As nurses and caregivers, when we think about support surfaces, our minds go directly to a therapeutic mattress of some sort. We think about the pressure redistribution that our patient/resident rests on, but we do not necessarily think about the cushion (or lack of one) on the bedside chair.
According to the Support Surface Standards Initiative (S3I), a subcommittee of the National Pressure Ulcer Advisory Panel (NPUAP), a support surface is a “specialized device for pressure redistribution and is designed for the management of tissue loads, microclimates, and/or other therapeutic functions.” 1
The NPUAP Pressure Ulcer Prevention Guidelines (2014) further describe a support surface as “any mattress, integrated bed system, mattress replacement, overlay, or seat cushion, or seat cushion overlay.” These guidelines indicate that you should choose a seating support surface that considers the patient’s body size and configuration, effects of posture on pressure redistribution and the mobility of the patient. In addition, the cover of the surface should be loose enough to allow it to conform to the body’s shape, and be made of a material that allows for temperature and moisture control (microclimate management).2
With the increased research and focus on the effects of immobility and complications from lying in bed, more and more facilities are developing an early mobility/progressive mobility program that has the goals of getting the patient out of bed and sitting in a chair or walking, as soon as possible. It is essential that we make sure that we are protecting our patients from the increased pressure in the sacral/buttocks area when they are seated in the bedside chair.
When should we provide chair cushions for our patients? For pressure injury/ulcer prevention in the seated patient, the guidelines state to “use a pressure redistributing seat cushion for individuals sitting in a chair whose mobility is reduced.” 2 For those patients with existing pressure injuries in the seating area, the guidelines suggest selecting a cushion that effectively redistributes the pressure away from the pressure ulcer. The construction of the cushion will allow for redistribution of pressure through immersion and envelopment (reactive surface) or through the off-loading of pressure by alternating pressure (active surface). The guidelines recommend to “use alternating pressure seating devices judiciously for individuals with existing pressure ulcers.” 2
There are several different types of chair support surfaces available to the clinicians to assist in the prevention and treatment of pressure injuries in their seated patients. At Arjo, we offer the Atmos Air 300 P (reactive) and the Aura Logic (active) chair cushions to meet your patient’s individual needs for seating solutions.
- The Support Surface Standards Initiative. “Terms and Definitions Related to Support Surfaces.” www.npuap.org. National Pressure Ulcer Advisory Panel, 29 Jan. 2007. http://www.npuap.org/wp-content/uploads/2012/03/NPUAP_S3I_TD.pdf. Accessed 25 April, 2018.
- National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Perth, Australia; 2014.