Registered Nurses' Association of Ontario

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.
Clinical Management
Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition
Point of Care Resources