Page 21 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

Support Surfaces

Pressure‐relieving devices are typically the first intervention to prevent development or progression of
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pressure ulcers. However, support surfaces cannot replace the basic patient care practices of
encouraging or assisting with ambulation and repositioning, turning and transferring. These
interventions may be scheduled, if necessary, to ensure the routine occurs. If patient ambulation or
repositioning is impossible, difficult, or painful, use of the appropriate support surfaces is critical. All
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support surfaces should meet the following criteria:
 minimize pressure, shear, and friction
 assist in moisture and temperature control
 cleanable surface to minimize contamination
 compatibility with multiple surfaces
 cost effective
 fulfill CMS regulatory requirements
 address patient safety and comfort

The Centers for Medicare and Medicaid Services (CMS) have divided support surfaces into three
categories for reimbursement purposes. Only the presence of pressure ulcers determines support
surface appropriateness.

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Types of Support Surfaces
Support Surfaces Description CMS Guidelines for Use
Category
 Static, non‐powered Any patient at risk of developing pressure ulcers
 Includes air, foam, gel
Group 1
or water overlays or
mattresses
 Dynamic, powered Patients who already have partial to full thickness
 Includes alternating pressure ulcers (stage 2 or worse)
Group 2
and low‐air loss May not be CMS reimbursed if used for
mattresses prevention only
 Dynamic, powered Patients with non‐healing full thickness pressure
Group 3  Includes air‐fluidized ulcers (stage 3 or 4) and those who have failed
beds only therapy with a Group 2 device

References Chapter 5
1. Alvarez OM, Kalinski C, Nusbaum J, Hernandez L, Pappous E, Kyriannis C, et al. Incorporating
wound healing strategies to improve palliation (symptom management) in patients with chronic
wounds. J Palliat Med 2007;10(5):1161‐1189
2. Spahn J. Support surfaces: science and practice. Presented at First Annual Palliative Wound Care
Conference, May 13‐14, 2010. Hope of Healing Foundation. Cincinnati, Ohio.
3. Lyder CH, Ayello EA. Pressure ulcers: a patient safety issue. In Agency for Healthcare Research
and Quality. Patient Safety and Quality: An Evidence‐Based Handbook for Nurses. AHRQ Pub No.
08‐0043, April 2008. [Internet] Available from:
http://www.ahrq.gov/qual/nurseshdbk/docs/lyderc_pupsi.pdf. Accessed 6/6/2012

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