Hello Blucken,
I've compiled plenty of information, which I think answers all your questions.
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?Why are these alternating pressure mattresses used??
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The short answer is to prevent or help heal decubitus ulcers,
commonly called ?bedsores? or ?pressure sores? and to provide burn
patients, patients with Multiple Sclerosis, Lou Gehrig?s disease,
fibromyalgia, etc. with some comfort. Patients at risk for bedsores
are those that are bedridden, have moist skin from fever, and those
that suffer from incontinence, perspiration, anemias, renal failure,
osteoarthritis, dehydration, and a decreased nutritional intake.
?If the patient is bedridden, sensitive body parts can be protected by:
·Sheepskin pads
·Special cushions placed on top of a mattress
·A water-filled mattress
·A variable-pressure mattress whose sections can be individually
inflated or deflated to redistribute pressure.
http://www.findarticles.com/p/articles/mi_g2601/is_0001/ai_2601000184/pg_2
?A hospital bed can make a big difference in comfort for ALS patients.
These beds have adjustments for raising and lowering both the head and
the foot sections. Sleeping with the head raised 10-40 degrees allows
for easier breathing. Sleeping with the legs raised slightly will help
reduce the common problem of swollen feet. There are three types of
hospital beds: manual, semi-automatic, and fully automatic. A
semi-automatic model with electrical controls to raise and lower the
head and the foot sections is the most appropriate type for an ALS
patient. A fully automatic bed which will also raise and lower the
entire bed to facilitate transfers and aid caregivers is nice but not
necessary. Hospital beds should be ordered with half linked side rails
that can be raised or lowered as desired. These give the patient
something to grab when transferring and turning or repositioning.
Insurance companies will usually cover the cost of a semi-automatic
hospital bed. In most cases, the beds are provided on a rental basis.?
?Another thing not mentioned in this article is a mattress overlay.
They are commonly used to help burn victims but they work well also
for people like us who have difficult turning at night. And probably
the best thing about them is that they don't cost and arm and a leg.
The fanciest one is by a company called Roho and it isn't cheap. It
can cost thousands. But there are plenty of other kinds that are as
effective for the purposes of someone with ALS. I found one that cost
about $200 and it was like sleeping on one of those floats you put in
a swimming pool. On a good night I can make it all the way through the
night without needing someone to turn me. Most nights I only need to
be turned once. This is a big deal because everything is easier when
I've slept well but everything is happier when my wife has slept
well.?
http://www.extrahandsforals.org/mt/archives/000084.html
Here is a description of their alternating pressure mattress
?When you lay on the surface: Preset, one-way pressure relief valves
open, allowing air to escape through an interconnected manifold
system. When the optimum internal pressure is reached, the pressure
relief valves automatically shut off, providing pressure relieving
weight displacement.
When you shift your weight: A reforming agent inside each cylinder
restores the air cylinder to its original shape as one-way intake
valves allow air to re-enter and re-fill each cylinder automatically.
The mattress automatically adjusts to your movements.
All AtmosAir? mattresses utilize:
Self Adjusting Technology (SAT) ?, a patented, technological
breakthrough; a non-powered, dynamic air suspension system that
delivers superior pressure relief using exclusive intake/release
valves
Sloped heel section helps take weight off the heels and ankles and
lower your chances of pressure ulcers
Firm foam perimeter provides seating support and stability for both
the patient and the caregiver
Easy to clean and maintain pleated, multi-way stretch cover helps
reduce friction and minimize staining while assisting with infection
control
1-1/2 inch anti-bacterial, stress relieved luxury foam topper
increases comfort and helps reduce the possibility of contamination.?
http://www.securedwww.com/kci/atmosair_m.html
?In the new Mediscus Mark 5A-M low air loss bed the patient lies on a
mattress formed by five groups of air sacs, adjustable in each section
to different air pressure and made of material permeable to
water-vapour. This prevents the formation of pressure sores and
ensures that the patient's skin is kept dry in a comfortable and
controlled warm air atmosphere. In cases of severe burns the patient
can be nursed supine for long periods without being turned and there
is no friction against painful burn wounds. When skin grafts are
applied, the patient may be placed on the bed resting on the grafts
without significant damage. The bed can be easily positioned in order
to achieve maximum patient comfort and it can be adapted to
accommodate any medical emergency. The recent experiences with two low
air loss beds in the care of burn patients over a period of six months
are described.
Damage to the skin and soft tissues following prolonged decubitus of
the patient in a conventional bed is known to be caused by excessive
pressure of the skeleton on the soft parts, with values 4-5 times as
high as that of the pressure within the capillaries, which is about 26
mm Hg. If these local conditions persist, the collapse of the
capillaries and the veins leads to functional circulatory
disturbances, at first transitory but later permanent, followed by
organic damage with cutaneous necrosis spreading to the subcutaneous
tissue, the fascia, the muscles and the bones.
Further damage is caused by friction between skin and bedsheet due to
gravitational slipping and by imperfect cutaneous evaporation at the
pressure points.?
http://www.medbc.com/annals/review/vol_2/num_3/text/vol2n3p140.htm
?In 1991 Krasner reported that there were over 115 different
pressure-relieving support surfaces on the market.13 Sheepskin and
other inexpensive pads (e.g., "egg-crate" mattresses) are common
pressure-reducing devices. Other static devices include
pressure-relieving pads (e.g., fabricated from elastic polymers) such
as those used to cover operating room tables. Constant, low-pressure
supports maintain uniform pressure throughout. Examples include
higher-grade foam, and gel-, air-, or water-filled supports. In
contrast, dynamic or alternating air devices have a built-in pump that
continually redistributes air pressure. Low air-loss beds, as their
name implies, permit small amounts of air to escape through a network
of pores, whereas high air-loss (or air-fluidized) beds purposefully
pump air through ceramic-type beads. Finally, kinetic turning beds,
which allow continual rotation, are used more commonly in critically
ill patients.?
http://www.ahrq.gov/clinic/ptsafety/chap27.htm
?Bedsores most often develop when constant pressure pinches tiny blood
vessels that deliver oxygen and nutrients to the skin. When skin is
deprived of oxygen and nutrients for as little as an hour, areas of
tissue can die and bedsores can form.
Slight rubbing or friction against the skin can cause minor pressure
ulcers. They can also develop when a patient stretches or bends blood
vessels by slipping into a different position in a bed or chair.
Urine, feces, or other moisture increases the risk of skin infection,
and people who are unable to move or recognize internal cues to shift
position have a greater than average risk of developing bedsores.
Other risk factors include:
·Malnutrition
·Anemia (lack of red blood cells)
·Diuse atrophy (muscle loss or weakness from lack of use)
·Infection.
http://www.findarticles.com/p/articles/mi_g2601/is_0001/ai_2601000184
Illustration of where bedsores often occur
http://www.nlm.nih.gov/medlineplus/ency/imagepages/19091.htm
From elder-abuse-information.com:
?Bedsore Prevention: Special Beds and Cushioning
Pillows and foam wedges can help relieve pressure that leads to
bedsores. A lifting device such as a specialized trapeze minimizes
friction against the skin when the patient needs to be moved or
transferred.
Special beds have been used in place of those with standard mattresses
to reduce pressure. Low air?loss beds have surfaces filled with air
from air pumps, but allow small amounts of air to escape through a
network of pores. There is some evidence that using a low?air?loss bed
helps heal and reduce the size of pressure sores (Ostomy Wound Manage.
