Transition from an Existing Support Surface to Higher Level of Support

A person should be transitioned from an existing support surface to a higher level support surface when:

• the quality of the surface has deteriorated and is no longer effective in facilitating wound healing
• the surface is deemed as a possible contributory/causative factor to the worsening or non-healing pressure injury
• The person cannot be positioned to avoid placing pressure on an existing pressure injuries
• The person has pressure injuries on two or more turning surfaces that limit repositioning while in bed
• The person is at high risk for developing further pressure injury
• The person is obese and requires a bariatric support surface that provides sufficient pressure redistribution
• The bed “bottoms out” on the current support surface.

• Bottoming out occurs when the support surface is compressed by high pressure and can no longer properly support the person.
• The use of the “hand checking” method has been common practice for air floatation and low air loss support surfaces.
• In a recent position statement published by the NPUAP, clinicians are cautioned on the increased safety risk and infection issues for the person and their caregivers related to hand checking.
• Hand checking should be limited to mattress overlay and seat cushions, and is not recommended for mattress replacement or integrated bed systems.