M2-Mobility & Moisture Protocol for the Prevalon Airtap

M2-Mobility & Moisture Protocol for the Prevalon™ AirTAP Patient Repositioning System

Authors: Kathleen M. Vollman MSN, RN, CCNS, FCCM, FAAN, Clinical Nurse Specialist, Educator, Consultant, ADVANCING NURSING LLC; Guy Fragala, Ph.D., FE, CSP, CSPHP; Susan Salsbury OTR/L CDMS CSPHP; Kim Hall DNP, RN, GCNS-BC, CWCN-AP; Christin Gordon BSN, RN.

Procedure: Prevalon AirTAP Patient Repositioning System The system is designed to facilitate easy repositioning while diminishing shear forces and minimizing the physical effort required for turning or repositioning by caregivers, thus helping to reduce the risk of injury to the patient and caregiver.

Purpose: The purpose of the Prevalon AirTAP System with M2 Microclimate Body Pad is to help the caregiver achieve the goal of:  Offloading pressure (turning) q2 hrs or more frequently to reduce the risk of pressure ulcers  Boosting and repositioning patients to promote less risk for the caregiver and less risk of shear and friction for the patients  Help maintain a lateral position  Support the safe lateral transfer of patients from surface to surface  Controlling the microclimate to reduce the risk of moisture-related skin injury  Easy removal and replacement of linens

Indications for Use: 1. Braden mobility score of 1 or patient requires assistance in turning q2 hrs or more frequently 2. Braden moisture score of < 2 3. Braden friction score of 1 4. Significant number of off unit tests that will require a lateral transfer 5. BMI >30, weight up to 550 lbs., unequally distributed adipose tissue making positioning difficult. 6. High risk patients: Likely to be ventilated >24 hrs with impaired mobility, history of a previous pressure ulcer, evidence of significant third spacing, hemodynamic instability that causes inability to perform a traditional turn, or requires micro shifts for offloading. 7. Caregiver at risk for injury related to frequent repositioning and awkward posture. 8. Progressive Mobility Protocol in use

AirTAP System Sizing and Use of the Prevalon AirTAP Booster Pump: 1. For use with a 36” wide bed (accommodating patients up to 550 lbs.). 2. Place a Booster Pump in each ICU room. 3. When using the AirTAP System, place the Booster Pump beneath the foot of the bed on its wheels and keep the blower hose attached to the Prevalon AirTAP at all times. 4. Do not plug the Booster Pump into a bed outlet. 5. When transporting the patient to procedures by bed, use the hook on the Booster Pump to attach it to the bed so Prevalon AirTAP can be used in procedural areas for lateral transfers. 6. See operator’s manual for full instructions for use, cautions and warnings.

Additional Evidence-Based Prevention Strategies To Consider When Using the Prevalon AirTAP System:

1. Risk assessment of the patient’s skin using a reliable and validated tool (Braden). Acting on low scores in the subscale of the risk tool may provide a more targeted use of prevention resources. 2. Positioning to reduce pressure and shear injuries. a. Repositioning should be undertaken to reduce the duration and magnitude of pressure over vulnerable areas of the body. Establish a positioning schedule at a minimum of every two hours or more frequently based on the individual’s condition and the support surface in use. b.Repositioning, using the 30° tilted side-lying positions, if the individual can tolerate the positions and if the medical condition allows.

24532 c. If sitting in bed is necessary, avoid greater than 30° head of the bed elevation and/or a slouch position that places pressure and shear on the sacrum and coccyx for greater than 60 minutes. Positioning with pillows under the arms may help reduce or avoid slouching. d.Document the repositioning schedule, including the frequency and position of the patient and an evaluation of the outcome and use of heel protection aids. e. When turning acute and critically ill patients, the evidence supports waiting 5-10 minutes after a turn before assessing toleration to position change. f. Use an active support surface, either an overlay or a mattress, for patients at higher risk of pressure ulcer development where frequent manual turning is not possible. g. More than three layers of linen reduces the effectiveness of the pressure reduction support surface. h.For patients who are not alert and cooperative, use a heel protecting device. The device should elevate the heel completely off the bed and distribute the weight of the leg along the calf without putting additional pressure on the Achilles tendon. For completely immobilized patients consider a device that incorporates a mechanism for the prevention of external rotation of the leg to prevent nerve injury. 3. Moisture management a. Cleansing of the skin as soon as soiling occurs. b.Use of a barrier on the skin with every soiling episode. Dimethicone, when used in combination with zinc or petroleum, serves as an effective barrier against both urine and stool. A one-step barrier cloth is recommended by the Institute for Healthcare Improvement to improve skin protection related to urine and stool. c. Use of an (absorbent) incontinent pad/body pad to wick moisture away from the skin, while allowing for airflow/breathing. d.Excessive linen use impacts the breathability of devices and/or surfaces designed to help maintain a healthy microclimate.