1995 Jun; 41(5): 46?8, 50, 52).
Alternating pressure mattresses have built?in pumps that continually
redistribute air pressure. In one study, alternating pressure
mattresses proved useful in reducing the incidence of bedsores when
compared with standard hospital mattresses (Age Ageing. 1995 Jul;
24(4): 297?302).
Air?fluidized beds (brand name Clinitron) have air pumped through an
area with ceramic?type beads. The patient feels as though he or she is
being supported by a fluid. In one study, use of these beds reduced
the size and incidence of bedsores when compared with alternating
pressure mattresses (Ann Intern Med. 1987 Nov; 107(5): 641?8). No
definitive studies have compared the effectiveness of air?fluidized
beds with low?air?loss beds.
Air?fluidized beds are very heavy and not all structures can
accommodate them. Because the beds cannot be raised and lowered,
transferring patients in or out of them can be difficult. They are
also generally more expensive than low?air?loss beds and alternating
pressure beds.?
http://www.elder-abuse-information.com/news/news_082903_bedsores.htm
?When the patient is supported in such a manner that a pressure
sufficient to obstruct blood flow in capillaries results, bedsores
(pressure ulcers) occur. This condition arises at bony prominences; by
far the most common location is the sacrum2.
A swimmer floating in water does not experience elevated pressure on
his bony prominences. By Archimedes principle, pressure is uniform on
all surfaces and in every direction. Engineers developed an ingenious
patient support system based on this principle over 30 years ago . In
order to fluidize a bed of particles, air is forced upward through the
bed at such a rate that the pressure drop is just sufficient to
overcome gravity: The particles (ceramic spheres), restrained by a
permeable sheet, act as a fluid of elevated specific gravity on top of
which the patient "floats".
In study after study this support system has been shown to be the most
effective therapy available to facilitate healing of advanced
bedsores. But the air-fluidized bed (AFB) is perceived to be an
expensive therapy. Medicare will pay for its use in nursing homes only
after a Stage 3 ulcer has developed (through fat and muscle and nearly
to the bone), or when multiple Stage 2 ulcers have appeared. In
hospitals, far too few administrators and/or physicians are willing to
use AFB therapy because, under Medicare's Prospective Payment System
(PPS), they fear that too few dollars will remain to pay their fees.
The availability of such studies showing the efficacy of AFB therapy
in healing bedsores, coupled with the fact that the AFB supports the
patient at below capillary pressure, leads to a reasoned judgment that
use of the AFB upon hospital admission, or possibly upon note of the
Stage 1 first bedsore indication, has the promise of reducing greatly
the incidence of these wounds. But there is further hard evidence.
Six beds of sand were used in a hospital ward in England for five
years in the early 1970's.8 The sand surface was carefully contoured
to provide recesses for bony prominences. For three of those five
years, a prototype air-fluidised bed was used along with the sand
beds. "This provides automatic accommodation of the sand surface to
the patient's contours and obviates the necessity to make manual
impressions in static sand trays..."
"During this period [5 yrs, 6 beds] no patient has developed a bed
sore...despite the fact that a considered high risk of decubitus
ulceration was the usual indication for the prescription of this form
of patient support."
http://www.decubitus.org/cost/cost.html
?The concept of alternating pressure has been around for 40-50 years,
with few changes to the concept. Alternating pressure in a mattress
provides a range of high and low internal cell pressures in differing
cycles depending on the product.
The internal cushion pressures are pre-set factory values and respond
very little to the size, weight or position of the patient. The
pressures have to be pre-set at high values to enable the product to
accommodate for up to 50% of the mattress being deflated at any one
time. If we apply the simple, well recognised physics formual,
Pressure = weight/surface area, by reducing the surface area by up to
50%, there will be an obvious increase in interface pressures and this
is usually indicated by patients complaining of discomfort (Rithalia
1998, Grindley and Acres 1996). It also results in a reduction in
tissue oxygenation (Schregel et al 1993).?
http://www.n2nmagazine.co.uk/articleDetails.asp?ArticleID=300
?What are mattress pads? Mattress pads (also called mattress overlays)
lie on top of a regular mattress to help decrease pressure on the
skin. This helps improve blood flow, and prevent open sores in people
who stay in bed most of the time. There are many different types of
special mattress pads. The most common types are egg crate and
alternating pressure pads.?
?What is an alternating pressure pad? An alternating pressure pad goes
under the sheets and covers the mattress top. It is made of soft
plastic divided into sections that have water or air inside. A tube
goes from the pad to an electric pump. The pump inflates and deflates
the divided sections in the pad. An alternating pressure pad may be
needed to help heal open sores. You can buy or rent an alternating
pressure pad from most medical supply stores. Follow these steps to
put the pad on the bed.
·Always read and follow the directions that came with the pad when
using an alternating pressure pad.
·Check the cord and plug of the electric pump to make sure they are
not cracked or torn. If the outlet only has two holes and the plug has
three prongs, do not use the outlet. Overloading an electrical outlet
may start a fire.
·Take the sheets off of the bed.
·Put the pad on top of the mattress and unfold it. Follow the
instructions to make sure the correct side faces away from the
mattress top.
·Put the electric pump on a footstool or on the floor where no one
will trip over it.
·Hook the tubes on the pad to the electric pump. Make sure the tubing
is not twisted or pinched.
·Turn on the electric pump and check the pad to make sure that the
sections are filling and emptying.
·Cover the pad with a bottom or fitted sheet.
·Move the person back into bed and help him get comfortable.
·Clean the pad with a wet cloth and mild soap when you change bed
linens and when it gets soiled. Be sure to dry it well before covering
it with a sheet. Do not use rubbing alcohol to clean the pad. Alcohol
may damage the plastic cover.
·Check with the device supplier or the directions before using an
additional pad or turn sheet under the person's bottom. Some cloth or
disposable (paper) pads may not allow the alternating pressure pad to
work as well as it could.?
http://www.healthtouch.com/bin/EContent_HT/cnoteShowLfts.asp?fname=02545&title=HOW+TO+CHOOSE+AND+USE+MATTRESS+PADS+&cid=HTHLTH
?Most support surfaces cannot adequately reduce the interface pressure
under the heels (explained under "Support Surfaces.") There are a few
types of "zero pressure," three-cell, alternating-therapy support
surfaces that will eliminate heel pressure in 7 1/2-minute cycles.?
?A cornerstone in reducing pressure is choosing support surfaces, such
as pressure-reducing cushions, mattresses (e.g., high-density foam,
gel, etc.), and specialty beds or mattress-replacement systems. The
intent of these products is to reduce interface pressure, forces that
act between the body and the support surface and are primarily
affected by the composition of the body tissue, the stiffness of the
support surface, and characteristics of the resident's body.
Interface pressure is different from capillary-closing pressure,
although there is often confusion between these two concepts.
Capillary-closing pressure describes the minimal amount of pressure
required to collapse a capillary, which causes tissue anoxia.
Commonly, capillary pressures are 32 mm Hg but, in reality, they vary
depending on the area measured. For example, capillary pressures are
commonly reported as 30-40 mm Hg at the arterial end, 10-14 mm Hg at
the venous end, and about 25 mm Hg in the middle. Capillary-closing
pressures actually range from 12-32 mm Hg.?
