A pressure injury is localised damage to the skin and/or underlying tissue, as a result of pressure or pressure in combination with shear. Pressure injuries usually occur over a bony prominence but may also be related to a device or other object. 1.

The treatment of any wound begins with a comprehensive understanding of its cause. Therefore, differentiating Pressure Injuries (PIs) from other wounds is the first step in assessing the PI and developing a treatment plan.

Pressure injuries can be caused by any of these conditions being present on the patient’s skin: pressure, shear, moisture, and raised temperature. The most influential of these is shear.

The patient’s weight and position cause pressure and shear to be applied to their skin and tissue, compressing it between the Support Surface and their bone structure. When external pressures are higher than the capillary blood-flow pressure in the patient’s tissue, the capillaries can become occluded and damaged, diminishing blood supply causing tissue damage from lack of oxygen and nutrition.

A PI can occur due to the forces of a patient’s body weight, or a result of externally exerted forces such as those applied by a medical device, the patient’s position, other objects, or a combination of these.

The PI can present as intact (or unbroken) skin or an open wound and may be painful. The tissue damage occurs because of intense and/or prolonged exposure to sustained deformation in compression, tension, or shear. Deformation means changing the shape of the cells.

Deformation may cause direct damage to the structures of the cells, but also trigger inflammation and development of oedema, distort the capillary network, reduce the supply of nutrients to tissues, or cause lymphatic obstructions which will compromise the clearance of metabolic waste products.

Pressure injuries can be prevented by interface pressure re-distribution (moving the pressure) and regular repositioning of the patient. Interface pressure distribution ensures the even spread of the patient’s weight, specifically over critical areas where pressure injuries develop. Repositioning the patient regularly decreases the duration of pressure, reducing the occurrence of capillary obstruction.

• Support Surface safe working load and /or patient weight

• User Pressure Injury Risk Assessment, for example, Waterlow Risk Assessment, to be completed by Nursing staff/Wound Care professional.

• Preference for overlay or mattress replacement

• Mattress surfaces size required- single or king single

• What is the priority – comfort or Pressure Injury Prevention and Management? Note if you let them get a wound breakdown, comfort will never happen

• Budget requirements

• What specific Support Surface functions are needed to assist carers and benefit patient experience? Panel Lock: useful in dementia facilities or where residents/visitors may tamper with pump settings. Max Inflate: ideal for transferring in/out of bed, allied health therapy