Warnings, Cautions: 1. Always follow your facility’s safe patient handling policies and procedures. 2. DO NOT use Prevalon AirTAP glide sheet to lift patients. 3. For single patient use only. If soiled, wipe the Glide Sheet or Body Wedges with damp cloth to clean. Do not launder. 4. Periodically check the product for signs of wear. Replace if the product is damaged. 5. Patient repositioning should always be performed using at least two caregivers. 6. To avoid potential skin injury, prevent the patient’s heels and head from dragging across the bed during repositioning. 7. To prevent injury or accidental inflation, ensure the patient is not in contact with the Valve or Hose. 8. Weight capacity: 550 lbs. 9. DO NOT cover or block any openings on the Booster Pump. 10. DO NOT tamper with or make any adjustments to any part of the Booster Pump. 11. DO NOT let the Booster Pump cord hang over the edge of a table or counter. 12. DO NOT immerse the Booster Pump cord or plug in water. 13. Keep the Booster Pump cord away from heated surfaces. 14. The AirTAP Booster Pump has been designed for use exclusively with Sage air-assisted technology products. 15. DO NOT use the Booster Pump during transport. 16. DO NOT operate the Booster Pump if it has a damaged cord or plug, if it is not working properly, or if it has been damaged or dropped. Contact Sage Products at 800.323.2220 for repair or replacement. 17. Please reference Instructions for Use for a full list of cautions and warning.

Contraindications: 1. Patients who have thoracic, cervical, or lumbar fractures should not use the Prevalon AirTAP System unless a clinical decision has been made by your facility. 2. Patient weight >550 lb (consider use of TAP XXL System). 3. Other contraindications as appropriate.

Discontinue Use If: 1. The patient is able to fully assist in his or her repositioning. 2. Braden mobility score of > 2. 3. Braden moisture score of > 3. 4. Braden friction score of > 2. 24532 References: 1. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington D.C. National Pressure Ulcer Advisory Panel;2009. 2. Institute for health care improvement: Prevent pressure ulcers. http://www.ihi.org/IHI/Programs/Campaign/PressureUlcers.htm. Accessed October 7th, 2007 3. Gould D, James T, Tarpey A, et al. Intervention studies to reduce the prevalence and incidence of pressure sores: a literature review. J Clin Nurs, 2000;9(2):163-177. 4. Bergstrom N, Braden B, Kemp M, Champagne M, Rudy E. Predicting pressure ulcer risk: A multisite study of the predictive validity of the Braden scale. Nursing Research, 1998;47(5):261-269 5. Black J, Baharestani M, Cuddigan J, et al. National Pressure Ulcer Advisory Panel’s Updated Pressure Ulcer Staging System. Derm Nurs. 2007;19(4):343–350. 6. Gray M, Weir D. Prevention and treatment of moisture-associated skin damage (maceration) in the periwound skin. J WOCN. 2007;34(2):153–157. 7. Warner D, Konnerth K, (1993). “A patient teaching protocol for pressure ulcers prevention and management” Ostomy and Wound Management, 39 (2): 35-43 8. Tescher, Ann N.; Branda, Megan E.; Byrne, T. J. O; Naessens, James M. All At-Risk Patients Are Not Created Equal: Analysis of Braden Pressure Ulcer Risk Scores to Identify Specific Risks. WOCN, 2012;39(3):282-291 9. Vollman KM. Understanding critically ill patients hemodynamic response to mobilization: using the evidence to make it safe and feasible..Crit Care Nurs Q. 2013 Jan-Mar;36(1):17-27 10. Brindle TC, Malhotra R, O'Rourke S, et al. Turning and Repositioning the Critically Ill Patient With Hemodynamic Instability: A Literature Review and Consensus Recommendations. Journal of Wound, Ostomy and Continence. 2013;40(3):254–267