?Professional caregivers have their own opinions and preferences when
it comes to specialty mattresses. Preferences are sometimes based on
the product, cost, corporate contracts, or relationship with the sales
representative. Clinically, it makes sense to me that, since
pressure-ulcer development is based on the intensity and duration of
pressure, you need a product that addresses both. For example, a
product that solely redistributes pressure (straight low-air loss) to
alleviate its intensity does not address the duration component. There
are combination products (low-air loss and alternating pressure),
however, that can assist with both. Research on some of the
three-cell, alternating-pressure surfaces has shown that they both
increase circulation to the wound and are able to provide pressure
elimination in cycles. I therefore recommend that you make an
alternating pressure component part of the equation.?
http://www.findarticles.com/p/articles/mi_m3830/is_9_53/ai_n6230150
?Most facilities have replaced, or are in the process of replacing,
standard mattresses with static pressure-reducing mattresses, most
often with high-density foam mattresses. But not all mattresses are
created equal. Facilities spend thousands of dollars each year to
purchase foam-replacement mattresses, and too often these decisions
are made by cost comparison. Rather, they should be based on knowledge
of the characteristics of foam in the context of effective pressure
reduction. Such characteristics include base height, density,
indentation load deflection (ILD), ILD ratio, and contour:
* Base height measures foam from its base to where the convolution of
the foam begins--not the peak of the convolution. The base height
should generally be 4".
* Density, the weight per cubic foot, measures the amount of foam in
the product and reflects its ability to support the resident's weight.
Recommended density is 1.3 to 1.6 lbs per cubic foot.
* ILD measures the firmness of the foam and is determined by the
number of pounds needed to indent it to a depth of 25% of the
thickness with a circular plate (e.g., in the case of a 4" foam
mattress, ILD would measure the number of pounds needed to make a 1"
indentation). ILD indicates the ability of the foam to distribute the
mechanical load. The goal is to have a low ILD (an ILD of
approximately 30 lbs is recommended).
* ILD ratio, recommended to be 2.5 or greater, reflects the
relationship between conformability and support. A relationship of 60%
ILD: 25% ILD is needed (e.g., if 30 lbs makes a 1" depression, then at
least 75 lbs would be needed to make a 2.4" depression in the same
foam).
* Contour is the surface of the foam, which may be either slashed,
smooth, or an egg-crate design. A study by Kemp et al (2) reported few
pressure ulcers when using solid-foam overlay instead of convoluted
foam.?
http://www.findarticles.com/p/articles/mi_m3830/is_9_53/ai_n6230150/pg_2
?Specialty beds/ * Provide pressure relief by a series of connected
mattress air-filled pillows
replacements: low * May have a bed frame or may be a mattress
air loss replacement
* Amount of pressure can be individualized to
provide maximum reduction
* Contraindicated for residents with an unstable
spine
Specialty beds/ * Creates high-pressure and low-pressure areas to
mattress prevent constant pressure and to enhance blood
replacements: flow
alternating * Air chambers with air pumped at regular intervals
pressure that provide inflation and deflation cycles
* Interface pressures lower than capillary closing
on deflation and higher when cylinders are
inflated
* Helps manage both the intensity and duration of
pressure
Air fluidized beds * Contains silicone-coated beads and incorporates
fluid and air support
* Air pumps through beads and fluidizes the beads
* Theoretically "floats" a portion of the body and
requires less frequent repositioning
* Continuous circulation of warm, dry air may
assist with high drainage wounds but may also increase risk of dehydration?
http://www.findarticles.com/p/articles/mi_m3830/is_9_53/ai_n6230150/pg_3
?To be effective, support surfaces must mold to the body to maximize
contact, then redistribute the patient's weight as uniformly as
possible. They're designed to work on the principle of Pascal's law:
The weight of a body floating on a fluid system is evenly distributed
over the entire surface. As pressure is increasingly distributed over
more body surface area, the intensity of pressure decreases over all
body areas. Support surfaces also use the principle of deformation:
They must be capable of deforming enough to permit prominent areas of
the body to sink into the support. Finally, they must be able to
transmit pressure forces from one body area to another.?
http://www.findarticles.com/p/articles/mi_qa3689/is_200410/ai_n9454962
For example:
?Protects patients day and night. Eliminates waking and turning every
2 hours. Continually changing air pressure keeps body fluids moving,
improving circulation. Model D ULTRA "Healing Environment" control
unit with pressure adjustment control dial comes with a plastic case
and one 8-gauge vinyl pad. 115V AC, 60-cycle, has a two lead cord and
plug. UL listed 2.75 lbs. 2-year warranty on pumps. 6-month warranty
on pads.?
http://www.consumermedhelp.com/pressuremgmt.html
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?Who prescribes the mattresses? Is it a specific type of doctor??
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An individual can purchase the beds listed in this article, without
a prescription, if they have sufficient funds. However, if Medicare or
an insurance carrier is to cover the mattress, the patient?s attending
physician must write a prescription and provide documented evidence
the mattress is deemed medically necessary. Each insurance company has
it?s own criteria for coverage. In other words, should a doctor
prescribe a special mattress for a patient that would like one purely
for comfort, but has no medical need, the insurance company is very
likely to deny the claim, even with a doctor?s prescription. Any
doctor who is attending the patient?s bedsores, or burns, can
prescribe the mattress. There will be paperwork to be submitted with
the prescription to Medicare or the insurance company.
?Medicare pays for the use of air?fluidized beds in nursing homes only
when pressure sores are in the critical Stage 3 or Stage 4 level,
exposing tissue, muscle, or bone. One nonprofit group, the National
Decubitus Foundation considers air?fluidized beds ?the only
engineering solution that removes the cause of the pressure wound.?
The group decries the present Medicare payment schedule and calls for
the use of air?fluidized beds in most long?term care situations. It
calculates how use of air?fluidized beds would actually cut costs as
well as ease suffering.?
http://www.elder-abuse-information.com/news/news_082903_bedsores.htm
Some Medicare criteria for covering support surfaced beds. ?An order
for the mattress or bed which is signed and dated by the ordering
physician must be kept on file by the supplier. The written order must
be obtained prior to the delivery of the item.
The supplier must obtain information concerning which, if any, of
criteria 1 - 6 listed in the coverage and payment rules section of
this policy the patient meets in a signed and dated statement from the
physician. Questions pertaining to medical necessity on any form used
to obtain this information may not be completed by the supplier or
anyone in a financial relationship with the supplier.?
http://users.erols.com/airsuprt/wo04000.html
?The cost of providing AFB therapy is a small fraction of the average
daily cost of hospital care. Yet the perception has always been that
the cost is too high for all but the most desperate cases. Writing in
1984, Dolezal reported:
"The current cost for the use of the Clinitron is high: the daily rent
is $65.00, but this represents an additional cost of only 4% to 6% of
the total hospital bill."
Based on today's costs, the expense of providing AFB therapy is still
in the same range as a percentage of total daily hospital costs. The
present rental rate for the most expensive model of AFB made by one
manufacturer is $155/day.
Three strategies for eradicating the scourge of the bedsore will be
evaluated. They are: 1) Provide AFB therapy to all patients upon
admission. 2) Provide AFB therapy to all admitted patients judged to
be at high risk for bedsores. 3) Provide AFB therapy only at the first
sign of a developing bedsore, at early Stage 1.?
http://www.decubitus.org/cost/cost.html
?Air support therapy units were exempt from Massachusetts sales tax as
alternating pressure pad units when sold as a single unit for a single
price pursuant to a written prescription of a registered physician. If
bed frames, mattresses, or similar components were sold or rented
separately without the alternating pressure pad units they would be
considered "hospital beds" exempt only if sold or rented for home use
and under prescription or if some other exemption applied. Parts for
repair and upkeep of products qualifying for exemption would also be
exempt from tax. (Letter Ruling 98-3, Massachusetts Department of
Revenue, February 13,1998.)?
http://www.findarticles.com/p/articles/mi_qa3646/is_199804/ai_n8795824
Cigna?s coverage
http://www.cignamedicare.com/dmerc/lmrp_lcd/SPSR1.html
Home Care magazine points out what goes into selecting the proper
mattress and whether insurance will cover it.: ?PATIENT NEEDS One of
the first steps in assessing patients' needs and assisting them in
selecting beds and support surfaces is to gather all the information
possible that may have an impact on the type of bed or support surface
that is eventually purchased.
