Fall Reduction in a Behavioral Health Setting
Inpatient fall rates have been a concern at Beckley Appalachian Regional
Hospital (Beckley ARH) for many years. In 2015, a project was launched
in order to evaluate and trend the falls that occurred in the Behavioral
Science Center (BSC)...
How to Reduce Pressure Injuries in the ICU by More than 10%
A level 2 trauma center in the Southeastern U.S. purchased new
mattresses for their facility with a “one size fts all” approach. The chosen
surface was an alternating pressure redistribution surface with a foam overlay.
Low Air Loss Support Surface Selection in the Neonatal and Pediatric Population
More than 50 percent of pressure injuries (PIs) occurring in the pediatric and
neonatal population are directly related to medical devices. Skin integrity
alteration in the pediatric population causes physical pain for the child...
Practice Changes to Decrease Patient Falls as well as Prevention/Treatment of Pressure Injuries
Falls with injury continue to be a costly burden to health care facilities
and patients. The purpose of this project was to evaluate a low bed
to reduce both the number of falls and the severity of injuries from
those falls. Current practice...
Pressure Injury Prevention Using Low Air Loss in the Burn ICU
Low air loss support surfaces have been used for the prevention and
treatment of pressure injuries (PI), formerly pressure ulcers, for many
years. Incidence rates for an intensive care unit (ICU) may be as high as
38 percent. The risk factors...
Prevent Pressure Ulcers in High-Risk Infants in the PICU
Immobilized critically ill pediatric patients are at risk for developing
pressure ulcers. The most common area for infants to develop
pressure ulcers is on the occipital area due to weight distributions.
Open heart surgery patients are...
Rehabilitation of a Person with Obesity and Post-Operative Hemiparesis
Healthcare workers have among the highest on-the-job injury rates, according
to the U.S. Centers for Disease Control and Prevention. Accreditation and
reimbursement pressures are encouraging healthcare facilities to focus on...
A Review of High-Risk Children on Crib Mattresses Designed to Support Skin Integrity
Identifying children at risk for skin breakdown has improved as the
organization has engaged in national efforts to improve awareness and
promote education among all staff. Children are identified either at
admission or early in the...
Skin Prevention for Manual Prone Therapy in ARDS
The purpose of this project was to decrease the amount of skin
breakdown in patients who received prone therapy after being
diagnosed with severe acute respiratory distress syndrome (ARDS).
ARDS is characterized by acute...
Thinking Outside the Box: Use of Low Air Loss in the Neonatal and Pediatric Population
The purpose of the project was to identify and develop
guidelines for multiple uses of powered low air loss
(LAL) within the neonatal and pediatric population at a
Magnet Designated Children’s Hospital. Diaper dermatitis is one of the most...
Use of Immersion Therapy Mattresses with Low Air Loss to Facilitate Healing of Post Myocutaneous
Historically, the use of support surfaces in the treatment of
myocutaneous flaps resulting from Stage IV pressure ulcers
on the torso has been limited in our hospital to air fluidized
therapy. The WOC nurses were asked to find an...
Using High Volume LAL Surfaces as Part of a Skin Treatment Bundle for Patients with
Full Thickness Sacral/Coccyx PIs and Multiple Comorbidities
Chronic or acute full thickness pressure injuries (PIs) are painful, costly to heal, and are associated
with increased complications and increased length of stay (NPIAP, 2019). Full thickness PIs on the
sacral/coccyx area are among the...
Using Standardized Testing of Support Surfaces to Enhance Clinical Decision-making for PI
Clinicians are challenged with having objective data to choose
support surfaces that will offer the most ideal clinical performance
for patient populations. Support surfaces are designed with different
materials and constructed in various ways...
Zero Incidence of Pressure Ulcers: Changing the Paradigm of Nursing in the Emergency Department
Pressure ulcers are a universally recognized indicator for
the quality of nursing care. In 2008, the Center for
Medicare and Medicaid Services established new
guidelines which significantly changed the acute care
approach to one of...
The Advantages of Green Support Surfaces
More chemicals are used in healthcare than just about any other industry. While immediate exposure may
come in the form of everyday cleaning products, numerous hidden chemicals can be found in construction
Air Support Surfaces for Spinal Cord Patients
Spinal precautions are a common set of protocols used to care for the most critical trauma
patients—especially those with suspected spine and/orneurological injury. EMS workers often use hard
C-collars to align and stabilize the neck and a...
CLRT and Percussion/Vibration for Pulmonary Support
The typical patient needing pulmonary support is vented, sedated, and unable to cough or deep breathe on
their own. This may lead to additional complications, including higher risk for ARDS or pneumonia.
Today’s ICU bed frames and/or...
Considering New Approaches to Patient Repositioning
The struggles of patient repositioning are as old as the nursing profession itself. But today, with the
average patient weight going up and the number of caregivers going down, the struggles are not only
growing more complex—they’re also...
The Continuing Challenge of Pediatric Obesity
Pediatric obesity is a serious problem in the United States—with a growing number of children and
adolescents considered overweight or obese. The Centers for Disease Control and Prevention (CDC) reports
the following statistics for children...
Controlling Microclimate: the Weather on Your Patients' Skin
A friend recently attended a conference in San Diego and sent along a photo of a local weather report
which included a Microclimate Forecast.1 We shared a laugh by text, as San Diego seems like an odd place
for such a complicated forecast...
