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Implementing Smart Bed Technology for Pressure Ulcer Reduction

Connie L. Zeller

Nursing Informatics

James Madison University

March 25, 2021

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Implementing Smart Bed Technology for Pressure Ulcer Reduction

Introduction:

As the population ages, hospitals are seeing sicker patients. These patients may become

less mobile as they age. As their mobility is lessened, patients are more at risk for developing

pressure injuries. These injuries are costly and associated with adverse patient outcomes. This

paper is intended for healthcare professionals interested in exploring technological solutions to

this problem. The aim of this quality change project is to reduce the occurrence of hospital

acquired pressure injuries through the use of smart bed technology.

Background:

Pressure ulcers are a detrimental health problem for patients with limited mobility.

Patients most at risk are the elderly suffering from hip fractures or dementia, the paraplegic, and

intensive care unit patients mechanically ventilated and sedated. While these are subjects

particularly at risk, any patient with limited mobility is at risk. Pressure ulcers, or decubitus

ulcers, are caused by impaired perfusion of tissues due to prolonged pressure blocking normal

blood flow. As tissues are unable to get oxygen rich blood and nutrients, the cells become

ischemic and progress to necrosis. They range from intact skin that is nonblanchable to full

thickness wounds down to the bone. They typically form in areas with boney prominences like

the sacrum and heels where there is less tissue to cushion the pressure. While the name pressure

ulcer points to the prolonged pressure as the root cause, they are also formed by moisture,

shearing, and friction (McCance & Huether, 2019, p. 1499). Thus, the incontinent and immobile

are at particular risk of pressure sore formation.

The implications of pressure ulcer development are extensive. They are linked to

extended patient stays, complications, and increased mortality. Pressure ulcers are time
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consuming and increase a patient’s length of stay. In a study following patients with spinal cord

injuries, the length of stay for those with pressure ulcers was 45 days while those without

pressure ulcers was 30 days (Lessing et al., 2020, p. 4). As injuries progress, the open skin

becomes a portal of entry for microbes that may lead to infection or sepsis. According to Jaul,

Meiron, and Menczel (2016) a study of patients with advanced dementia with pressure ulcers had

a higher and earlier mortality than the survival expectancy of advanced dementia patients

without pressure ulcers. Advanced dementia patients with pressure ulcers had significantly

lower survival expectancy in comparison with similar patients without pressure ulcers(p. 387).

Costs of pressure ulcer treatment are high. According to research by Padula and

Delarmente (2019), the average cost of a hospital acquired pressure injury is $10,708 per patient;

with 2.5 million reported cases, this ends up costing around 26.8 billion dollars per year

nationally (p. 638). As hospitals are responsible for the cost of pressure sores acquired during a

patient’s stay, this has the potential to be an enormous loss.

HAPI could cost $10 708 per

patient on average, exceeding a total
of approximately $26.8
billion in the United States annually
based on 2.5 million
reported cases.
HAPI could cost $10 708 per
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patient on average, exceeding a total

of approximately $26.8
billion in the United States annually
based on 2.5 million
reported cases.
HAPI could cost $10 708 per
patient on average, exceeding a total
of approximately $26.8
billion in the United States annually
based on 2.5 million
reported cases.
Methods

To reduce the incidence of pressure ulcers, change is needed. The current patient turn

schedule is done manually by the nurses every two hours. Even the best intentioned and well-

meaning nurses may fall behind on turns. Emergencies with other patients, accompanying

patients to procedures off the unit, finding enough hands to help turn a particularly heavy patient

can all lead to the turn schedule getting off. To combat the occurrence of pressure ulcers and all

their associated problems, I propose a quality change with the implementation of hospital beds

equipped with new smart technology mattresses capable of turns or sensing pressure. After the

new bed systems are implemented, the number of occurrences will be monitored and compared

to prior numbers.
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One option that exists without having to replace the entire hospital bed, is the MAP

system. This is a pad filled with sensors that is placed on an existing mattress and then relays

sensor data to a screen showing exactly where the patient’s current high-pressure points are

(Ajami & Khaleghi, 2015, p.1012). This mat allows caregivers to see exactly how to reposition a

patient to allow perfusion to resume on stressed tissues. The ability to visualize the pressure

points would theoretically greatly reduce pressure ulcer formation, especially as the screen also

outlines and counts down to when the next scheduled turn should be. According to research by

conducted by Ajami and Khaleghi (2015) “two clinical studies were done at two ICUs in two

hospitals. One of them used MAP and other one did not. Results demonstrated significant cost

reduction with some cases down to zero, and economic benefits ranging was from $125,000 to

650,000 in saving per ICU over six months” (p. 1012). This demonstration strongly supports the

implementation of this device.

