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

Introduction and aims

The purpose of commissioning this document is to identify the clinical performance and suitability of Winncare PAC’s latest hybrid mattress design – The Argyll Hybrid™ classified to be used on patient groups being very high risk of pressure damage (including existing wounds up to and including Grade IV). Sincere consideration of using a very high-risk static and dynamic mattress combined in a single product, versus that of independent mattresses (separate systems) is at the height of the papers ethos.

This consideration and design structure, follows a time when many patients are unnecessarily exposed to both systems via over and indeed under prescription of product. The patient utilised in this extensive trial has been exposed to several static (none powered) but mainly dynamic or alternating systems over a 2 – year period. Most of such systems have proven to be none effective for this particular patient’ and his associated clinical condition.

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.

Initial Financial Consideration

During the ongoing financial challenges that face the NHS and wider public or even private authorities, due to extended
financial constraints. Sadly (or rather sensibly) Clinicians are now being encouraged to look at “best value” solutions more
than ever, whilst ensuring that clinical compromise is not achieved, whilst innovation is still championed throughout.
As the market (an arena where many companies sell pressure care devices), can become overwhelming as to any
differentiating factors between such equipment and indeed why the cost varies so much.
The original mattresses used prior to changing to the Argyll Hybrid™ mattress range, varied in both features
and price substantially and was identified to be almost four times the cost of the product used during the trial. The
patient’s condition improved on the Hybrid mattress; however, there was additional contribution via regular levels of
nursing care during the evaluation that should also be noted and multidisciplinary team input

Staffing & Decontamination Challenges

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.

Other

This paper was developed to provide a clinical overview, post paper, product selection guide to those who require
guidance, whilst identifying product effectiveness of a hybrid design mattress on a complex patient type. Best value for
money was also of sincere consideration at the time of print.
This localised patient evaluation, although conducted on a small basis in this printed instance has been used
successfully on many patients since. No arising complications, (linked to the mattress) had been identified throughout.
Clinical disclaimer:
Please note that the use of any mattress system, whether that is of a static, hybrid or dynamic basis, must first and
foremost be used alongside a full holistic assessment. These include, but are not exhausted to those of regular skin
inspections (searching for reddening / deterioration) and appropriate dressings usage. Where static mattresses and
immobility is concerned, regular patient re-positioning must occur whenever possible. Consideration of the patient’s
nutritional status, including hydration and general care of the skins surface, during moving and handling procedures,
plus those of continence aspects must be considered. These are but a few points combined with full comprehensive
documentation

PATIENT OVERVIEW/EVALUATION DETAIL

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.