The COVID-19 pandemic has caused heightened levels of stress among healthcare workers—and now there is
growing concern about the long-term psychological efects, including post-traumatic stress disorder
(PTSD). Before COVID, about 22%...
Detecting Pressure Injuries in Non-Caucasian Skin
One of the most challenging areas in pressure injury (PI) prevention and treatment is the detection of
PIs among patients with non-Caucasian skin. Certified wound nurses often have extra training and
experience in this area, but most staff...
Exploring the Unique Bed Frame Needs of Post-Acute Care
Average lengths of stay at LTAC (long-term acute care) or inpatient rehab facilities could be 25 days or
more, and LTC residents may live there many years. Patients and residents in post-acute settings are
often older, sicker, and have more...
Infection Control and Prevention through Fabric Technology
In 2013, the U.S. Food and Drug Administration (FDA) warned about the infection control risks of damaged
hospital mattress top covers.1 A 2018 study published in the New England Journal of Medicine noted that
More Hospitals Establishing Specialized Emergency Departments
As many as one half of all hospital admissions begin in the emergency department (ED), and CDC data
shows that visits by patients older than 65 increased by more than 25 percent between 2005 and 2015.1
The idea of specialty EDs emerged in...
Pediatric Pressure Injuries: Different Needs for Smaller Bodies
The care and prevention of pressure injuries (PI) in adult patients is well researched—with best
practices, tools, and resources readily available. But with childhood obesity rates now at 19% and
pre-term babies at high-risk for PI, there...
Preventing a Challenging Side Effect of Pediatric ECMO
A highly-specialized life-support tool. A modified, long-term heart-lung bypass machine. A hopeful last
chance. These all describe ECMO (extracorporeal membrane oxygenation). Simply put, physicians turn to
ECMO when all other...
Proning Patients as a COVID-19 Treatment
In the early weeks of COVID-19—before fully understanding the illness’s complexities and nuance—prone
positioning became a clear treatment preference among ICU and COVID unit caregiver teams. But doing it
correctly, without risk...
Redefining Support Surface Terms and Definitions
The Support Surface Standards Initiative (S3I) is the official industry standards body within the
National Pressure Ulcer Advisory Panel (NPUAP). S3I develops terminology, test methods, and reporting
standards for medical support surfaces...
Restraints Then and Now: How Viewpoints and Policies Have Changed
The debate over restraints in patient care goes as far back as the 1840s, when British Parliament
established a commission to abolish restraint usage. Meanwhile, American mental health professionals
used restraints as normal...
RNs/PTs in the ICU
In the ICU, nurses and physical therapists (PTs) quickly learn the stark diferences not only in their
patient care priorities, but also in the ways they communicate. Of course, they always share at least
one thing in common: a mutual goal of getting...
Understanding and Preventing Bed Rail Entrapment
Entrapment is defined as an occurrence involving a patient who is caught, trapped, or entangled in a
hospital bed system. Since 1997, the U.S. Food and Drug Administration (FDA) has published and updated
its guidance to reduce...
Understanding When a Foam Mattress Alone Isn’t Enough
When it comes to pressure injuries (PI), prevention is key. The right foam support surface—including
convertible mattresses with added therapies—can make all the difference. Unfortunately, there is no
agreement among clinicians, researchers...
The Unique Skin Challenges of COVID-19 Positive Patients
The National Pressure Injury Advisory Panel (NPIAP) recently released a position statement on the
effects of COVID-19 on the skin, which appears to create a perfect storm for unavoidable pressure
injuries (PI) in the critically ill patient. This...
Automated vs. Manual Proning of Patients with ARDS
The possible benefits of prone positioning, or “proning”, were first researched in 1974 in studies
on the effects of sedation and paralysis on the diaphragm. The hypothesis was that patients in a
prone position would exhibit a better expansion...
Avoiding Skin Breakdown During CLRT
The development of nosocomial pneumonia in intensive care unit (ICU) patients is one of the most
important safety issues in critical care. Continuous lateral rotation therapy (CLRT) is often used to
rescue the lungs, but the shearing effects can...
Bariatric Sensitivity Training: Providing Dignified Care to All Patients
More than 77.6 million adults in the US suffer from obesity, and as many as 112,000 deaths are
associated with the disease. Coupled with this health crisis is the fact that weight bias remains very
socially acceptable in North America culture...
The Importance of Early Mobility
Historically, ICU patients were thought to be in too much pain or too sick to be awakened while on
mechanical ventilation. As a result, immobile patients were not moved by the healthcare team. It was
common for patients to remain...
Preventing PIs in the Acute Burn Population: The Role of Low Air Loss
A review of recent burn care text outlines the risk of complications for patients in the acute phase as
well as rehabilitation. While risks include seemingly more critical issues such as permanent
disfigurement, disability and serial surgeries...
SPHM: Dynamic Approaches to Practice Patterns
In 2014, more than 11,000 registered nurses (RNs) suffered injuries while assisting patients and
performing their jobs. Every day, nurses and other caregivers suffer debilitating pain and often
career-ending musculoskeletal disorders due to...
Suicide in the Emergency Department
In 2015, more than 44,000 people took their own lives, making suicide the tenth leading cause of death
in the U.S. It was the second leading cause of death among individuals aged 15-34. There were more than
twice as many suicides (44,193)...
Surfaces Across the Continuum of Care
Choosing the right therapeutic support surface for a patient at risk for pressure injury (PI) is an area
where consistency must be maintained across the patient care continuum. The prevalence of hospital-
(or facility) acquired pressure...