Another option are beds that have programmable turn. These beds will assist with

keeping patients turned on schedule. Some beds are equipped with a turn assist function. This

function allows the patient to be turned without the nurse needing to do so manually. According

to a study of effectiveness of these beds, Buarick et al. (2020) state “no differences were shown

in this study between manual and turn-assist pressure outcomes indicates that turn-assist surfaces

are comparable to the current gold standard in redistributing pressure” (p. 8). The gold standard

they mention refers to the manually facilitated patient turns. Buarick et al. (2020) continue that

the turn-assist is a safe, ergonomic option for hospitals (p. 10).

Other beds have the option of continuous turning. These beds can be programmed to turn

the patient at a constant speed over 15 minutes from supine to the right or left and back to supine

in another 15 minutes (Do et al., 2016, p. 461). According to research by Do et al. (2016), risk
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of pressure ulcers is reduced as pressure points are continuously moving and would assist nurses

in preventing ulcer formation while improving the patient’s quality of care (p. 465). This bed

seems a wonderful solution to the problem, however not all patient populations may tolerate or

enjoy the consistent, slow, movement. These would be a great option, especially for the

mechanically ventilated and sedated patients incapable of any movement.

After reviewing these options, it seems the MAP pad would be the most accessible

change. This system can be added to current beds without the cost of full bed replacement.

They would also eliminate the need to contact hospital resources to arrange the swap of a normal

bed to a more specialized bed that may be kept in storage. The nurse would simply need to add

the MAP mat and monitoring screen to the room. The clear visualization of pressure points

should allow for the most beneficial positioning to be made. The prior ICU study results by

Ajami and Khaleghi (2015) indicating the cost saving advantages of the system is also a strong

factor in it’s favor (p. 2012). It seems an easy, effective option that can be implemented to serve

at risk patients. The number of hospital acquired pressure injuries acquired after the staff

education and initiation of the MAP system compared to numbers prior to initiation will help to

illustrate its rate of effectiveness and success.

Conclusion:

Pressure ulcers are avoidable and costly injuries. The costly effects extend beyond

monetary and negatively affect time, resources, patient outcomes, and mortality. The

implementation of new technology to combat pressure injury formation has strong implications

for improving patient quality of care, reducing financial burden, and decreasing poor patient

outcomes, complications, and mortality.

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References

Ajami, S., & Khaleghi, L. (2015). A review on equipped hospital beds with wireless sensor
networks for reducing bedsores. Journal of Research in Medical Sciences, 20(10), 1007–
1015. https://doi.org/10.4103/1735-1995.172797

Budarick, A., Moore, C., & Fischer, S. (2020). Evaluating patient turn effectiveness using turn-
assist technologies. Journal of Medical Engineering & Technology, 44(1), 1–11.
https://doi.org/10.1080/03091902.2019.1707889

Do, N., Kim, D., Kim, J., Choi, J., Joo, S., Kang, N., & Baek, Y. (2016). Effects of a continuous
lateral turning device on pressure relief. Journal of Physical Therapy Science, 28(2),
460–466. https://doi.org/10.1589/jpts.28.460

Jaul, E., Meiron, O., & Menczel, J. (2016). The effect of pressure ulcers on the survival in
patients with advanced dementia and comorbidities. Experimental Aging Research, 42(4),
382–389. https://doi.org/10.1080/0361073X.2016.1191863

Lessing, N. L., Mwesige, S., Lazaro, A., Cheserem, B., Zuckerman, S., Leidinger, A.,
Rutabasibwa, N., Shabani, H., Mangat, H., & Härtl, R. (2020). Pressure ulcers after
traumatic spinal injury in east Africa: risk factors, illustrative case, and low-cost protocol
for prevention and treatment. Spinal Cord Series and Cases, 6(1), 1–9.
https://doi.org/10.1038/s41394-020-0294-5

McCance, K., & Huether, S. (2019). Pathophysiology: the biologic basis for disease in adults
and children (8th ed.). Mosby.

Padula, W., & Delarmente, B. (2019). The national cost of hospital-acquired pressure injuries in
the United States. International wound journal, 16(3), 634–640.
https://doi.org/10.1111/iwj.13071