Cheltenham Hospital Trust undertook a process of audit and evaluation of mattresses prior to purchasing and found that cost effectiveness of mattresses did not relate to the cost of initial outlay. A mattress replacement programme introducing Thermo contour visco

Introduction High quality service is an essential element within the modern Health Service, but budgetary constraints often reflect on the type of service that may be provided. However, in prevention of pressure ulcers, high quality need not have to equate with high cost, and raised financial outlay may well lead to a reduction in overall financial costs for the trust. More importantly for the patient, there is a reduced potential for the psychological and physical trauma created by the formation of a pressure ulcer. In 1994-1995, the Department of Health Priorities and Planning Guidance set targets for the NHS to reduce pressure ulcer incidence by 5% per year. Since then a plethora of air and foam mattresses have entered the market, offering a confusing choice for all practitioners and each manufacturer claiming to be the superior mattress. Pressure ulcers occur when immobility creates high pressures between a surface and the patient’s bony prominence if this pressure is sustained, or is exacerbated by shearing forces. There are methods of reducing the potential for pressure ulcer formation such as repositioning in the 30 tilt, or placing the patient on a pressure relieving or reducing mattress. However, repositioning takes a great deal of nursing time and can sometimes be missed on busy wards, and is often difficult in the community due to time and distance restraints. Purchase, decontamination and, particularly, maintenance of dynamic air mattresses can be expensive. Dealey noted “As staff become better educated, there is an increased awareness of the need to provide adequate pressure relief for vulnerable patients”. Hampton also found that an increase in education, combined with the provision of air mattresses as required, actually increased the demand for air mattresses leading to a ‘bottomless pit’ of requests. This problem led the author, the Tissue Viability Sister (TVS), at Cheltenham Hospital, to seriously review patients who were nursed on air mattresses ensuring they were downgraded to static mattresses as their condition improved, thereby releasing mattresses for higher risk patients. In 1997, Cheltenham owned 150 dynamic air mattress replacements and overlays. The only available static mattresses within Cheltenham Hospital were the contract standard NHS mattress, identified by Medical Devices Agency (MDA) as “representing a significant danger to ‘at risk’ patients”. The MDA found that the lack of stretch in the covering material resulted in a hammocking effect, which contributed to the high pressures that were measured. There is also a potential for the mattress to allow ‘strike through’ (picture 1) and, therefore, an alternative, clinically effective pressure-reducing mattress needed to be found.