Some key first questions about beds include:
* What is the patient's age, weight and height?
* Is an extra-long or obese-capacity bed necessary?
* Is the patient ambulatory or in a wheelchair?
* Is the patient able to transfer in and out of bed?
* How much weight can the patient pull with each hand?
* Does the patient currently have any skin breakdown problems?
* If so, on what part of the body are the wounds, and what type are they?
* Is the patient on any medications?
* Is the patient incontinent?
* How long will the bed be needed?
* Will the bed be on a first or second floor?
As for support surfaces, providers suggest asking the following:
* Does the surface conform to the patient's bony prominences?
* Does it provide maximum patient immersion?
* Does it have significant memory?
* Does it "bottom out"?
* Does it prevent skin maceration?
* Does the surface relieve shear forces caused by patient movement?
* Is patient comfort addressed?
But be forewarned: This information-gathering process may be much more
interactive than merely having patients fill out a questionnaire, say
providers. The challenge is to attain accurate and precise
information-and some customers may not be able to clearly articulate
their medical conditions, let alone their needs.
"The intake of information from the patient is a science but also
partly an art form that requires carefully listening to the client,"
says David Bouslog, president of Chesapeake Medical Supply, West
Conshohocken, Pa. "Even though their everyday actions are routine,
some patients have never thought about exactly what they're doing."
Bouslog adds that while HME providers try to be as clinically adept as
possible, they must not attempt to make any independent clinical
assessments when they encounter issues that are beyond their own
knowledge. Instead, providers must rely on therapeutic input from
doctors, nurses, and occupational and physical therapists.
Indeed, deciding on the right bed or support surface is a
collaborative endeavor that often involves other parties with a vested
interest in making sure that customers get the appropriate products.
Depending on the customer, providers may need to coordinate with
nurses, doctors, hospital discharge planners, long-term-care
facilities, home health agencies, nursing homes, even insurance case
managers.
MEDICARE DEMANDS What else does it take to provide customers with the
beds they need? Determining who will pay for the bed and any
additional support surfaces. Most providers bill Medicare, so when
advising patients about beds and surfaces, they must take into account
its many rules and regulations.
Medicare allows for HME providers to charge for beds over 15 months as
capped rental items. (Purchasing beds is usually a consideration only
if the patient is likely to need the bed over a longer period.)?
?But with the cuts in Medicare funding, providers lament,
reimbursement levels for beds are not what they used to be. Patients
are often required to pay a certain amount out of their own pockets.
And it is only those with the financial means who can consider buying
a bed that most closely fits their specific needs, as opposed to
settling for something that they may not be fully satisfied with but
that offers better reimbursement.
In recent years, note providers, more patients have opted to purchase
specialized rehabilitative beds equipped with a greater number of
features. And while certain payers, such as Medicare, are unwilling to
provide any funding for such specialized beds, other payers may be
willing to coordinate some sort of arrangement.
"If there is a long-term problem, we try to work it out with the
customers up front so that they can stay on the equipment," says Tom
Oliver, chief operating officer of National Wound Care, Champaign,
Ill. "We talk to the insurance companies to determine what works best
long term. For example, a patient may get a higher costing product
initially but then step down later on to save cost to the payer."
http://www.homecaremag.com/mag/medical_searching_comfort_zone/
Here is how Great Lakes Home Medical Equipment handles purchases of
medical equipment:
?Who pays for Home Medical Equipment?
Medicare covers home medical equipment provided by Great Lakes Home
Medical Equipment under Part B of the government insurance package.
Part B is a purchased plan, which covers home medical equipment items
and physician?s visits at 80% of the reasonable fee, leaving 20% to be
paid by the patient or co-paying insurance.
Medicaid pays for some equipment, but not all. Most equipment requires
a doctor?s prescription authorization before we can provide it to you.
Insurance generally does not pay for equipment such as bathroom safety
items, over the bed tables, daily living aids, or Lifeline (Emergency
Notification Program).
We will be pleased to check to see if a particular insurance covers
the cost of the home medical equipment which you may require.
Is Home Medical Equipment available to me?
Great Lakes Home Medical Equipment allows patients and their families
to purchase or rent home medical equipment. This equipment is
available to anyone who may require this service, typically prescribed
by their physician. Qualifying for insurance reimbursement to pay for
those items prescribed by your physician requires a prescription.
Convenient ordering is available with a prescription via phone, fax,
mail or by visiting our offices. Our Customer Service Representatives
are ready to assist you during our regular business hours, Monday
through Friday from 8:00 am to 5:00 pm. Delivery is available 24-hours
a day, 7-days a week.
If your rental equipment requires service, we have a home medical
equipment professional available 24 hours a day, 7 days a week.
Patients in a hospital or skilled nursing facility must request Great
Lakes Home Medical Equipment to avoid being discharged to another home
medical equipment provider who may not offer the extensive equipment,
services or superior quality provided by Great Lakes Home Medical
Equipment.?
http://www.glhhs.com/homemedical.php
?Atrice's colleague at the Shepherd Center, Michelle Nemeth, PT,
medical-surgery team leader, adds that a virtue of today's
state-of-the-art support surfaces is they make it possible to send
home many patients who otherwise would have been appropriate only for
institutionalized care.
"These support surface systems enable a lone caregiver at home to
attend to other tasks or even to get some rest without having to
constantly worry about whether pressure sores are going to develop,"
she says.
Moreover, good support surfaces also save the health care system substantial sums.
"They cost as little as $500 and top out at around $1,400," says
Atrice. "In contrast, the cost of treating a patient who develops
pressure sores is around $60,000 to $70,000 per incident."
?Prescription Problems
A challenge for therapists who prescribe these mattresses is that it
can be exceptionally difficult to determine which type will be the
most effective from one patient to the next, says Mathewson.
"The vendors all have studies available on each of their mattresses,
which can help guide a therapist's decision," she says. "But since
these studies are vendor-sponsored, they need to be approached with
some skepticism."
The team at Shepherd Center relies more on the insights gleaned from
the federal government's 1994 Agency for Health Care Policy and
Research Publication 95-0652, Clinical Practice Guideline Number 15:
Treatment of Pressure Ulcers.
And the facility has records of its own to draw on. "We've kept track
of which mattresses worked best for various patients under actual
conditions," says Nemeth. "When we have a patient for whom we want to
prescribe a support surface, we consult the matrix we developed in
order to see which mattress would be most appropriate for that
patient, given his or her clinical parameters and other factors."
?Differences in mattresses are substantial enough that one can
facilitate a client's independence while another might cause it to be
lost," says Nemeth. "I've had patients who were totally independent
with their transfers, but the mattress was such that it took away some
of that independence. It's been my experience that solid surfaces are
easier for patient transfers. But these tend to be harder on the skin,
so they contribute to a higher risk of pressure ulcers. On the other
hand, a low air-loss mattress tends to be very soft and thus easier on
the skin. But it makes for difficulty in transfer.
"What that says is there are trade-offs involved, no doubt about that.
