximum surface area of the body, which therefore lowers the pressures under the bony prominences.

Q: What is the Difference Between Pressure-Relieving Equipment and Pressure-Reducing Equipment?

A: Pressure-reducing equipment aims to provide maximum support of the body surface area, thereby reducing interface pressures over bony prominences. Such equipment is normally referred to as static equipment. The Emerald mattress is a static visco elastic mattress. Pressure-relieving equipment aims to give pressure relief over small areas of the body at a time.

This is achieved by inflating and deflating air cells alternately. This type of equipment is usually referred to as dynamic equipment. Therefore pressure-reducing equipment gives uniform pressures throughout the whole body, whereas conversely pressure-relieving equipment intermittently relieves pressure under individual areas of the body.

Normally, pressure-reducing equipment is provided for patients who are known to be at risk of pressure ulcer development. Dynamic mattresses are provided for patients with existing ulcers, or who are know to be at very high risk of pressure ulcer development.

Q: When Should Pressure-Reducing Equipment be Provided?

A: Pressure-reducing equipment should be provided as soon as the patient is deemed to be at risk. Trolleys in A & E, and Operating Tables should therefore be used in conjunction with suitable pressure-reducing mattresses, in addition to the mattress on the patient's bed and cushion on their bedside chair.

Q: What is the Emerald Mattress?

A: The Emerald mattress has been manufactured from a visco-elastic polymer foam. This type of foam is sensitive to the heat of the body, and as the foam is gradually warmed, it conforms to the body shape.

The mattress therefore reduces peak pressure points by supporting the load over a wide surface area.
Due to the high degree of conformity achieved with the Emerald mattress, the effects of shear forces and friction are reduced.

In addition to the pressure-reducing qualities of the Emerald mattress, patients who are nursed on these mattresses frequently comment on their comfort.

Q: Can the Emerald  Mattress be used with Profiling Beds?

A: Yes. The combination of the Emerald mattress and a profiling bed provided both excellent pressure reduction and ease of position change.

Q: Does the Emerald Mattress Require Regular Turning?

A: The Emerald mattress has been designed so that it does not require turning or rotation.

Q: Is it Unnecessary to Turn the Emerald?

A: The Emerald mattress is constructed from two layers, each of which has a particular function. The top layer of the mattress is constructed from visco-elastic polymer, and this is the layer that is in contact with the patient. It reduces interface pressure by conforming to the shape of the body. The base foam acts as the supporting structure.

Q: Do Patients Require Regular Repositioning on the Emerald Mattress, if at Risk of Pressure Ulcer Development?

A: All patients should be repositioned for eating, toileting and for provision of comfort. In general terms, if there is a sign of blanching hyperaemia, the patient may require increased frequency of repositioning or placing on an alternating pressure-relieving mattress.

Q: How Should Patients be Positioned in Order to Reduce Pressure over the Sacrum and Heels?

A: Patients should be repositioned in the 30° tilt, as this loads the gluteal area of the body, thereby lessening weight taken over the bony prominences such as the sacrum.

Q: Do Patients with a Waterlow Score of Over 15 Require their Pressure Areas Examining During Each Nursing Shift?

A: Patients with Waterlow scores of over 15 require regular skin assessment, even if they have been provided with a pressure reducing mattress. If any signs of persistent redness are noticed, then the frequency of repositioning should be increased, or an alternating pressure-relieving system provided.

The special heel care panel of the Emerald mattress reduces the possibility of damage to the skin over the heels, although they require regular reassessment in order to identify any damage caused.

Q: What Should I do if the Patient has Reddened Areas?

A: Firstly the frequency of re-positioning should be increased. The patient should be re-assessed, and if necessary provided with an alternating pressure-relieving system such as the Jade, Ruby or diamond dynamic mattress systems.

Q: Should Bottom Sheets be Tucked-In to Ensure that there are no Wrinkles?

A: If a tight sheet is provided, the mattress will be unable to contour to the patient. This consequently reduces the pressure reduction provided by the mattress, and is known as "hammocking".

When making the bed, it is important to obtain the correct tension on the sheets, allowing immersion into the mattress and preventing hammocking, but without allowing the sheet to wrinkle.

 
Q: Should the Top Sheet be Tucked-in Loosely or Folded, to Ensure that there is no Pressure on the Toes or Heels?

