Real-world evidence from a large-scale multisite evaluation of a hybrid mattress

Preventing pressure ulcers (PUs) in an acute hospital setting is a complex activity. It clearly sits within the definition of implementing complex care to a complex group of patients in a complex setting (Raine et al, 2016). The multiple comorbidities and increased acuity of the at risk patient result in many conflicting care priorities. In addition there are many changes in healthcare provision. Healthcare services are constantly adapting and evolving to meet changes in demand driven by demography, disease, evidence and lifestyles. Changes in available capacity as workforce supply, capability, regulation and expectations change (NHS Scotland, 2011) makes delivering care in a standard way challenging. In itself delivering evidence based PU prevention is complicated as high level randomised controlled trials (RCTs) are difficult to achieve requiring significant numbers of patients and long time scales — in an area where technology changes rapidly this is frequently not a viable option. An alternative to the prospective RCT is to consider a real world review, in this case a retrospective analysis of the incidence of PU occurrence pre and post implementation of a powered hybrid mattress. The scale of the review – eight hospitals and over 650,000 patient admissions coupled with the rigorous improvement methodology gives significance to the result of overall reduction in the number of PUs of 56% (a 93% reduction in incidence) across the reference sites. This is the first review of this scale that examines the impact of implementation of one technology and the impact that this has had on PU occurrence. Whilst it is acknowledged that the provision of specialist equipment forms only one part of PU prevention, the size and number of sites included suggest that the equipment implementation (which is the constant) has played a significant role in driving down the number and severity of PUs.