So, you have to look at all issues and find out which are the most
important and somehow come up with a compromise between them. On one
side, you've got to prevent the pressure sore from forming. On the
other side, you have to provide mobility. Deciding which one to give
the most weight to depends on the patient's unique situation."
http://www.rehabpub.com/ltrehab/12002/4.asp
=======================================================================
?Are there any products that would be considered "competitive
products" to these mattresses? Why might one be used over the other??
=======================================================================
This from a study at Queens University, Kingston, Ontario
?In the high risk frail elderly population, evidence does suggest that
therapeutic air mattresses are effective in preventing and healing
pressure ulcers. However, which surface is more effective than another
is still to be determined. Turning/repositioning schedules is a
clinically accepted practice, which should continue, regardless of the
type of surface the client is on, until research proves otherwise.?
?Author?s Conclusion:
Pressure-reducing devices are more effective than standard mattresses
in preventing pressure ulcers. Pressure-reducing devices improve the
healing rate of pressure ulcers; however one has not been shown to be
more effective than another.?
http://www.rehab.queensu.ca/cats/PDFs%5C9.pdf
?Medical therapy: The first step in resolution is to reduce or
eliminate the cause, ie, pressure. Specialized support surfaces are
available for bedding and wheelchairs, which can maintain tissues at
pressures below 30 mm Hg. These specialized surfaces include foam
devices, air-filled devices, low-airloss beds (Flexicair, KinAir), and
air-fluidized beds (Clinitron, FluidAir). Low-airloss beds support the
patient on multiple inflatable air-permeable pillows.
Air-fluidized beds suspend the patient as air is pumped into an
air-permeable mattress containing millions of microspheric uniformly
sized silicone-coated beads. No one device has been shown to be
clearly superior over the others, but they all have been shown to
reduce tissue pressure over conventional hospital mattresses and
wheelchair cushions. Over 75 companies sell pressure-reduction
devices, with annual industry revenues in excess of $8 billion.
Regardless of the choice of support surface, turning and repositioning
the patient remain the cornerstones of prevention and treatment. This
should be performed every 2 hours, even in the presence of a specialty
surface or bed.?
http://www.emedicine.com/med/topic2709.htm
?Nursing homes must make sure that residents do not develop pressure
sores during their stay and that residents who have them are given
treatment to promote healing and prevent infection. Residents confined
to a bed or a chair should have their position changed (turned) every
two hours ? more often if the resident is uncomfortable. If needed,
supportive devices, special mattresses, pads and pillows should be
used to maintain normal body pressure and to relieve pressure on the
skin. Residents should receive daily help with walking and exercise to
help maintain or improve their circulation, strength and use of their
body.?
http://cbcmi.org/publications/care_req.htm
The Nursing Center Web site has an extensive review of ?pressure?
mattresses. I?m posting a snippet of each type here (Again, due to
copyright restrictons)
Elastic Foam
?Foam products typically consist of either foam layers of varying
densities or combinations of gel and foam or fluid-filled bladders and
foam. The advantage of support surfaces with a combination of
fluid-filled bladders and resilient foam would be to provide a degree
of postural stability with a resilient shell and improved immersion
and envelopment with a fluid or viscous fluid-filled layer at the skin
interface.
An elastic foam support surface should have a resistance to pressure
that is high enough to fully support the load (prevent bottoming out)
without providing a reactive force (memory) that is too high to keep
the interface pressure low. Over time and with extended use, foam
degrades and loses its stiffness. This results in higher interface
pressures. Mattresses typically wear out in 3 years and the pressure
is then transferred to the underlying supporting structure used to
support the foam. In other words, the mattress bottoms out.
The stiffness and thickness of foam limits its ability to immerse and
envelop. Soft foams will envelop better than stiffer foams, but will
necessarily be thicker to avoid bottoming out. Foam seat cushions are
frequently contoured to improve their performance. Precontouring the
seat cushion to provide a better match between the buttocks and the
cushion increases the contact area, thus reducing average pressure.
Precontouring also increases immersion and envelopment properties,
thus decreasing pressure peaks. The increase in moisture in foam
products with porous covers is comparatively lower because the open
cell structure of the covers provides a pathway for the moisture to
diffuse. Water vapor transmission rates can be reduced by more than
half when foam mattresses are covered with nonstretch and 2-way
stretch covers.?
Viscoelastic Foam
?Viscoelastic foam products consist of viscoelastic, open-cell foam
that is temperature-sensitive. The foam becomes softer at operating
temperatures near body temperature, the effect of which is that the
layer of foam nearest to the body provides improved pressure
distribution through envelopment when compared with high-resilient
foam. The viscoelastic foam acts like a self-contouring surface
because the elastic response diminishes over time, even after the foam
is compressed. The disadvantage of the temperature- and time-sensitive
response is that the desirable effects may not be realized when the
ambient temperature is too low. The properties of viscoelastic foams
vary widely and must be chosen according to the specific needs of the
patient for seat and mattress applications. Solid gel products are
also viscoelastic in nature and are included in this category.
Mean temperature increases of 2.8°C have been reported for
viscoelastic foam. Gel products, on the other hand, tend to maintain a
constant skin-contact temperature or may even reduce the contact
temperature. Gel pads have higher heat flux than foam due to the high
specific heat of the gel material. However, in 1 study, the heat
transfer rate decreased after 2 hours, indicating that the heat
reservoir was filling. This suggests that temperature may increase
during longer periods of unrelieved sitting (more than 2 hours). In
addition, this study found that moisture increased by 22.8% during a
1-hour period. The relative humidity of the skin surface increases
considerably because of the nonporous nature of the gel pads.?
Viscoelastic foam products consist of viscoelastic, open-cell foam
that is temperature-sensitive. The foam becomes softer at operating
temperatures near body temperature, the effect of which is that the
layer of foam nearest to the body provides improved pressure
distribution through envelopment when compared with high-resilient
foam. The viscoelastic foam acts like a self-contouring surface
because the elastic response diminishes over time, even after the foam
is compressed.
The disadvantage of the temperature- and time-sensitive response is
that the desirable effects may not be realized when the ambient
temperature is too low. The properties of viscoelastic foams vary
widely and must be chosen according to the specific needs of the
patient for seat and mattress applications. Solid gel products are
also viscoelastic in nature and are included in this category.
Mean temperature increases of 2.8°C have been reported for
viscoelastic foam. Gel products, on the other hand, tend to maintain a
constant skin-contact temperature or may even reduce the contact
temperature.
Gel pads have higher heat flux than foam due to the high specific heat
of the gel material. However, in 1 study, the heat transfer rate
decreased after 2 hours, indicating that the heat reservoir was
filling. This suggests that temperature may increase during longer
periods of unrelieved sitting (more than 2 hours). In addition, this
study found that moisture increased by 22.8% during a 1-hour period.
The relative humidity of the skin surface increases considerably
because of the nonporous nature of the gel pads.
Given the large variety of materials used as covers for products in
the fluid-filled category, it is difficult to generalize on moisture
control characteristics. However, the insulating effects of rubber and
plastic used in some fluid-filled products have been shown to increase
the relative humidity due to perspiration.?
AIR-FLUIDIZED
?Air-fluidized beds have been available since the late 1960s and were
originally developed for use with burn patients. These products
consist of solid particles, usually glass solid particles (75 to 150
mm), encased in a cover sheet. The solid particles take on the
characteristics of a fluid when pressurized air is forced up through
them. Feces and other body fluids flow freely through the sheet. In
order to prevent bacterial contamination, the bed must be pressurized
at all times and the sheet must be properly disinfected after use by
each patient, and at least once a week with long-term use by a single
patient.