A: A fold in the sheet near to the heel section of the mattress will ensure that the surplus sheet material does not apply pressure to the bony prominences. Alternatively, a bed cradle may prove more comfortable.

Q: Does the Conformity of the Mattress Inhibit Patient Transfers?

A: Not normally. However, moving and handling equipment such as sliding boards and sheets can easily be used with the mattress.
 


Q: How Should the Mattress be Cleaned?

A: The mattress can be simply cleaned between patient use with soap and water, providing that there has been no spillage of bodily fluids. If a spillage of bodily fluids has occurred, then the mattress should be cleaned according to the hospital's decontamination policy. REFERENCES: Waterlow, J. (1985) A Risk Assessment Card, Nursing Times, 81: 49 - 55

Pressure area care - Seating

Q: Why is Provision of Suitable Seating Equipment so Important?

A: At-risk patients are more vulnerable in a seated position than when in a lying position, due to the small surface area of the body being supported. The buttocks and thighs support 75% of the body weight, and so there is an increased risk of damage to tissues due to pressure compared to lying.

The shape of the pelvis makes it difficult to achieve stability when sitting, due to the rounded shape of the ischial tuberosities. Gravity continually causes the body to slide down in the chair, and this results in shear forces and friction, which cause damage to internal tissues.


Q: What are the Requirements of a Pressure-Reducing Cushion?

A: It should allow the ischial tuberosities to be accommodated, thereby allowing the thighs to support the body weight.

It should promote a symmetrical, stable sitting position.

It should provide comfort.


Q: What is the super flex Cushion?

A: The Superflex Cushion is a pressure-reducing cushion that has been manufactured from a visco-elastic foam. This type of foam is sensitive to the heat of the body, and as the foam is gradually warmed, it conforms to the body shape. The cushion therefore reduces peak pressure points by supporting the load over the maximum surface area possible. As a consequence, the superflex-Visco cushion can be safely used with patients who are at medium to high risk of developing pressure ulcers.

The cover of the superflex-Visco cushion is constructed from a multi-stretch fabric that is waterproof and vapour permeable. The cover allows the patient to easily contact with the cushion, and prevents hammocking.

Due to the high degree of conformity achieved with the superflex-Visco Cushion, the effects of shear forces and friction are reduced.

The conformity of the Cushion means that patients find it extremely comfortable and stable.



Q: Is the Superflex & Neo range suitable for use as a Wheelchair cushion?

A: Yes. This product is widely used as a wheelchair cushion and comes in various sizes to suit individual needs.


Q: Can the Superflex & Neo range be integrated into an Armchair?

A: Yes, the pressure reducing cushions can be easily integrated into existing ward chairs / armchairs.



Q: Can the Superflex & Neo range be used on an existing Ward Chair?

A: Yes. Where possible it is preferable to remove existing foam seat bases before placing the superflex & Neo range on the chair.


Q: What is the Correct Sitting Position?

A:The correct sitting position should allow the ischial tuberosities to support body weight evenly, thereby providing a symmetrical sitting position.

The hips and knees should be flexed to 90°, and the feet should be placed flat on the floor (feet take 19% of the body weight in sitting).



Q: Do patients Require Regular Repositioning on the superflex & Neo range, if at Risk of Pressure Ulcer Development?

A: All patients who are expected to sit for long periods of time should be regularly repositioned, and research has demonstrated that mobilisation of patients every two hours will reduce the incidence of pressure ulcers.

If seated patients are not regularly repositioned, then their posture will become adversely changed, which will load areas of the body which are unable to withstand it, for example the sacrum and heels.



Q: What Should I do if the Patient has Reddened Areas?

A: Firstly the frequency of re-positioning should be increased. The patient should be reassessed, and if necessary provided with an alternating pressure-relieving cushion.



Q: Does the Conformity of the superflex & Neo range Inhibit Patient Transfers?

A: Not normally. However, moving and handling equipment such as sliding boards and sheets can easily be used with the cushion.



Q: How Should the superflex & Neo range Cushions be cleaned?

A:The cushion can be simply cleaned between patient use with soap and water, providing that there has been no spillage of bodily fluids.

See recommended cleaning instructions with each Cushion Provided or go to our downloads

REFERENCES: Waterlow, J. (1985) A Risk Assessment Card, Nursing Times, 81: 49 - 55