FAQ: Evaluating a positioning support device

Whether you work for a medical facility or you are a caregiver at home, the quality of your pressure injury (bedsore) prevention is only as good as your Turning and Repositioning program. And the positioning device you choose to support a person in a 30 degree lateral turned position can make or break the quality of the Turning and Repositioning. (Read More) In other words, if don’t choose a positioner that works well, you will not be able to stop sacral/coccyx bedsores.

People taking care of a loved one at home are quick to purchase one or two Bedsore Rescue Cushions (aka The BackBone) because they need something now and our cushion is the only design that looks like it will actually work. People know that if doesn’t work, its back to the drawing board and the internet to try to find something that does. We offer a satisfaction guarantee because we know that The Bedsore Rescue cushion will work better than anything out there.

Medical facilities, on the other hand, are willing to wait and experiment. They have to make sure they are getting the most bang for their buck. And its a big investment when you compare the cost of an advanced positioning device to standard pillows, which are a dime a dozen.

But faced with the MUCH more expensive reality of increase pressure injuries and that standard pillows are ineffective, facilities often ask us to send a few samples to try out.
We stand by our retail satisfaction guarantee for the same reason we are happy to send discounted samples to medical facilities. Because we know the Bedsore Rescue/BackBone positioning wedge cushion works better than anything else out there. Hands down it relieves pressure correctly, longer and more comfortably than any other cushion on the market.

Retail customers do not return the cushion often. It seems they keep it simple and judge the cushion’s performance by the basic measures: pressure relief, stability and comfort.
But recently a medical facility we sent a sample to told me they decided to “stick with pillows for now”. When I asked them why, they said “Because our nurse said the pillows are better”. Yes, they only showed one nurse. I asked them how the nurse determined that pillows are better? I could practically hear the Deer-in-the-headlights look on their faces.

It wasn’t until then that I realized that the truth is, most caregivers don’t really know how to evaluate a support device. Most have no idea what makes a positioning pillow “better” or “not better”. So to make things easier and more clear for anyone pondering which 30 degree lateral positioning device works best for you and your facility, I have assembled an guide and quick reference cheat sheet.
Happy reading and I support your pressure relief efforts! (If you’ll excuse the pun 🙂
Gwen Jewell, Clinical Nurse II, Certified Wound Care Nurse Specialist
Founder, Jewell Nursing Solutions

Positioning Device Performance Measures

A guide for how to evaluate the effectiveness of support device used for 30 degree lateral turned support.

Aka Jewells Rules for Evaluating a Positioning Cushion
The better your positioning device works, the better your chances of preventing or healing a pressure wound. Below are performance measures you can use to evaluate how well a positioning device is serving its purpose.

Rule #1. A positioning device should support a pressure relieved position
A positioning device should consistently support a person near 30 degree lateral turned to the side so that there is minimal to no pressure against vulnerable body areas.
The device should support a position that is just high enough to get lift off the sacrum/coccyx, buttocks and/or protruding areas of spine, but not too far over where there may be pressure on protruding areas of the pelvis and the greater trochanter (side of hip).

Rule #2. A positioning device should NOT present a potential risk for harm to the person/patient.
A positioning device should;
A. Lower pressure Injury risk (aka pressure ulcer, bedsore). A positioning device that is ineffective puts a person at risk for a pressure injury or for worsening of an existing pressure injury.
B. Not risk skin damage. The surface material should not risk skin damage due to:
– Mechanical forces (friction and shear). The material must be soft and smooth, without rough surfaces, edges or wrinkles.

– Micro-Climate control (aka moisture control) The material should be “skin friendly” and not cause skin sweating or irritation. Vinyl, plastic, rubber, uncovered foam or wet cotton all cause sweating or irritation, even to healthy skin. “Wet skin” becomes very soft and so is much more vulnerable to breakdown and pressure injury.

– Skin Reaction. Materials such as bare foam, certain vinyl’s, plastics or sheets washed in harsh chemicals can irritate the skin and cause rashes and excoriation and so should not be used.

C. Not mis-alignment/mis-position. A support device should provide even support across the entire surface area of the persons back and hips at the same angle. The support should not cause twisting of the spine and hips. A device that supports only under the back but not the pelvis may cause twisting of the spine without relieving pressure from the sacrum/coccyx area.

D. Support without vascular occlusion. A positioning device should not support in such a way as to cause occlusion of blood circulation.
To avoid cutting off the blood circulation, the positioning device should:
– Fully contact the support surface. The device should support as much of the supported body surface area possible. So that the person’s body weight is as evenly distributed as possible. It should support from the top of the back to the pelvis.
– Even contact. It should not be possible to set the positioning device so that there is lumps, wrinkles or “fall off” where the remaining body surface area is ‘hanging’ off the edge of the support. Lumps, wrinkles and fall off areas cause uneven and excessive pressure over a smaller area which compromises blood circulation.
– Be just firm enough to hold a lift without “bottoming out” or flattening, but not so firm as to be too hard and “push” against the body. If the device is too soft or “does not hold its shape” it will flatten out and the person will return to a flat position. If the device is too hard, the blood supply can be reduced, leading to bruising pressure injury (aka deep tissue injury or stage 1 pressure injury). You can see when a support device is bottomed out the person is no longer in a turned position. But knowing how hard is too hard is more difficult, especially when the person is unable to articulate his/her comfort level. See below for more info about this.
NOTE: Do not use doughnut rings to remove pressure from sacrum/coccyx area. Because they “circle” the area and cut off the blood circulation to the entire center.

Rule #3. A positioning device should be resistant to contamination
A positioning device should be covered with a material/fabric that is resistant and does not host bacteria or fungus. Most moisture resistant covers are also resistant to contamination. Cottons, knits, wools and polyesters can host bacteria over time if not washed. Bare foams tend to be resistant to bacteria but can host fungus easily from moisture.

Rule #4. A positioning device should be compatible in all environments
A. A positioning device should be compatible with the caregiver and patients. Compatibility increases compliance. If the positioning device meets the needs of the patients and their caregivers, they will use it.
– Reliable
– Lightweight
– Easy, simple and quick to place
– Not bulky or cumbersome
– Easy to clean
– Long lasting
– Re-usable
– Versatile; usable at home or medical setting, on recliners, chairs, and in other environments such as MRI, CT and Operating room.

Rule #5. A support device should be cost effective.

A. A support device is cost effective when it’s use can be associated with the below benefits

– Reduces pressure injury incidence and prevalence rates
– Reduce caregiver fatigue and lift injury rates
– Lower length of stay and reduce re-admission rates.
– Increase patient satisfaction.

B. Re-usable (multi-patient use) positioning devices are more cost effective because use per patient is very low. Re-useable cushions are also less wasteful and better for the environment

Read on. Together we can stop pressure injuries!

Gwen Jewell, Clinical Nurse II, Certified Wound Care Nurse Specialist
Founder of Jewell Nursing Solutions