Air-fluidized beds use fluid technology to decrease pressure through
the principle of immersion while simultaneously reducing shear.
Air-fluidized products permit the highest degree of immersion among
those currently available, allowing the surface to conform to bony
prominences. Almost two-thirds of the body may be immersed into the
surface, effectively lowering the interface pressure by increasing the
surface pressure distribution area. The high degree of immersion
possible with this technology enables the transfer of pressure to
adjacent body areas and other bony prominences. Shear force is
minimized by the use of a loose (reduced surface tension) cover
sheet.?
LOW-AIR-LOSS
?Low-air-loss describes a support surface feature that lets the air
pass through the pores of the cover material. The covers are usually
made of a special nylon or polytetrafluoroethylene fabric with high
moisture vapor permeability. Many support surfaces employing this
feature use a series of connected air-filled cushions or compartments.
These cushions are inflated to specific pressures to provide loading
resistance based on the patient's height, weight, and distribution of
body weight.
An air pump circulates a continuous flow of air through the device,
replacing any air that is lost through the surface's pores. The
inflation pressures of the cushions vary with patient weight
distribution; some systems have individually adjustable sections for
the head, trunk, pelvic, or foot areas. One manufacturer offers the
ability to individualize each of the compartments rather than just the
sections. Support surfaces are available that combine low-air-loss
with alternating and pulsating pressure features.
In low-air-loss systems, the patient lies on a loose-fitting,
waterproof cover that is placed over the cushions. The waterproof
covers are designed to allow air to pass through the pores of the
fabric; they are usually made of a special nylon or
polytetrafluoroethylene fabric with high moisture vapor permeability.
Manufacturers have addressed the problem of dehydration of the skin by
altering the number, size, and configuration of the pores in the
covers. The material is very smooth, with a low coefficient of
friction; bacteria impermeable; and easy to clean.?
Alternating Pressure
?Rather than increasing the surface area for distribution through
immersion and envelopment, alternating pressure devices distribute the
pressure by shifting the body weight to a different surface contact
area. This may increase the interface pressure of that area during the
inflation phase.
The lack of sufficient study of the tissue responses to alternating
pressure leaves many questions regarding this type of support surface.
For example, what are the ideal characteristics of the support surface
(geometry of the surface [size/shape of cells and space between cells]
and the material, depth, composition, and shape of the supporting
structure)? Also, what are the ideal characteristics of the
alternating cycle (rise time, hold time, duration of total cycle,
pattern of relief)?
Alternating pressure technology has the same potential as any other
fluid-filled support surface to influence temperature at the
interface, and care must be taken to maintain the correct levels of
inflation. The skin moisture control and temperature control
characteristics of an alternating pressure surface will also depend on
the characteristics of the cover and supporting material.?
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=581437
Air Fluidized Beds
?One nonprofit group, the National Decubitus Foundation, recently
praised air-fluidized beds as "the only engineering solution that
removes the cause of the pressure wound." Air-fluidized beds are
inflated by air that's pumped through an area with ceramic-type beads.
A patient lying on an air-fluidized bed feels supported by liquid.?
http://www.amda.com/caring/january2004/pressureulcers.htm
?Air-fluidized beds have been available since the late 1960s and were
originally developed for use with burn patients. These products
consist of approximately 2000 pounds of silicon (glass) beads (75 to
150 (mu)m) encased in a polyester or Gore-Tex sheet. The beads take on
the characteristics of a fluid when warm pressurized air is forced up
through them. Feces and other body fluids flow freely through the
sheet.?
?Air-fluidized beds use fluid technology to decrease pressure through
the principle of immersion while simultaneously reducing shear.
Air-fluidized products permit the highest degree of immersion
currently available, allowing the surface to conform to bony
prominences. Almost two-thirds of the body may be immersed into the
surface,ll effectively lowering the interface pressure by increasing
the surface pressure distribution area. The greater deformations
possible with this technology enable the transfer of pressure to
adjacent body areas and other bony prominences. Envelopment and shear
force are minimized by the loose (reduced surface tension) but tightly
woven polyester or Gore-Tex cover sheet.?
http://www.findarticles.com/p/articles/mi_qa3977/is_200009/ai_n8917618/pg_2
?Low-air-loss
Low-air-loss systems use a series of connected, air-filled cushions or
compartments. These cushions are inflated to specific pressures to
provide loading resistance based on the patient's height, weight, and
distribution of body weight. An air pump circulates a continuous flow
of air through the device, replacing any air that is lost through the
surface's pores. The inflation pressures of the cushions vary with
patient weight distribution; some systems have individually adjustable
sections for the head, trunk, pelvic, or foot areas. One manufacturer
offers the ability to individualize each of the compartments rather
than just the sections. In addition to static low-airloss systems,
these products are now available with alternating and pulsating
pressure features.?
http://www.findarticles.com/p/articles/mi_qa3977/is_200009/ai_n8917618/pg_2
Read how the air-loss mattress works (Very technical)
http://www.freepatentsonline.com/5483709.html
?Alternating Pressure
Alternating pressure systems contain airfilled chambers or cylinders
arranged lengthwise, interdigitated, or in various other patterns. Air
is pumped into the chambers at periodic intervals to inflate and
deflate the chambers in opposite phases, thereby changing the location
of the contact pressure. Pulsating pressure differs from alternating
therapy in that the duration of peak inflation is shorter and the
cycling time is more frequent.?
?Alternating pressure technology has the same potential as any other
fluidfilled support surface to influence temperature at the interface
and care must be taken to maintain the correct levels of inflation.
The skin moisture control and temperature control characteristics of
an alternating pressure surface will also depend on the
characteristics of the cover and supporting material.?
http://www.findarticles.com/p/articles/mi_qa3977/is_200009/ai_n8917618/pg_2
?*Group 1 surfaces don't require electricity and include air, foam,
gel, and water mattresses or overlays. These surfaces are intended for
pressure ulcer prevention.
Foam surfaces come in various densities (or weights), depths, and
construction. To reduce pressure, foam must be high quality and at
least 4 inches (10 cm) thick.
Static air overlays have multiple chambers that allow air exchange
between compartments (or cells) when a person lies on the surface. The
air exchange between cells allows the surface to deform and permits
the body to sink into the surface, reducing pressure on bony
prominences. Maintain adequate air volume with inflation or
reinflation devices.
Gel mattress overlays have a tissuelike composition that reduces shear
and supports weight without bottoming out. They're self-sealing if
punctured and can be reused. Gel doesn't deform easily and may become
stiff over time.
* Group 2 surfaces include dynamic powered surfaces and advanced
nonpowered surfaces. These surfaces are indicated for patients with
Stage III or Stage IV pressure ulcers on the trunk or pelvis, muscle
flap repair of a pressure ulcer within the last 60 days, or multiple
Stage II pressure ulcers that haven't improved on a Group 1 surface in
the last month, even with comprehensive care (more on that later).
Dynamic air overlays are used with a mechanical pump to alternate
inflation and deflation of chambers and constantly change pressure
points. Air chambers must have enough depth and be close enough
together to lift the body during alternating cycles.
Low-air-loss systems are available as mattress overlays and whole bed
systems. An air compressor inflates the mattress cushions. It also
circulates air across the patient's skin to reduce moisture.
