Clinical case study – Argyll Hybrid; a modern effective design of a Hybrid Mattress?

The benefits of a hybrid mattress versus the use of both high risk static mattresses and then “stepping up or down” to alternating / dynamic mattresses are well publicised over the last few years. These are points such as reduced moving and handling considerations for both the patient and carer’s alike, reduced cleaning and infection control considerations, speedier upgrade to dynamic systems for the patient, enhanced comfort and of course reduced cost (being two systems in one). There is also evidence to suggest that some designs of alternating mattresses (namely heel cells) can exacerbate heel damage throughout the very alternating cycle that is meant to alleviate pressure damage and other associated factors. As shear and friction forces are becoming increasingly a primary consideration, then the use of alternative methods, in the place of air cells is of high intertest from the author with the Winncare hybrid design. The final part of any evaluation, aside from patient safety throughout is the aim to achieve a better patient outcome, whilst substantiating contributing factors to the healing / care and of course comfort process throughout. The alternative, very high-risk hybrid mattress system was chosen from Winncare from a variety of hybrid mattress systems on the market. There are many systems similar to this product on the market, however none with the combination of head care alternation and sloped heel zone with wave technology. This was chosen following multiple attempts to find a suitable dynamic system to suit the needs (clinical, comfort and noise output) for the patient. The patient in question was transferred from system to system and latterly a market leading device that was not fully contributing to the patient’s collective healthcare package. Furthermore, the extended purpose was to ascertain its suitability with further patients or group of patients on a wider scale, who had existing and or previous damage, along with other clinical complications thereafter.

Similarly, as many Care organisations / NHS Trusts are experiencing high levels of staff vacancies, including that of District Nursing and or turnover of care staff within a nursing and residential home setting, further complications can arise, when selecting appropriate equipment. , it is always the opinion of the author that mattress / pressure relieving equipment designs, must be very easy to use and be readily available at an affordable price, whilst delivering ease of moving and handling.

Mr H is a 67-year-old gentleman with multiple clinical considerations. He was specifically chosen to take part in this evaluation due to his complex requirements and of course failure to achieve both comfort and indeed complete wound healing over a lengthy period. He weighs approximately 72kgs at start of evaluation and his weight remained static throughout and with no dietary / nutritional complications. A Waterlow score of 20+ was identified at start of the trial. The gentleman’s conditions include Hypertension and severe Parkinson’s disease. He is also an insulin dependent diabetic and extremely immobile. He has been in care for 5 years in a local nursing home. Although it was not always the case, the patient is now full body - hoist transferred and “controlled sits” in a very specialist chair when out of bed, to try and assist with complete quality of life targets. He has been nursed on several dynamic mattresses and one very high risk static mattress for approximately 2 years on and off which he found to be uncomfortable and noisy. All systems used throughout this period did not substantiate an improvement towards the clinical situation, outside of excellent, 24-hour nursing care throughout. Having tried many mattresses, he is now being nurses on a Hybrid mattress from Winncare and a standard electric profiling bed. The profiling bed has also formed part of his care over the last 2 years. Mr H is able to sit (albeit supported) in a high specification wheelchair for short periods and family still try to take this gentleman home 2-3 times per week for 4-6 hours in the afternoon. Despite being frail he maintains his weight and his general health is good, aside from the reported conditions within this document. He is at high risk of choking but eats well with assistance. He has suffered a chest infection approx. every 6 months for the last 2 years which does debilitate him massively. This is also a consideration of mattress design and any product selected, must be high angle, profile dependant in accordance with the bed. However, despite it taking a few months to get back to full health, then with the aid of the holistic care package provided, he has delightfully achieved this. Mr H first developed a pressure ulcer Grade 2 (EPAUP) 18 months ago when very unwell with an undiagnosed infection and has continued to have these recurrent grades 2 to natal cleft/ sacral area (as evidenced by the scar tissue you can see on the photos). He also has history of heel damage, hence the selection of this design for full product evaluation. When in bed he is repositioned side to side except when being fed when he is propped up with pillows as he tends to pull his knees up into foetal position when in bed, thus exerting a large amount of pressure to the sacral area. His chair has built in pressure relief and when seated in wheelchair or at home he has a high-risk pressure cushion. Mr H reports that the hybrid mattress is very quiet and extremely comfortable compared to other equipment that has been used previously. The staff report that the equipment is easy to use, easy to clean and maintain and is quiet thus aiding patient sleep.