* Group 3 consists of air-fluidized beds, a high-air-loss system with
ceramic silicone beads that become fluidized as warm pressurized air
is forced up through the beads. This gives the beads the
characteristics of fluid, allowing the patient's body to float on the
surface and minimizing pressure, shear, and moisture. A Group 3
surface is indicated for patients with Stage III or Stage IV pressure
ulcers that haven't improved on a Group 2 surface over the last month,
even with comprehensive care.?
http://www.findarticles.com/p/articles/mi_qa3689/is_200410/ai_n9454962
?A lot of attention is being paid to support surface materials,
Asturias said, with latex and visco elastic foam making significant
sales inroads. Although latex "has been a taboo word in the medical
industry" because of the proliferation of latex allergies, he said the
substance has found a new purpose in the bedding market.
"There is a new process that allows it to be 99.9% allergen-free," he
said. "It's a completely new product - one that should remove the
stigma that has surrounded latex in the past few years."
Temperature sensitive, visco elastic foam warms and softens at the
points of greatest interface pressure. It also stays compressed for a
certain amount of time before returning to its original position.
Although it has been on the market for more than a decade, visco
elastic foam has only gained popularity recently because mass
production has driven prices downward, Asturias said.?
http://www.findarticles.com/p/articles/mi_qa4029/is_200310/ai_n9312660
I am unable to copy any of this article, but if you go to Page 2,
bottom right hand corner, look for ?Conclusions? to which mattress is
best for bedsores ? Air fluidized won in this study:
http://www.cinahl.com/cexpress/hta/summ/summ509.pdf
?Most studies have found foam mattresses equal to or superior to low
air flow mattresses. Two trials, involving a total of 120 persons,
have found significant advantages to air mattresses over other
mattresses. Others studies have found favorable but not
statistically signficant advantages to air mattresses?
http://66.102.7.104/search?q=cache:CdtwPkFxSssJ:www.fda.gov/ohrms/dockets/dockets/04d0343/04D-0343-EC-2-Attach-1.doc+manufacturers+%2B+air+fluidized+beds&hl=en
A study was done to determine whether a viscoelastic polymer (energy
absorbing) foam mattress was superior to a standard hospital mattress
for pressure ulcer prevention and to analyze the cost-effectiveness in
comparison with standard hospital mattresses.
?A recent Cochrane Review11 similarly found that, although there is
good evidence of the superiority of high-specification foam over
standard hospital foam, it is impossible to determine the most
effective support surface for PrU prevention or treatment. The review
identified 29 PrU prevention trials and concluded that the
methodologic quality was generally poor and that randomization was
only adequate in 22% of trials.
Pour trials demonstrated a statistically significant reduction in the
incidence and severity of PrUs in high-risk patients when compared
with patients on a standard foam mattress.12-15 One study comparing
high-specification foam mattresses showed that all were superior to
standard foam mattresses; however, no individual comparisons showed
any significant differences.16 The study concluded that further
research was necessary and suggested that future trials must be large
enough to identify differences, be randomized with concealed
allocation, be assessed by a blinded observer, include information
about patient comfort, and be adequately statistically analyzed.? (I
am unable to copy the entire article, due to copyright restrictions)
http://www.findarticles.com/p/articles/mi_qa3977/is_200311/ai_n9342471
http://www.findarticles.com/p/articles/mi_m2459/is_n4_v24/ai_17450243#continue
A European study:
?The foam mattress appears to have little or no pressure reducing
effect and is of no use in the prevention of ulcers. The frequently
used gel mattress reduces pressure only in a limited matter (in supine
position 5.6+9.9 mmHg). The effect on pressure ulcer prevention is
therefore minimal. ANOVA and Tukey HSD analysis reveals that the
polyurethane mattress (16.3+7.7 mmHg pressure reduction) and the
polyether mattress (13.7+11.7 mmHg pressure reduction) reduces
pressure significantly (p<0.005) better than the other mattresses.
Pressures are highest in lateral position. All mattresses generate a
significant lower pressure (on average between 10.1 and 18.1 mmHg) in
this position than the standard operating table mattress, but
bottoming out effect is still noticed. There is no mattress that
significantly reduces the pressure. Other preventative measures have
to be taken.
Conclusion
Not all the anti-decubitus mattresses really succeed in reducing the
interface pressure. The foam and gel mattresses have no or limited
pressure reducing qualities. The polyether mattress and especially the
polyurethane slow foam mattress reduce pressure best and are
preferable in the prevention of pressure ulcers on an operating table.
None of the mattresses tested reduced the pressure sufficiently in
lateral position.?
http://www.epuap.org/abstracts/abstract98a.html
?What is the difference between alternating pressure and low-air-loss?
Although they're both EO277 powered mattresses, alternating pressure
and low-air-loss operate on two totally different principles.
Alternating pressure mattresses consist of individual air tubes that
inflate and deflate on a set schedule, and in an A-B-A-B pattern. That
is, at a given moment the A tubes are inflated and the B tubes are
deflated, and then they reverse. This automatically changes the
pressures on a given point on the body, enhancing tissue perfusion by
"milking" blood through capillaries as pressure is applied and
released.
Low-air-loss mattresses consist of large bladders with tiny pin-holes
implanted in them. As the patient sinks into the mattress, air is
pushed from the bladder through the holes, and a motor replaces the
air to float the patient. This equalizes pressure across the body,
decreasing pressure on any one point. Low-air-loss also decreases the
negative effects of heat and moisture buildup on the skin by pulling
excesses away from the body.
Both technologies are used in the management of skin and wounds.
Neither has consistently documented benefits over the other.?
http://www.spanamerica.com/main_med_faq.html
Another study
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11889743&dopt=Abstract
Illustrations of some kinds air/low air loss mattresses
http://www.progressivemedicalinc.com/air_mattresses.htm
Foam Mattresses:
http://www.progressivemedicalinc.com/foam_mattresses.htm
More Illustrations
http://www.rehabmart.com/bedsores.asp
===================================================================
?I believe the mattresses are used in 3 different segments - acute
care, nursing home, home healthcare - what are differences and
similarities between these segments??
===================================================================
The largest similarity is care. Good nursing care, by an in-house
nurse, a visiting nurse, or a trained family member is essential. If
the patient lacks quality care, no mattress will be able to eliminate
bedsores. Treatment of ulcers and proper care of dressings, and
turning schedule of patient, combined with an effective mattress is
key.
Price is the main factor when it comes to buying a specialty mattress
of any kind. A hospital is more likely to have these beds on hand, and
to properly maintain them. Nursing homes would be next in the numbers
of this type of beds present on site. Unless insurance or Medicare
covers the cost, at east in part, the cost of these beds is
prohibitive to most households. Medical supply stores often rent this
type of bed. Whether Medicare/Insurance covers the cost depends on the
medical diagnosis and into which class it falls.
Another Adobe document that is unable to be copied. Please see Page 2,
last two paragraphs in the right column. The following pages also have
some price comparisons of different manufacturers.
http://www.wheelchairnet.org/WCN_ProdServ/Docs/TeamRehab/RR_99/Apr99/9904art2.PDF
Another difference is training in sanitary procedures and ability to
follow them, especially with regard to cleaning the mattress and/or
covers.
?Two thirds of pressure sores occur in patients older than 70 years.
The prevalence rate in nursing homes is estimated to be 17-28%.
Among patients who are neurologically impaired, pressure sores occur
with an annual incidence of 5-8%, with lifetime risk estimated to be
25-85%. Moreover, pressure sores are listed as the direct cause of
death in 7-8% of all paraplegics.
Patients hospitalized with acute illness have an incidence rate of
pressure sores of 3-11%.
Disturbingly, even with current medical and surgical therapies,
patients who achieve a healed wound have recurrence rates of as high
as 90%.?
http://www.emedicine.com/med/topic2709.htm
?The physician is ultimately responsible for a wound, even in home
care. The cause and effect of this responsibility varies. In some
case, the wound is created by a surgeon's direct act. In others, the
physician's management of problems such as nutrition, pedal edema or
peripheral vascular disease contribute to wound development or affect
healing. We order the wound treatments through our certification of
the care plan (i.e. signing of the 485). We must certify the medical
necessity of durable medical equipment such as pressure reduction
mattresses.
The American Academy of Home Care Physicians hopes physicians will
increase their active involvement in all aspects of wound care in the
home. We hope physicians will be actively involved in careful
observation and documentation of the status of a wound, patient and
family teaching, and treatment decision making. Only then will wound
care be a true collaboration of the home care nurse and physician.?
http://www.aahcp.org/wounds.shtml
?The mattress alone does not prevent bedsores. Patients still need
good nutrition and frequent turning. The ICU staff turns the patient
if the patient is unable to turn effectively. In patients at high risk
for bedsores, nurses often place another mattress, called an overlay,
on top of the bed mattress. This helps avoid the development of
bedsores. Even with the best of care and special beds/mattresses,
patients may still develop bedsores.?
http://www.icu-usa.com/tour/supplies/beds.htm
?The costs of treating a pressure ulcer are estimated to range from
$4000 to $40,000 for newly developed ulcers.32 Indeed, both hospital
costs and length of stay are significantly higher for patients who
develop pressure ulcers during hospitalization, as noted earlier.21 In
the nursing home in particular, failure to prevent this adverse
outcome carries increasing liability?the median settlement for
pressure ulcer-related disputes was $250,000 between the years 1977
and 1987.33 The cost of specialized beds and mattresses to prevent
pressure ulcer development can be high, ranging from $40 to $85 per
day for low air-loss beds.34 Specialized beds and intensive nursing
interventions all carry clear resource implications. Inman and
colleagues35 have demonstrated the cost-effectiveness of an air
suspension bed compared to a standard intensive care unit bed. Yet
cost-effectiveness studies of the many different pressure-relieving
devices have not been formally completed.
In terms of the feasibility of implementing these specific devices and
following guidelines for high-risk patients, both cost and time
considerations must be examined.36 Other considerations relate to the
design and functionality of a particular bed or mattress?for example
the ability of nursing staff to move and transfer patients placed on
deeper or bulkier beds. Finally, difficulty in accurately assessing
changes in the incidence and prevalence of pressure ulcers resulting
from the institution of preventive measures is another barrier to
documenting progress.?
http://www.ahrq.gov/clinic/ptsafety/chap27.htm
Telemedicine is becoming part of home care ?The procedure begins with
the home care visiting nurse documenting the state of the wound
(Figure: Step 1). An adequate description of the wound is essential to
allow communication among members of the health care team in addition
to providing serial documentation of the wound for educational and
research purposes. Wound assessment includes a description of the
wound and surrounding tissue, location, shape, and approximation of
size and depth. The presence of odor as well as amounts and color of
drainage should be noted. In addition, evaluation should document the
presence or absence of granulation tissue and fibrinous and necrotic
debris along with signs of infection and degree of undermining.
As part of routine patient care, the nurse takes images of the wound
using a digital or video camera and makes an audio recording of
clinical observations. The pictures are sent to the wound therapist
either instantly as digital images by e-mail or in videotapes by
overnight mail. The audio observations can be included in the video or
forwarded to the wound therapist by voice mail.
The wound therapist (ideally an ET) processes the wound image,
observations, and other information; diagnoses the state of the wound;
and recommends a treatment plan to the wound care team ( Figure: Steps
1 and 2). The authors' wound management system database automatically
presents all of the wound care team consultants with the clinical
images and information as well as the recommended treatment plan
(Figure: Steps 3 and 4). This communication is made possible by the
use of standard Internet- based browsers. The attending physician and
the wound therapist target wound care team members (such as
occupational therapists, physical therapists, nutritionists,
podiatrists, prosthetic technicians, and social service personnel) for
consultation in their areas of expertise.?
http://www.rubic.com/articles/article1.html
At-home Coping Strategies
·Be meticulous about skin care. Examine skin daily for signs of sores.
·Protect vulnerable areas from pressure, friction and moisture.
·Ask a health professional how to clean, dress and bandage pressure
sores properly.
·Alert a doctor or nurse immediately, if you notice signs of infection.
·Assist healing by ensuring proper nutrition.
·Discover helpful products to relieve and treat pressure sores.
·Encourage a balanced diet with extra protein to keep tissues healthy.
http://www.howtocare.com/pressure2.htm#coping
========================================================================
?Who are the main manufacturers of these mattress replacement products??
========================================================================
Here are the major hospital-type mattress manufacturers:
BG industries
1-800-822-8288; http://www.bgind.com
Bio Clinic
1-800-688-4083
Casco Solutions
3107-3111 Spring Grove Ave.
Cincinnati, OH 45225
tel 1.800.843.1339
fax 1.513.853.3605
inquiries@cascosolutions.com
http://www.cascosolutions.com/support-surfaces.htm
Crown Therapeutics
1-800-851-3449
http://www.crownthera.com
Flofit Medical
1-800-223-1218
http://www.fIofitmed.com
Gaymar Industries
1-800-828-7341
http://www.gaymar.com
Grant Airmass Corporation
1-800-243-5237; http://www. grantairmass.com
Healthcare Corporation
1-800-267-2812
Hill-Rom
1069 State Route 46 East
Batesville, Indiana 47006
United States
800-445-3730
1-800-638-2546
http://www.hill-rom.com
Home Care@hill-rom.com
Huntleigh Healthcare
1-800-223-1218
http://huntleigh-healthcare.com
Invacare
1-900-33-6900
http://www.invacare.com
KCI
1-800-ASK-4KCI
http://www.kci1.com
Medline Industries
1-800-MEDLINE
http://www.medine.com
Morton Plant
Low Air Loss mattress system
Alternating Pressure Low Air mattress system
Turn Q Plus turning mattress
Electric heavy duty beds (up to 600 lbs.)
Long electric hospital beds
Alternating pressure overlays
For Skilled Nursing and other facility Sales and Rentals:
David Cover
Coordinator
Specialty Bed Services - Facility Liaison
david.cover@baycare.org
For more information, call (727) 544-6400
For Consumer Sales and Rentals:
Pat Soffredine
Manager
Durable Medical Equipment
patrick.soffredine@baycare.org
For more information, call (727) 394-6588
http://www.mortonplant.com/11818.cfm
Pegasus Airwave
1-800-443-4325
http://www.pegasusairwave.com
PinDot
1-800-451-3553
SenTech Medical Systems
1-800-474-4225
http://www.sentechmedical.com
Span-America Medical Systems
1-800-888-6752
http://www. spanamerica.com
Sunrise Medical
1-800-648-8282
http://www. sunrisemedical.com
Tempur-Medical, Inc.
1-800-878-8889
http://www. tempurmed.com
Varilite
1-800-827-4548
http://www.varilite.com
Zero Gravitiy
1-800-984-8901
This site lists the major disbursement centers, which you may find useful.
http://www.woundtx.com/summaries/index.html
==========================================================================
I hope this is precisely the information you were seeking. If not,
please do not close this answer by rating, until you have requested an
Answer Clarification, and allowed me to respond. I will be glad to
assist you further, if possible.
Regards, Crabcakes
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